What Happens at AFCA Conciliation: What to Expect

AFCA conciliation is an informal conference (usually by phone) where your AFCA case manager facilitates a discussion between you and your insurer to try to reach a resolution. It typically happens 4 to 8 weeks after your complaint is registered. You don't need a lawyer, preparation is straightforward, and if conciliation fails, your complaint moves to the formal determination stage where AFCA makes a binding decision.

Key takeaways

• Conciliation is an informal phone conference facilitated by your AFCA case manager.
• It typically happens 4 to 8 weeks after your complaint is registered.
• You do not need a lawyer. Prepare your key points, evidence, and desired outcome in advance.
• If conciliation fails, the complaint moves to formal determination where AFCA makes a binding decision.

What is AFCA Conciliation?

If your insurance complaint has reached the Australian Financial Complaints Authority (AFCA), there is a good chance conciliation will be the next step. For many consumers, this is unfamiliar territory, and the word itself can sound intimidating. It shouldn't be. AFCA conciliation is simply a facilitated negotiation between you and your insurer, guided by a neutral AFCA case manager. It is not a court hearing, not a tribunal, and not adversarial.

Think of it as a structured conversation. Both sides explain their position, and the case manager helps explore whether an agreement can be reached. The process is free for consumers, and it is designed so that everyday people can participate without legal training or representation.

Who is Involved?

Three parties take part in a typical AFCA conciliation:

• You (the complainant)
• A representative from your insurance company, usually from their internal disputes or complaints team
• An AFCA case manager who facilitates the discussion

You do not need a lawyer. AFCA is specifically designed so that consumers can participate without legal representation. You are welcome to bring a support person or authorised representative if you wish, but it is not required and most people manage well on their own with good preparation.

The AFCA case manager is impartial. They are not on your side or the insurer's side. Their job is to help both parties understand each other's position and work towards a fair outcome.

How the Process Works

Most conciliations happen over the phone as a conference call. You do not need to attend an office or appear in person. AFCA will contact you beforehand to schedule a convenient time and explain what to expect. The case manager will have already reviewed the key documents from both sides before the call.

During the conciliation, the case manager will typically:

• Outline the issues in dispute and confirm the facts
• Give each party a chance to explain their position
• Identify areas of agreement and disagreement
• Explore potential solutions or compromises
• Help negotiate a resolution if both parties are willing

The call usually lasts between 30 minutes and an hour, though more complex matters may take longer. The case manager may also speak to each party separately during the call (called a private session) to test ideas or discuss settlement positions in confidence.

What to Prepare Before Conciliation

Preparation is where most outcomes are decided. A well-prepared consumer is far more likely to achieve a fair result. Before your conciliation, you should:

1. Review your insurance policy carefully, paying close attention to the relevant coverage clauses, definitions, and any exclusions the insurer has relied on.
2. Gather all supporting documents: claim correspondence, photographs, expert reports, repair quotes, medical certificates, or any other evidence that supports your position.
3. Write a brief summary of your case: what happened, why you believe the claim should be accepted or the settlement increased, and what specific outcome you are seeking.
4. Understand the insurer's reasons for their decision by carefully reading their decline letter or settlement offer.
5. Consider what outcome would be acceptable to you, including any reasonable compromise position.

Know Your Rights Under the Law

Under the General Insurance Code of Practice 2020, insurers are required to handle claims promptly, fairly, and transparently (Part 8). If your insurer has not met these obligations, for instance by causing unreasonable delays or failing to properly explain their decision, this is worth raising during conciliation.

Section 13 of the Insurance Contracts Act 1984 requires both parties to act with the utmost good faith. If you believe your insurer has not acted in good faith, you should mention this. Section 54 of the same Act is also important: it prevents insurers from refusing a claim based on a technicality or policy condition that did not contribute to the loss. If the insurer is relying on a narrow exclusion or a procedural breach that had no bearing on the actual event, section 54 may be relevant to your case.

You Can Accept or Reject the Outcome

This is one of the most important things to understand: conciliation is voluntary. If the insurer makes a settlement offer during the call, you are free to accept it or reject it. There is no pressure to agree on the spot. You can ask for time to consider the offer, and the case manager will usually allow a reasonable period for you to think it over.

If you accept the outcome, AFCA will document the agreement and the insurer is bound to honour it. If you reject the outcome, or if no agreement is reached, your complaint does not disappear. It simply moves to the next stage.

What Happens if Conciliation Fails?

If conciliation does not produce an agreement, your complaint progresses to the determination stage. At this point, an AFCA decision maker (an ombudsman or adjudicator) will independently review all the evidence from both sides and issue a binding decision.

Under the AFCA Rules (Rule A.14.2), the decision maker considers what is fair and reasonable having regard to legal principles, applicable industry codes and guidelines, good industry practice, and previous AFCA decisions. The determination is not simply about strict legal rights; it takes a broader view of fairness.

If the determination is in your favour, the insurer must comply. If it goes against you, you still retain the right to pursue the matter through the courts, though most insurance disputes are resolved well before that point.

Practical Tips for Getting the Best Result

• Stay calm and professional. The case manager will give you time to speak, so there is no need to rush or become confrontational.
• Stick to the facts. Emotional accounts are understandable, but clear, factual submissions carry more weight in the process.
• Reference specific policy wording. If your claim falls within the coverage, point to the exact clauses that support your position.
• Challenge exclusions properly. If the insurer is relying on an exclusion, check whether it was clearly disclosed in the Product Disclosure Statement and whether it fairly applies to your circumstances.
• Keep records of everything. Note the date, time, and content of all communications with your insurer and AFCA throughout the process.
• Share expert reports early. If you have building reports, medical opinions, or other independent assessments, make sure AFCA and the insurer have copies before the conciliation, not on the day.
• Be clear about what you want. Whether it is full payment of the claim, a revised settlement figure, or another specific remedy, state your desired outcome clearly.

You Do Not Need to Go Through This Alone

AFCA conciliation can feel daunting, especially when you are already dealing with the stress of a denied or underpaid insurance claim. But the process is designed to be fair and accessible, and most consumers find it far less intimidating than they expected. You do not need a law degree to participate effectively. What you do need is clear, well-organised documentation that presents your case in a way the case manager and insurer can follow.

If you would like help preparing your dispute documents, organising your evidence, or drafting a clear written submission for AFCA conciliation, The Fair Claims Co can help. We prepare insurance dispute documents and AFCA submissions that present your case clearly and reference the policy wording, legislation, and industry standards that support your position. You do not need a lawyer to get a strong result at conciliation, but you do need well-prepared documents.