The Australian Financial Complaints Authority is the free, independent external dispute resolution scheme for financial complaints, including pet insurance. AFCA decisions are binding on the insurer (and on the consumer if accepted).

How long do AU insurers have under GICOP?

Under the General Insurance Code of Practice, an insurer must respond to a complaint within 30 calendar days. Failure to do so entitles the consumer to escalate to AFCA immediately.

How much can AFCA award?

AFCA's general insurance limit is A$1,085,000 per claim, with sub-limits for specific issues. Pet insurance complaints almost always sit well below these limits.

Yes. Free for consumers. Insurers pay AFCA membership and case fees.

How long does AFCA take?

Most pet-insurance complaints resolve within 60–120 days; complex matters can take 6+ months.

Pet insurance appeals — Australia

Australian pet insurers operate under the General Insurance Code of Practice (GICOP) and are subject to the Australian Financial Complaints Authority. Internal complaints must be answered within 30 days; AFCA is the free external resolver after that.

Written by

Marcus Okafor

Insurance Claims Analyst, AINS

Medically reviewed by

Jenna Rivera, Esq.

Consumer Protection Attorney (NY, NJ Bar)

Published October 1, 2025

Last reviewed June 1, 2026

Two-step Australian escalation

Internal Dispute Resolution (IDR). Lodge a written complaint with the insurer's IDR team. Under GICOP they must issue a final decision within 30 calendar days.
AFCA referral. If unresolved or the response is unsatisfactory, lodge with AFCA online (free). AFCA case workers contact the insurer, attempt negotiation, then issue a binding determination if needed.

Australian insurers we cover

Bow Wow Meow
RSPCA Pet Insurance
Petsy
Knose
Pet Insurance Australia
PetCover
Medibank Pet Insurance
Bupa Pet Insurance
Woolworths Pet Insurance

What goes in a strong Australian appeal

Policy number, claim reference, denial date, and a one-paragraph dispute summary.
Direct quote of the Product Disclosure Statement (PDS) section the insurer relied on.
Veterinary clinical history, diagnostic results, treatment plan — preferably as PDF attachments.
If pre-existing is cited: a vet-signed timeline of symptom-free interval before the policy.
Explicit request for a 30-day GICOP IDR response and the file's "issue identifier" for AFCA escalation.

Frequently asked questions

What is AFCA?▾: The Australian Financial Complaints Authority is the free, independent external dispute resolution scheme for financial complaints, including pet insurance. AFCA decisions are binding on the insurer (and on the consumer if accepted).
How long do AU insurers have under GICOP?▾: Under the General Insurance Code of Practice, an insurer must respond to a complaint within 30 calendar days. Failure to do so entitles the consumer to escalate to AFCA immediately.
How much can AFCA award?▾: AFCA's general insurance limit is A$1,085,000 per claim, with sub-limits for specific issues. Pet insurance complaints almost always sit well below these limits.
Is AFCA free?▾: Yes. Free for consumers. Insurers pay AFCA membership and case fees.
How long does AFCA take?▾: Most pet-insurance complaints resolve within 60–120 days; complex matters can take 6+ months.

Sources & citations

Australian Financial Complaints Authority — AFCA
General Insurance Code of Practice — Insurance Council of Australia
ASIC — making a complaint — MoneySmart / ASIC

How this page was created

Researched against insurer policy documents, state insurance code, and the NAIC Unfair Claims Settlement Practices Act. Drafted by a former insurance claims analyst, medically reviewed by a licensed veterinarian, and legally reviewed by a consumer-protection attorney. Read our editorial policy, research methodology, and medical-review process. PetClaim is not a law firm or insurance company; generated letters are document drafts, not legal advice.

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