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Article 3 - WIRO's Complaints Process: Regulating insurer's bad behaviour

Article 3 – WIRO’s Complaints Process: Regulating insurer’s bad behaviour

Published on November 5, 2020 by Scott Dougall and Sabrina BathgateScott Dougall and Sabrina Bathgate

WIRO’s Solutions Group investigates and resolves complaints made by injured workers about an insurer’s conduct or decision in managing a workers compensation claim.

The Solutions Group will endeavour to resolve complaints within 2 business days and does so by contacting the parties to clarify any confusion and assist with negotiating a solution.

Complaints which are considered frivolous, vexatious, historical or are those which relate to a close compensation claim will not be investigated.

WIRO manages complaints in three stages:

  1. Preliminary Inquiries

Within 24 hours of receiving a complaint, the Solutions Group will contact the insurer for more information about the issue so as to determine an appropriate solution. The insurer will be requested to respond within 48 hours.

Where WIRO forms the view that the insurer’s actions are reasonable, the complaint will be closed and the parties will be advised of the outcome.

  1. Further Inquiries

Following a preliminary inquiry, if WIRO considers that there may be an issue with the insurer’s handling of a claim, further information will be sought from a senior officer of the insurer.

  1. Investigations

If at any stage WIRO considers the complaint to be serious and the insurer’s response to be clearly inadequate or inappropriate, formal investigations will be commenced.

At the conclusion of an investigation, WIRO will provide a written report of its findings as well as any non-binding recommendations.

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