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Complaints Resolution Policy

Policy
To ensure that complaints are resolved in an efficient and professional manner in accordance with our Funds requirements to ensure client satisfaction.

It is our policy to promote the highest standard of service for our clients. We endeavour to ensure that all complaints are resolved satisfactorily and in a timely manner.

To provide assistance to The Doctors’ Health Fund staff on the interpretation of dealing with member and client complaints in accordance with the Funds Complaints Handling Procedure and to advise members of their rights with respect to handling of complaints.

Commitment

We are committed to efficient and fair resolution of complaints by people in the organisation at all levels, including the Head of Business and Board of Directors.

We acknowledge consumers’ rights to complain and actively solicit feedback from consumers.

 
Fairness

We recognise the need to be fair to both the complainant and the organisation or person against whom the complaint is made.

 
Resources

We have adequate resources for complaints handing with sufficient levels of delegated authority. We further identify the need for complaints to be reviewed by someone in an independent position (ie. someone who was not involved in the matter complained about).

 
Visibility

Our Complaints Resolution Policy & Procedure will be available on our website, www:doctorshealthfund.com.au

 
Access

Our Complaints Resolution Policy is accessible to all and ensures that information is readily available on the details of making and resolving complaints, The Complaints Resolution Procedure and supporting information is easy to understand and is in plain language.

 
Assistance

We will offer assistance to complainants in the formulation and lodgment of complaints.

 
Responsiveness

Complaints shall be dealt with quickly and the complainants shall be treated courteously.

 
Charges

Where complaints are dealt with under the Funds Internal Dispute Resolution procedure there will be no charge to the complainant, to lodge a complaint.

Where complaint is referred to an external mediator, the Fund reserves the right to recover costs of defending claim where ultimate finding is in the Funds favour.

 
Remedies

Our Complaints Resolution Policy & Procedure has the capacity to determine and implement remedies.

 
Data Collection

Complaints will be recorded in our Complaints Register located within our operating system.

 
Systemic and Recurring Problems

Complaints shall be classified and analysed for the identification and rectification
of systemic and recurring problems.

 
Accountability

We have appropriate reporting on the operation of the complaints handling
process against documented performance standards.

 
Reviews

Our Complaints Resolution Policy is scheduled to be reviewed annually in August.

 
   

 Defining a Complaint
Complaints that must be recorded under this policy may constitute, but are not
limited to, the following: 

  • Where the complainant has suffered financial loss as a result of a failure on the
    part of The Doctors’ Health Fund in the provision of a product and/or service pursuant to a contract
  • Error in any matter relating to documentation or advice given by the Fund
  • Incorrect benefit payment 
  • Criticism from a member, client or regulator 
  • Failure to provide appropriate advice I information 
  • Failure to meet consumer protection standards or codes of conduct 
  • Fraud 
  • Breach of Terms or Conditions

Items which fall outside of the above criteria will be handled as a grievance. Grievances will be recorded separately for record purposes only in the Complaints Register. Grievances can generally be resolved within a day or two, if not immediately.

Procedure
This section sets out the procedure to be followed on receipt of a complaint whether written or verbal.

Receiving a Complaint
Complaints defined under item 2 above are to be recorded as outlined in this Policy.
It is preferable that complaints of this nature are received in writing (including email, facsimile and letter). Verbal complaints will be accepted under this policy.

Written Complaints
The written complaint should clearly state: 

  • the exact dissatisfaction with the product / service; and 
  • any financial loss incurred

This letter should be addressed to: The Complaints Officer
The Doctors’ Health Fund Limited
PO Box 482 St Leonards NSW 1590

Verbal Complaints
Where possible it is desirable that complaints are submitted in writing by the
complainant. Should the complainant not wish to comply with this request, then
the following process should be followed: 

  • Identify yourself, listen, record details and determine what the complainant
    wants
  • Confirm the details received
  • Empathise with the complainant in a courteous manner
  • Explain the courses of action available
  • Do not attempt to lay blame or be defensive
  • Resolve the complaint if possible or commit to doing something immediately, irrespective of who will ultimately handle the complaint
  • Ensure that the complainant is informed the complaint is receiving attention, without creating false expectations
  • Check whether the complainant is satisfied with the proposed action and, if not, advise alternative courses of action
  • On completion of the conversation with the complainant, the employee will compile a file note of the conversation and record in the Complaints Register

Recording a Complaint
It is the responsibility of the employee who receives the complaint to forward the complaint to the Complaints Officer who must enter the complaint into the Complaints Register.

The Complaints Register records the following information: 

  • Internal Case Number 
  • Date 
  • Time 
  • Name 
  • Contact telephone number 
  • Nature of Complaint 
  • Service / Product 
  • Response Time 
  • Referral Source 
  • Staff Involved 
  • Action taken including remedies, determinations and results

Advise the client that the complaint will be forwarded to the Complaints Officer and they will be contacted within 72 hours.

Provide details of our Complaints Officer to the client for their future reference.

Complaints Officer
Responsibility of the Complaints Officer
The Complaints Officer must send a letter to the client within 72 hours of receipt of a written or an unresolved verbal complaint assuring earliest attention and that an investigation is underway. 

  • The complaint must be resolved within 10 business days where practicable
  • Where the complaint cannot be resolved within 10 business days, the client must be contacted and the delay explained. In any event, the complaint must be resolved within 45 days from the date of receipt of the complaint
  • The client must be informed of the criteria and process, including the avenues for further review, applied by the Fund in dealing with complaints. Explain their rights to them and be patient and courteous
  • Ensure that the complainant is familiar with the complaints resolution procedure
  • The client must be advised that they have a right to be heard and supply material in support of their complaint, if they desire
  • The Complaints Officer must arrange a meeting with the relevant employees and Head of Business to discuss the complaint and develop an immediate action plan to resolve it
  • The Complaints Office should, at all times, keep the client informed in writing of what is happening. Wherever possible, try to keep to a timetable and, if there are any delays, advise the client promptly in writing and inform them of when they can expect to hear additional information
  • The Compliance Officer will review the Complaints Register on a quarterly basis for the purpose of providing analysis to the Head of Business on systemic and recurring problems

Complaints Register
The Complaints Officer is responsible for logging the complaint into the Complaints Register.

Maintenance
The Complaints Officer must maintain the Complaints Register.
Complaints must be kept on the register for 7 years.
Every Complaint must be recorded in the Complaints Register.

Remedies for Resolving Disputes
Possible remedies for resolving disputes include:
Apology
Financial assistance
Provision of free services
Reduction or refund of fees paid
Compensation
Disciplinary action against staff member; and
Mediation
Refund
Replacement
Repair
Substitute
Technical Assistance
Additional information
Other assistance
Goodwill gift or token

The Complaints Officer must approve remedies before being offered to the client. In dealing with a compliant, ensure the company addresses all aspects of the complaint; follow up where appropriate and; whether it is appropriate to offer remedies to others who may have suffered in the same way as the complainant but did not make a formal complaint.

Dispute Resolution Scheme
The following internal path will to be followed where complaint cannot be resolved initially. Where a complaint is received by the Head of Business or the Board it will be referred back to the Complaints Officer to be dealt with in accordance with this procedure.

Complaints Officer -> Head of Business  -> Board

Where complaints cannot be resolved internally, complainants retain the right to refer the complaint to:

The Private Health Insurance Ombudsman
Freecall Complaints Hotline:1800 640 695
Email: info@phio.org.au 
www.phio.org.au 
Level 7, 362 Kent Street Sydney NSW 2000
Telephone: (02) 8235 8777
Facsimile: (02) 8235 8778