Complaint handling policy

1. Overview

What: This policy sets out how we respond to your complaint or other information you send us about employers and providers, and some complaints about insurers, under the following schemes:

• NSW Compulsory Third Party (CTP) Scheme
• NSW Workers Compensation Scheme
• Home Building Compensation (HBC) Scheme.

Who: It applies to our authorised complaint handling staff and the people who complain to us.

Why: This policy ensures you understand your rights and responsibilities. It also ensures we handle complaints fairly and send you a timely response. An effective complaints handling process helps improve our services and the schemes we regulate.

How: This policy has 3 parts.

• Part 1 is this overview.
• Part 2 explains what we can and can’t help with, who to contact for help, and your and our rights and responsibilities.
• Part 3 explains how we handle your complaint.

To complain, please:

• phone us on 13 74 72
• go to our website at www.sira.nsw.gov.au/contact-us
• email us at contact@sira.nsw.gov.au
• write to us at State Insurance Regulatory Authority, Locked Bag 2906, Lisarow NSW 2252.

In this policy, we write about legislation and the groups we regulate, but you may notice other documents use different names for these, for example:

2. Policy

We can only handle certain types of complaints about employers and providers, and some complaints about insurers, and their obligations and services. For the complaints we do not handle, you can contact third parties instead. You can expect us to handle your complaint fairly and send you a timely response. But you also have responsibilities, such as giving us as much relevant information as you can and treating our staff respectfully.

2.1. We handle complaints about employers and providers, and some complaints about insurers

A complaint is an expression of dissatisfaction about an employer, provider or insurer’s:

• products
• services
• staff
• complaint handling.

And where a response or resolution is explicitly or implicitly expected or legally required.

We acknowledge that people may complain when their expectations are not met, standards are not upheld or when they perceive they, or someone else, has been unfairly treated.

A complaint is not:

• asking us for services or information
• asking us to explain our policies or procedures
• giving us feedback
• reporting suspected fraud – please use our Fraud Framework instead
• telling us about systemic issues with a scheme or employer, provider or insurer – please use our Regulatory Framework instead.

We handle complaints about employers and providers, and some complaints about insurers, and their obligations and services, for example:

To complain, please:

• phone us on 13 74 72
• go to our website at www.sira.nsw.gov.au/contact-us
• email us at contact@sira.nsw.gov.au
• write to us at State Insurance Regulatory Authority, Locked Bag 2906, Lisarow NSW 2252.

2.2. We will help you find the right organisation for your complaint

We cannot:

• handle complaints about an insurer’s service if it is about a workplace injury or motor accident
• resolve disputes between you and your workers compensation or CTP insurer
• handle complaints about employers, providers or insurers that are outside our jurisdiction.

If we cannot handle your complaint or part of it, a third party may be able to help, or you may want to ask for a lawyer’s help.

If you aren’t sure who can help, please contact us, and we’ll help you find the right organisation. The following table has some suggestions.

2.3. You have rights and responsibilities and so do we

3. Procedure

When we receive your complaint, we will:

• tell you we received it (within 2 business days)
• we will tell you if we can handle it (usually within 5 business days)
• give you information and/or investigate your complaint
• close your complaint (usually within 20 business days, unless we need more time to investigate).

If you believe our decision about your complaint is wrong, you can ask us to review it. But you must explain why you believe it was wrong.

3.1. We will acknowledge and assess your complaint within 5 business days

We acknowledge that we received your complaint within 2 business days.

Then, we assess if we can handle it. We usually let you know if we cannot handle your complaint or part of it within 5 business days.

For each issue in your complaint that we can handle, we address it in one of 3 ways, by:

• explaining how to raise it directly with the person, employer, provider or insurer, or resolve it with your agreement
• investigating the issue
• declining to handle the issue.

To decide how to address each issue, we can:

• consider documents
• discuss it with you or the person, employer, provider or insurer your complaint is about (in person or another way)
• discuss it with any other relevant person, employer, provider or insurer (in person or another way)
• ask any relevant person, employer, provider or insurer for information or documents.

3.2. We can try to help you resolve the issue directly or investigate your complaint

If we decide to help you resolve the issue directly with the person, employer, provider or insurer, we can ask them to:

• consider the issue
• try to resolve the issue with you directly
• tell us the outcome.

If we investigate your complaint or the information in it, we will tell the person, employer, provider or insurer what we are investigating and why. But this does not apply if we believe telling them will, or is likely to, interfere with our investigation or risk anyone’s safety, health or wellbeing.

As part of our investigation, we can recommend an employer, provider or insurer take specific actions. We expect them to act on our recommendations unless they have a good reason not to. If an employer, provider or insurer fails to follow our recommendations, we can apply our Regulatory Framework to ensure they do. We do this as part of our ongoing supervision of employers, providers and insurers – it is separate to our complaint handling under this policy.

3.3. We can decline to handle part of your complaint or close it entirely

If we decline to handle an issue or close your complaint, we will tell you as soon as we reasonably can. We will tell you about:

• our decision
• our reasons, including any findings or recommendations
• our review process if you want us to review our decision
• any other appropriate information.

We can decline to handle part of your complaint if it is not serious or is vexatious, or for another relevant reason. For example:

• we have already handled the issue under this policy
• you have not given us the information we asked for and need to keep working on your complaint
• you are a third party, and the affected person, employer, provider or insurer does not consent for us to consider the issue
• the issue is or has been subject to legal proceedings
• another person or organisation has jurisdiction or would handle the issue better
• you complained about something that happened more than a year ago and it is no longer happening
• we cannot act meaningfully or legally on the issue after considering all the circumstances.

We can decide to close your complaint for the same reasons we can decline to handle an issue or because:

• you and the person, employer, provider or insurer have resolved the issue
• we have substantiated the issue partly or fully
• we cannot determine if a specific event happened or substantiate the issue’s circumstances despite our investigation.

3.4. We will resolve your complaint and send you a timely response

We can resolve some complaints quickly. But others need more time because they take longer to investigate. We aim to address most complaints within 20 business days and more complex complaints within 90 business days. We will update you regularly.

3.5. You can ask us to review our decision

You or the person, employer, provider or insurer you complained about can ask us to review our decision.

To ask us to review our decision, phone or write to us and tell us:

• why you believe our decision is wrong
• why you are dissatisfied with the complaint process (if you are)
• what outcome you are hoping for from the review.

You must include enough information for why you believe our decision or the complaint process was wrong.

You must ask us for this review within 30 business days of us telling you we have ended our investigation, closed your complaint or will take no further action. If you cannot meet this timeframe, please phone or write to us and explain why. We will consider your request if the reasons for it are serious enough.

We will acknowledge valid requests within 2 business days and contact you with more information about the review process and timeframe.

The following table explains how we review our decisions.