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IRO's Complaints Process: Regulating insurer's bad behaviour in NSW

IRO’s Complaints Process: Regulating insurer’s bad behaviour in NSW

Published on May 18, 2021 by Sabrina Morell and Scott DougallSabrina Morell and Scott Dougall

IRO’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.

IRO 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 IRO 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 IRO 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 IRO 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, IRO will provide a written report of its findings as well as any non-binding recommendations.

Read other articles in this series on IRO including Who is IRO?  and Eligibility for Free legal advice under IRO.

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