Managing Unreasonable Conduct by Customers and Stakeholders 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.

We are committed to being accessible and responsive to all customers and stakeholders who approach us, regardless of ethnic identity, national origin, religion, linguistic background, sex, gender expression, sexual orientation, physical ability or other cultural or personal factors.

At the same time, the success of our office depends on:

• our ability to do our work in the most effective and efficient ways possible
• the health, safety, and security of our staff
• our ability to allocate our resources fairly across all customers and stakeholders we deal with.

When customers or stakeholders behave unreasonably, their conduct can significantly affect the successful conduct of our work. We will act proactively and decisively to manage any conduct that negatively and unreasonably affects us and will support our staff to do the same in accordance with this policy.

We have a zero-tolerance policy towards any harm, abuse or threats directed towards our staff. Any conduct of this kind will be dealt with under this policy, and in accordance with our duty of care and work health and safety obligations.

2. Defining unreasonable conduct

2.1 Unreasonable conduct

Most customers and stakeholders act reasonably, respectfully, and responsibly in their interactions with us, even when they are experiencing high levels of distress, frustration, confusion or anger about their circumstances.

Despite our best efforts to help them, in a very small number of cases customers or stakeholders display inappropriate and unacceptable behaviour. They can be aggressive and verbally abusive towards our staff, threaten harm and violence or bombard us with unnecessary and excessive phone calls, emails, correspondence, or comments on social media. They may make inappropriate demands on our time and resources or refuse to accept our decisions and recommendations in relation to their complaints, representations, or other enquiries. When customers or stakeholders behave in these ways, we consider their conduct to be ‘unreasonable’.

In short, unreasonable conduct by customers or stakeholders is any behaviour which, because of its nature or frequency, raises substantial health, safety, resource or equity issues for our organisation, our staff, other service users or the customer or stakeholder themselves.

Unreasonable conduct can be divided into five categories of conduct:

1. Unreasonable persistence
2. Unreasonable demands
3. Unreasonable lack of cooperation
4. Unreasonable arguments
5. Unreasonable behaviours

2.1.1 Unreasonable persistence

Unreasonable persistence is continued, persistent and unrelenting conduct from a customer or stakeholder that has a disproportionate and unreasonable impact on our organisation, staff, services, time, or resources.

Some examples of unreasonably persistent behaviour include:

• An unwillingness or inability to accept reasonable and logical explanations, including final decisions that have been comprehensively considered and dealt with (even when it is evident a customer or stakeholder does understand the information provided).
• Persistently demanding a review simply because it is available, and without arguing or presenting a case for one.
• Pursuing and exhausting all available review options, even after we have explained that a review is not warranted – and refusing to accept that we cannot or will not take further action.
• Reframing a complaint, representation, or enquiry in an effort to get it taken up again.
• Multiple and repeated phone calls, letters, emails (including cc’d correspondence), social media comments, after we have repeatedly asked them not to.
• Contacting different people within or outside our organisation to get a different outcome or a more sympathetic response to their complaint, representation, or enquiry – this is known as internal and external ‘forum shopping’.

2.1.2 Unreasonable demands

Unreasonable demands are any demands expressly made by a customer, stakeholder or complainant that have a disproportionate and unreasonable impact on our organisation, staff, services, time, or resources.

Some examples of unreasonable demands include:

• Issuing instructions and making demands about how to handle their matter, the priority it should be given, or the outcome to be achieved.
• Insisting on talking to a senior manager or a member of the Board, the Chief Executive, an Executive Director or Director personally when the reasons that this is not appropriate or warranted have been carefully explained to them.
• Emotional blackmail and manipulation resulting in intimidation, harassment, shaming, seduction or portraying themselves as being victimised when this is not the case.
• Insisting on outcomes that are not possible or appropriate in the circumstances or within the boundaries of the legislation, for example asking for someone to be fired or prosecuted, or for an apology or compensation when there is no reasonable basis for this.
• Demanding services of a nature or scale that we cannot provide, even after we have explained this to them repeatedly.

2.1.3   Unreasonable lack of cooperation

Unreasonable lack of cooperation is when a customer or stakeholder is unwilling or unable to cooperate with us, our staff, or our processes – resulting in a disproportionate and unreasonable use of our services, time, or resources.

Some examples of unreasonable lack of cooperation include:

• Sending us a constant stream of complex or disorganised information without clearly defining the issue at hand or explaining how the material provided relates to their matter (where the customer or stakeholder is clearly capable of doing this).
• Providing little or no detail around their matter or providing information in separate emails or correspondence, without a consideration that it may be more appropriate to send a considered email with collated information.
• Refusing to follow or accept our instructions, suggestions, or advice without a clear or justifiable reason for doing so.
• Arguing that a particular solution is the correct one in the face of valid contrary arguments and explanations.
• Unhelpful behaviour such as withholding information, acting dishonestly and misquoting others.

2.1.4 Unreasonable arguments

Unreasonable arguments include any arguments that are not based on any reason or logic, that are incomprehensible, false, or inflammatory, trivial, or delirious, and that disproportionately and unreasonably impact upon our organisation, staff, services, time, or resources.

Arguments are unreasonable when they:

• Fail to follow a logical sequence that the customer or stakeholder is able to explain to staff and that are either not supported by any evidence or are based on conspiracy theories.
• Lead a complainant to reject all other valid and contrary arguments that are trivial when compared to the amount of time, resources, and attention than the matter demands.
• Are false, inflammatory, or defamatory.

2.1.5 Unreasonable behaviour

Unreasonable behaviour is conduct that is unreasonable in all circumstances (regardless of how stressed, angry, or frustrated a customer or stakeholder is) because it unreasonably compromises the health, safety and security of our staff, other service users or the customer or stakeholder themselves.

