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Complaints Resolution Policy

1. Purpose 

The purpose of this policy is to:

  • ensure that complaints received by The Doctors' Health Fund Pty Ltd ('The Fund'), are resolved in an efficient and professional manner
  • improve the standard of service for our members by ensuring that all complaints are addressed and, where relevant, used to improve processes
  • provide assistance to Fund staff in dealing with complaints by establishing procedures for making complaints, and
  • advise complainants of their rights with respect to the handling of their complaint.

2. Definition

A complaint is an expression of dissatisfaction with a product of service provided by the Fund. A complaint can be received from a number of sources including members, providers, agents or consumers.

Our Customer Service team should be able to resolve your complaint immediately, however if you are not satisfied with the response, your complaint will be considered under the Fund's Complaints Resolution Policy.

3. Principles

The Fund applies the following principles in this policy:

3.1 Commitment: The Fund is committed to the efficient and fair resolution of complaints by staff at all levels, including the Chief Executive Officer and the Board of Directors.

3.2 Right to complain: the Fund acknowledges consumers' right to complain and encourages feedback from consumers. 

3.3  Fairness: The Fund recognises the need to be fair and objective in its assessment of the complaint and to manage the process in an unbiased manner. Fairness applies to all parties, including the complainant, the Fund membership as a whole and any individual against whom a complaint may be raised. 

3.4  Resources: The Fund will maintain adequately trained staff to handle the complaint procedures.

3.5 Visibility: The Fund will make the Complaints Resolution Policy publicly available in plain language on its website and to anyone who requests it. 

3.6 Responsiveness: The Fund will deal with complaints quickly and treat complainants courteously.

3.7 Costs: The Fund will not apply a charge where the complaint is dealt with internally. All reasonable costs incurred or to be incurred by the Complainant resulting from the decision to refer the matter to an external mediator shall be borne by the Fund.

3.8 Remedies: The Fund has the capacity to determine and implement remedies.

3.9  Data collection: The Fund will record and monitor the status of complaints.

3.10 Continual improvement: The Fund will review its processes or products or retrain staff as appropriate and where the complaint involves a systemic or recurring issue.

3.11 Accountability: The Fund will apply appropriate reporting on the operation of the complaints resolution process against documented performance standards.

3.12 Confidentiality: Personally identifiable information (as per the Privacy Act 1988) concerning the complainant shall be actively protected from disclosure, unless the customer or complainant expressly consents to its disclosure.

3.13 Review: The Fund will review this policy annually.

4. Complaints Resolution framework & processes

4.1  The Fund has systems and procedures in place to log, monitor and report complaints. 

4.2  Complainants may make complaints in whichever way they feel most comfortable: by e-mail, letter, fax, face-to-face or telephone. In order to clarify the exact nature of the grievance, it is usually preferable for the complainant to put the complaint in writing. All complainants must be sent an acknowledgement of receipt of their complaints.

4.3 Where unresolved immediately, the complainant should be advised that they will be contacted within three business days of receiving the complaint, or the progress of their complaint.

4.4  The complaint must, where practicable, be resolved within 10 business days. In any event, the complaint must be resolved within 45 days from the date of receipt of the complaint. 

4.5 The complainant must be informed of the criteria and complaints resolution process, including the avenues for further review through the PHIO. Contact details for the PHIO are provided at the end of this policy.

4.6 Where possible, complaints should be reviewed by a staff member who has not been involved in the matter. Ideally, if the complaint is about the quality of service, the CEO should independently review the complaint.

Fund Contact Details:

Head of Operations

The Doctors' Health Fund Pty Ltd

PO Box Q1749 Queen Victoria Building

Sydney NSW 1230

 

5. Private Health Insurance Ombudsman contact details

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

The Private Health Insurance Ombudsman (PHIO)

Hotline: 1300 362 072 (option 4 for Private Health Insurance)

Website: www.ombudsman.gov.au

Email: phio.info@ombudsman.gov.au

Fax: (02) 6276 0123

Post:

Private Health Insurance Ombudsman

Office of the Commonwealth Ombudsman

GPO Box 442

CANBERRA ACT 2601