The Independent Review Office ('IRO') helps people make complaints against insurers if they've been injured at work or in motor vehicle accidents. They also provide free legal help through the Independent Legal Assistance and Review Service ('ILARS') and look into complaints relating to workers' compensation and motor vehicle accident systems.
What types of complaints can you make?
Complaints can be made about the conduct of insurers in instances of injury at work or in motor vehicle accidents. The IRO focuses on complaints including, but not limited to:
- Complaints about Weekly Benefits: If you experience issues related to an insurer’s calculation, reduction, termination, or delay of weekly compensation benefits.
- Complaints about Medical Treatment: If you have concerns about an insurer’s coverage, denial, or adequacy of medical treatment and rehabilitation services.
- Complaints about Denials of Liability: If insurers deny liability for incidents covered by their policies.
- Complaints about Delays in Determining Claims: If insurers do not process your claim within 10 business days of receiving it.
- Unfair Treatment: If you feel your entitlements, rights, or obligations have been unjustly affected by an insurer’s actions or omissions.
- Incorrect Handling of Claims: If you experience errors in processing your claim, misinterpretation of medical reports, or non-compliance with procedures by an insurer.
Jurisdiction:
The IRO can act on complaints about the conduct of insurers related to NSW workers’ compensation legislation and NSW motor accident compensation legislation.
Time Limitations:
There are no relevant time limitations for making a complaint to the IRO. However, it is recommended to make the complaint as soon as possible after the relevant conduct to increase the likelihood of resolution.
The IRO will not deal with complaints about:
The IRO does not address complaints that are more appropriately dealt with by another forum, complaints outside its jurisdiction, complaints previously considered unless new circumstances apply, complaints without consent from the claimant, or complaints about lawyers' competence or professional conduct.
Exercise of Discretion:
The IRO may decline to deal with complaints for any reason it considers relevant, including complaints that are not genuine or made to cause trouble or annoyance.
Who can you make a complaint against?
You can make a complaint against:
- Insurers/Insurance Companies: Insurance corporations or financial intermediaries offering direct insurance or reinsurance services under NSW workers' compensation or motor accident compensation legislation.
The IRO will not deal with complaints about:
The IRO has limited functions regarding lawyers, focusing only on ILARS grants management. It does not handle complaints about lawyers' competence or professional conduct.
Additional Information:
The IRO deals only with complaints from injured persons in the NSW workers' compensation or motor accident compensation system, not from interstate claimants or those under Comcare.
Are you eligible to make a complaint?
Who can make a complaint?
A complaint can be made by someone making an insurance claim under NSW workers’ compensation or motor vehicle insurance, or their representative (solicitor, union representative, spouse, etc.).
Before you lodge a complaint:
A worker seeking to make a claim for workers' compensation must notify their employer of the injury or illness as soon as possible with details like the date, time, description of the incident, and nature of the injury/illness.
Can Complaints be Made on Behalf of Someone?
Yes, a third party can report a work-related injury/illness to an insurer on behalf of a worker, providing their name, relationship to the worker, and contact details.
The IRO will not deal with complaints about:
The IRO cannot handle general statements or requests such as reviews of funding decisions, requests for information or assistance, expressions of opinion about government policy, or complaints about other organisations or individuals.
Additional Information:
For non-English speakers, the IRO provides interpreter services through TIS, and brochures in various languages.
What can this body do to help?
This body may provide:
- Legal Referral Services: The IRO can refer you to legal services, such as ILARS, to assist in pursuing your claim through formal legal channels.
- Negotiation/Direct Intervention: The IRO investigates complaints fairly, often resolving issues through negotiation or clarifying rights and obligations.
- Recommendations for Resolution: The IRO can make non-binding recommendations to the insurer to resolve the complaint.
- Referral to Mediation: For complex disputes, the IRO might refer the case to mediation to help both parties reach an agreement.
- Escalation to Regulatory Authorities: If systemic issues or serious non-compliance are identified, the IRO may escalate the matter to relevant regulatory authorities.
How to prepare your complaint
Format:
Complaints can be made by telephone, in writing (email or post), or using the online form.
Personal Details:
Include your role (injured person, lawyer, family member, etc.), request type (complaint, information), insurer, claim number, injury date, and a brief description of the complaint.
Respondent’s Details:
Name of the insurance provider being complained about.
Relevant Facts:
Specify the injury date and a brief description of the complaint (max 1600 characters). Indicate if the issue was previously discussed with the IRO.
File Upload:
You can upload relevant documents (file types: msg, pdf, docx, doc, jpg, png, tiff, xlsx, jpeg, rtf, tif, mp3, zip, eml, xls; max total size: 20MB, individual file: 5MB).
What NOT to Include:
Do not make false or misleading statements.
Additional Information:
Personal information is collected and used in accordance with privacy laws.
Time Limits for Claiming Workers Compensation:
Claims should be made within six months of the injury/illness. Extensions may apply in certain circumstances.
Lodging your complaint and next steps:
Where to Lodge:
- Online Form: Contact IRO
- Email Addresses:
- ILARS: ilarscontact@iro.nsw.gov.au
- IRO Solutions: complaints@iro.nsw.gov.au
- Media: editor@iro.nsw.gov.au
- Other Enquiries: contact@iro.nsw.gov.au
- Postal Address: McKell Building, 2-24 Rawson Pl, Haymarket NSW 2000
- Telephone: 139 476 (8:30 am to 5 pm, Monday to Friday, excluding public holidays)
Receipt/Acknowledgement of Complaint:
The IRO will acknowledge receipt of each complaint within two working days. The appropriate method for communication will be considered (telephone, email, or letter).
Methods of Complaint Resolution:
- Negotiation: Quick resolution through information exchange and option development.
- Investigation: Formal model involving information requests and non-binding recommendations. Both methods may be used to achieve a fair resolution.
More information:
Refer to the factsheet provided below for more information.
