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1. Introduction
1.1 Purpose
The State Insurance Regulatory Authority (SIRA) supervises the Compulsory Third Party (CTP) insurance, workers compensation insurance and the home building compensation 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 enabling legislation.
This policy applies to complaints managed by our authorised complaint handling staff. It sets out what we can do in response to a complaint or other information we receive in relation to the schemes, employers, providers, and insurers we regulate.
In this policy references to enabling legislation means the relevant scheme legislation. Employers, providers and insurers are referred to as regulated entities.
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 What is a complaint?
A complaint is an expression of dissatisfaction about the operation of a scheme, or the products, services, staff or management of a complaint by a regulated entity, where a response or resolution is explicitly or implicitly expected or legally required.
We acknowledge that people may make complaints when their expectations are not met, standards are not upheld or when they perceive they, or someone else, has been unfairly treated.
1.3 What isn't a complaint?
Asking us for services, for information, or for an explanation of our policies or procedures, or providing us with feedback is not a complaint.
You can also report suspected fraud or tell us about systemic matters relating to a scheme or regulated entity. These matters are managed under our Fraud and Regulatory frameworks separately to complaints under this policy.
1.4 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.
1.5 Complaints we can handle
We can handle complaints about the obligations of, and services delivered by employers, providers, and insurers (if the complaint is made by a provider or employer) under the enabling legislation.
Examples of the types of complaints that we can handle include:
Employer complaints
- return to work obligations
- not passing on weekly payments
- not providing documentation to the insurer upon request
- delays in or failing to notify the insurer of an injury
- dismissal of an employee within 6 months of an injury, because of the injury.
Provider complaints
- delivery of services to people with an injury in connection with their claim
- adherence with applicable provider guidelines
- fees, billing and invoicing requirements.
Insurer complaints
- delivery of services to employers in connection with claims
- management of employer policies and premiums
- approval of provider requests and provision of payments.
1.6 Complaints we don’t handle
We cannot handle complaints from people with an injury about their insurer or intervene in disputes between them. We are also unable to handle complaints about regulated entities where another person or body has jurisdiction to deal with the matter.
If we cannot deal with your complaint (or part of your complaint) we can refer your complaint to another person or body for assessment or other appropriate action.
Examples of the types of complaints that others handle and who we may refer to include:
- Manages complains about any act or omission (including any decision or failure to decide) of an insurer that affects the entitlements, rights or obligations of a person with an injury under the enabling legislation.
- Resolves disputes between people with an injury, employers and insurers under the enabling legislation.
- Investigates workplace incidents and enforces work health and safety laws.
NSW Health Care Complaints Commission
- Manages complaints about health service providers, including health organisations, registered and some non-registered health practitioners.
NSW Information and Privacy Commission
- Manages information access complaints about NSW government agencies, and privacy complaints about NSW government agencies, both public and private health service providers and some large organisations that deal with health information.
Office of the NSW Legal Services Commissioner
- Deals with complaints about lawyers.
- Manages complaints about unfair treatment by most NSW government agencies.
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 74 72
- Website: www.sira.nsw.gov.au/contact-us
- Email: contact@sira.nsw.gov.au
- Post: State Insurance Regulatory Authority, Locked Bag 2906, Lisarow NSW 2252.
2.2 You can withdraw your complaint
You can withdraw your complaint if you decide after making it that you no longer want to proceed.
You can do this at any time, either by phone or in writing.
If you withdraw your complaint, we will not notify you of any further action taken.
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 1: Acknowledge complaint received
- Step 2: Initial assessment
- Step 3: Address/inquire
- Step 4: Decision and outcome
- Step 5: Closure and review
3.1.1 Acknowledging your complaint
We will acknowledge your complaint within 2 working days.
3.1.2 Initial assessment of your complaint
After acknowledging your complaint, we will confirm if we can handle it. We will usually let you know within 5 business days if we are unable to deal with your complaint or any part of it.
3.1.3 Addressing your complaint
In relation to each issue in your complaint that we can handle, we may:
- provide you with information about how to raise the issue directly with the person or body the complaint is about or otherwise resolve the issue with your agreement
- decline to deal with the issue, or
- investigate 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 ask the person or body your complaint is about to examine and attempt to resolve the issue or issues with you directly, and report back to us on the outcome.
If we decided to investigate an issue or issues raised in your complaint or in information provided to us, we will advise the person or body the complaint is about, that we are investigating and why. This doesn’t apply if we believe that giving notice will, or is likely to, impede our investigation or place the safety, health, or wellbeing of anyone at risk.
