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Complaint Handling Policy
1. Introduction
1.1 Purpose
The State Insurance Regulatory Authority (SIRA) has oversight of the statutory workers compensation, motor accident compulsory third party (CTP), and home building compensation insurance schemes in New South Wales.
Our functions and objectives are set out in the State Insurance and Care Governance Act 2015, together with complaints functions under the Motor Accident Injuries Act 2017, Workplace Injury Management and Workers Compensation Act 1998, and Home Building Act 1989.
This policy sets out what we can do in response to your complaint or other information we receive in relation to the schemes we regulate and the services we provide. It applies to complaints managed by our authorised complaint handling staff.
You may also want to raise concerns about our staff. You can do that using the Department of Customer Service Complaint Handling Policy as a guide.
1.2 Your rights and responsibilities
You have the right to:
- Make a complaint and to express your opinion in a reasonable, appropriate, and lawful way and to be treated with courtesy and respect.
- A fair and impartial assessment and response to your complaint based on its merits.
- Receive a timely response and feedback on the outcome of your complaint and to request a review of our decision.
You are responsible for:
- Treating our staff and other parties to the complaint with courtesy, respect and without discrimination.
- Clearly outlining your complaint to the best of your ability and working with us to achieve the best outcome.
- Providing as much relevant information as you can, as early as you can.
- Letting us know if you require reasonable adjustments so we can assist you.
1.3 Complaints we can handle
We understand that policy holders, people injured in motor accidents or workplaces, or who are involved with residential building work may have concerns about advice given or services provided to them by licensed insurers, employers, or providers. Other people or bodies providing services or otherwise engaged within the schemes we regulate may also have concerns.
Complaints about workers compensation, CTP, and home building compensation help us to understand how these schemes are operating. As the regulator of these three schemes, we can receive complaints about the insurers, providers, and employers we regulate, unless another person or body has jurisdiction to deal with the matter.
1.4 Complaints we don’t handle
We record all complaints about the insurers, employers, and providers that we regulate. If we are not able to handle your complaint, we can refer you to another person or body who can deal with your complaint. Even when we can’t handle your specific complaint, we still welcome your feedback and may use this to help us assess and monitor the performance of the insurers, employers, and providers we have oversight of.
Examples of the types of complaints that other agencies handle and who SIRA may refer a complaint to include:
Health Care Complaints Commission
- Manages complaints about health service providers in NSW including health organisations, registered and some non-registered health practitioners.
- Resolves disputes between people injured in motor acciens and workplaces, employers and insurers in NSW.
- Handles complaints about NSW government agencies, local councils.
- Manages complaints from people injured at work or on roads in NSW about their insurers.
- Investigates workplace incidents and enforce work health and safety legislation.
2. Making a complaint
2.1 What you need to know
When you make a complaint, you can tell us if you want the complaint to be confidential or if you wish to remain anonymous. This means you can ask us to keep your name, the name of someone else, or any other details about your complaint private. If you make an anonymous complaint, we won’t be able to respond to you.
We may also ask you if you have tried to resolve your complaint with the body or person you are complaining about. If you have not attempted to resolve your complaint directly, you may be asked to do this if it is safe and practicable for you to do so before we take any action.
We will ask for your consent before sharing your personal or health information with other parties who may be involved in responding to your complaint. However, if we receive information that raises serious concerns about the safety of you or someone else, this information may need to be provided to an external person or body without seeking your consent.
You can raise a complaint with us by:
- Phone - 13 10 50
- Online
- Post - State Insurance Regulatory Authority, Locked Bag 2906, Lisarow NSW 2259.
2.2 You can withdraw your complaint
Sometimes, after making a complaint, you may decide you want to withdraw it. You can do this at any time, either over the phone or in writing. If you withdraw your complaint, we will not notify you of any action taken or the outcome.
We may continue to make inquiries in relation to your complaint or any other information we receive where it is necessary for us to do so.
3. How we manage your complaint
3.1 What to expect when you make a complaint
Some complaints are quick to resolve. Others will take more time and require us to make formal inquiries into the issue or issues raised. We aim to address most complaints within 20 working days or more complex complaints within 90 working days.
The five key steps to our complaint management approach are:
- Step one: Acknowledge complaint received
- Step two: Initial assessment
- Step three: Address/inquire
- Step four: Decision and outcome
- Step five: Closure and review
3.1.1 Acknowledging your complaint
We will acknowledge your complaint and provide contact details for the person handling your complaint within two (2) working days.
3.1.2 Initial assessment of your complaint
After acknowledging your complaint, we will confirm that we have the power to handle the issue or issues raised in your complaint. We will let you know as soon as practicable if we are unable to deal with your complaint.
3.1.3 Addressing your complaint
In relation to each issue you raise we may:
- decide to take no further action
- provide you with information about how to raise the issue directly with the person or body your complaint relates to, or resolve the issue with your agreement, or
- make formal inquiries into the issue.
To respond to your complaint we may consider documents, discuss the issue or issues, in person or by other means, with you, the person or body your complaint is about, or any other relevant person or body. We can also ask for information or documents from any relevant person or body.
In dealing with your complaint, we may request that the person or body identified in your complaint examine and attempt to resolve your issue and report back to us on the outcome.
If we decided to make inquiries into an issue or issues raised in your complaint or in information provided to us, we will, as soon as practicable, advise the person or body identified in the complaint or information, that we are inquiries and why.
This doesn’t apply if we believe that giving notice will, or is likely to, impede our complaint inquiry process or place the safety, health, or wellbeing of anyone at risk.
3.1.4 Providing outcomes and reasons for our decisions
If we decide to take no further action or to end our formal inquiries into the issue or issues raised in your complaint, we will as soon as practicable, tell you about:
- our decision and the reasons for the decision
- information about how you may apply for a review of our decision, and
- any other appropriate information.
3.1.5 Closing your complaint and review
We may give information about a complaint, whether from an individual or raised as part of the complaint inquiry process, to an external person or body who has a relevant interest in the matter.
If we receive a request from you or the party identified in your complaint, we may also review a decision to close your complaint.
4. Your review rights
4.1 You may request a review of our decision
You, or the person or body identified in your complaint, may request a review of our decision to take no further action or to end the inquiry process in relation to an issue or issues raised in the complaint.
A request for review can be made in writing or over the phone and should set out the reasons for your request. A request for review must be made within 30 working days of you or the person or body identified in the complaint being notified of our decision.
We will acknowledge your request for review within two (2) working days and follow up with further information about the process and the timeframe for the review. A request for review will not be accepted if you do not provide sufficient reasons for why you believe our original decision was wrong.
4.2 How we review our decisions
If you or the person or body identified in the complaint requests a review, our decision will be reviewed by someone who was not involved in making the original complaint decision, and who is no less senior than the original decision maker.
After reviewing the decision, the internal reviewer can:
- affirm our original complaint decision
- add to or change our original complaint decision, or
- undertake a new complaint inquiry process into the issue or issues in the complaint under Part 3 of this policy.
You will be kept informed of the progress of your request for review. The internal reviewer will provide the review applicant written notice of the review decision and reasons for the decision.
A decision to affirm, add to, or change the original complaint decision under review cannot be further reviewed.