Some examples of unreasonable behaviours include:

• acts of aggression, verbal abuse, derogatory, racist, or grossly defamatory remarks
• harassment, intimidation, or physical violence
• rude, confronting, or threatening correspondence
• threats of harm to self or third parties, threats with a weapon or threats to damage property, including bomb threats
• stalking in person or online
• emotional manipulation.

3. How we manage unreasonable conduct

3.1 Changing or restricting customer or stakeholder access to our services

Incidents of unreasonable conduct will generally be managed by limiting or adapting the ways we interact with or deliver services to customers or stakeholders by restricting:

Who they have contact with

• Limiting contact to a sole staff member or team in our organisation.

What they can raise with us

• Restricting the subject matter of communications that we will consider and respond to.

When they can have contact

• Limiting their contact with our organisation to a particular time, day, or length of time, or curbing restricting the frequency of their contact with us.

Where they can make contact

• Limiting the locations where we will conduct face-to-face interviews to secured facilities or areas of the office.

How they can make contact

• Limiting or modifying the forms of contact that the customer or stakeholder can have with us. This can include modifying or limiting face-to-face contact, telephone, and written communications (including social media), prohibiting access to our premises, contact through a representative only, taking no further action or terminating provision of services altogether.

When using the restrictions provided in this section, we recognise that discretion will need to be used to adapt them to suit the personal circumstances of our customers or stakeholders such as level of competency, literacy skills, and cultural background.

In this regard, we also recognise that more than one strategy may be needed in individual cases to ensure their appropriateness and effectiveness.

3.2 Completely terminating customer or stakeholder access to our services

In rare cases, we may decide that it is necessary for our organisation to completely restrict a customer or stakeholder’s contact or access to our services.

A decision to have no further contact with a customer or stakeholder will only be made if it appears that they are unlikely to modify their conduct, or their conduct poses a significant risk for our staff or other parties because it involves one or more of the following:

• acts of aggression, verbal or physical abuse, threats of harm, harassment, intimidation, stalking, assault
• damage to property while on our premises
• threats with a weapon or common office items that can be used to harm another person or themselves
• physically preventing a staff member from moving around freely either within their office or during an off-site visit – eg: entrapping them in their home
• conduct that is otherwise unlawful.

In these cases, the customer or stakeholder will be sent a letter notifying them that their access has been restricted as outlined in Part 5.

A customer or stakeholder’s access to our services and our premises may also be restricted (directly or indirectly) using legal mechanisms like trespass laws and other legislation or legal orders to protect members of our staff from personal violence, intimidation or stalking.

4. Alternative dispute resolution

If we cannot terminate our services to a customer or stakeholder in a particular case or if we or our staff bear some responsibility for causing or aggravating their conduct, they may consider using alternative dispute resolution strategies (ADRs) such as mediation and conciliation to resolve the conflict with the customer or stakeholder and attempt to rebuild our relationship with them.

If an ADR is considered to be an appropriate option in a particular case, it will be conducted by an independent third party to ensure transparency and impartiality.

However, we recognise that in some situations an ADR may not be an appropriate or effective strategy – particularly if the customer or stakeholder is uncooperative or resistant to compromise. Therefore, each case will be assessed on its own facts to determine the appropriateness of this approach.

5. Procedure we follow when changing or restricting a customer or stakeholder’s access to our services

5.1 Providing a warning letter

Unless a customer or stakeholder’s conduct poses a substantial risk to the health and safety of staff or other third parties, we will provide them with a written warning about their conduct in the first instance. If the complainant is unable to read the letter, it will be followed/accompanied by a telephone call, using an interpreter if necessary.

The warning letter will:

• specify the date, time, and location of the unreasonable conduct incident(s)
• explain why the customer or stakeholder’s conduct breaches this policy
• list the types of access changes and/or restrictions that may be imposed if the behaviour continues
• provide clear and full reasons for the warning being given
• briefly state the standard of behaviour that is expected of the customer or stakeholder
• provide the name and contact details of the staff member who they can contact about the letter.

5.2 Providing a notification letter

If a customer or stakeholder’s conduct continues after they have been given a written warning or in extreme cases of overt aggression, violence, assault, or other unlawful/unacceptable conduct, we maintain discretion to send a notification letter immediately restricting the customer or stakeholder’s access to our services (without prior or further written warning).

If the customer or stakeholder is unable to read the letter (due to literacy issues, non-English speaking, etc.) the letter will be followed or accompanied by a telephone call, using an interpreter if necessary.

This notification letter will:

• specify the date, time, and location of the unreasonable conduct incident(s)
• explain why the customer or stakeholder’s conduct breaches the policy
• Identify the change and/or restriction that will be imposed and what it means for the customer or stakeholder
• provide clear and full reasons for this restriction
• specify the duration of the change or restriction imposed, which will not exceed 12 months
• indicate a time period for review
• provide the name and contact details of the staff member who they can contact about the letter and/or request a review of the decision.

5.3 Notifying relevant staff about access changes/restrictions

We will notify relevant staff about any decisions to change or restrict a customer or stakeholder’s access to our services.

We will also update our customer or stakeholder account record with an alert outlining the nature of the restriction imposed and its duration.

5.4 Continued monitoring/oversight responsibilities

Once a customer or stakeholder has been issued with a warning letter or notification letter, we will review the customer or stakeholder’s record/restriction every three months, on request by a staff member, or following any further incidents of unreasonable conduct that involve the particular customer or stakeholder to ensure that they are complying with the restrictions/the arrangement is working.

If we determine that the restrictions have been ineffective in managing the customer or stakeholder’s conduct or are otherwise inappropriate, we may decide to either modify the restrictions, impose further restrictions, or terminate the customer or stakeholder’s access to our services altogether.