Recommendations
We can make recommendations for specified action to be taken by a regulated entity as part of a complaint investigation. Unless the regulated entity has a good reason not to, we expect them to act on any recommendations made by our authorised complaint handling staff.
As part of SIRA’s ongoing supervision of regulated entities (separate to the handling of individual complaints under this policy), we may initiate action under our Regulatory Framework if a regulated entity fails to act on a complaint recommendation.
3.1.4 Providing outcomes and reasons for our decisions
If we decline to deal with, or end our investigation, 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 including any findings or recommendations made
- information about how you may apply for a review of our decision, and
- any other appropriate information.
Declining to deal with an issue
We can decline to deal with an issue on the basis that it is frivolous or vexatious or should not be dealt with for such other reason as we consider relevant. For example, we will generally decline to deal with an issue if:
- the issue has previously been dealt with under this policy
- you have not provided information upon request that we need to progress our assessment or investigation of the issue
- you are a third party, and the affected person or body, does not consent for the issue to be considered by us
- the issue is, or has been, subject to legal proceedings
- the issue is better dealt with, or has been dealt with, by another person or body
- the issue relates to a matter that occurred more than one year before the complaint was made and is not ongoing, or
- in considering all the circumstances, no meaningful action in relation to the issue can be taken.
Ending an investigation
We may decide to end an investigation into an issue for any of the reasons listed above, or because:
- you and the person or body your complaint is about have agreed to an outcome
- the issue has been substantiated either in full or in part, or
- despite our investigation we are unable to determine whether a specific event occurred or substantiate the circumstances giving rise to the issue.
Timeframes for us to decide
You can ask us for an update on our assessment of your complaint, if it has been more than 20 working days since you raised your complaint and:
- we have not resolved the issue or issues with your agreement,
- declined to deal with the issue or issues, or
- notified you that we are undertaking an investigation.
Within 5 working days we will either resolve the issue or issues with your agreement, decide to take no further action or decide to undertake an investigation.
If we have decided to investigate and it has been more than 90 working days since you raised your complaint, you can ask us to finalise our investigation. Unless you agree to provide us with more time to investigate your complaint, we will tell you about our decision to end our investigation and the reasons for the decision within 5 working days.
3.1.5 Closing your complaint and review
We may share information collected as part of the complaint process with an external person or body that has a relevant interest in the matter. We may also use any information collected as part of the complaint process to fulfil our other functions and objectives.
You or the person or body your complaint is about can ask us to review the decision to close the complaint.
4. Your review rights
4.1 You may request a review of our decision
Depending on the decision, a review application can be made by the person who raised the complaint, or the person or body the complaint is about:
Declining to deal with an issue
- The person who made the complaint may request an internal review of our decision to decline to deal with an issue or issues raised in their complaint.
Ending an investigation
- The person who made the complaint, or the person or body the complaint is about, may request an internal review of our decision to end our investigation in relation to an issue or issues raised in the complaint.
A request for review can be made in writing or over the phone. The request should set out why the review applicant:
- believes the decision to decline to deal with, or to end the investigation into, the issue or issues was wrong
- is dissatisfied with the complaint process (if applicable), and
- what outcome they are seeking in requesting an internal review of the complaint decision.
A request for review should be made within 30 working days of review applicant being notified of the decision to take no further action or end an investigation. We will consider a request received outside of this timeframe if there are sufficient and extenuating circumstances for the delay.
A request for review will not be accepted unless the review applicant provides sufficient reasons for why they believe the complaint process was defective or the decision was wrong.
We will acknowledge a valid request for review within 2 working days and follow up with further information about the process and the timeframe for the review.
4.2 How we review our decisions
A review will be undertaken by someone who was not involved in making the original complaint decision, and who is no less senior than the original decision maker.
In undertaking the review, the internal reviewer can consider documents, discuss the issue or issues, in person or by other means, with any relevant person or body. They can also ask for information or documents from any relevant person or body.
The internal reviewer must complete the review within 20 working days of acknowledging a valid request for review. The internal reviewer can extend the timeframe for completing the review if the person seeking the review agrees to it.
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.
The internal reviewer will provide the review applicant written notice of the review decision and reasons for the decision. They may also provide a copy to any other person or body with a relevant interest in the matter.
A decision on internal review will not be further reviewed by us.
This policy was last updated on 17 November 2025.