The State Insurance Regulatory Authority ('SIRA') is a government agency in New South Wales that oversees insurance programs like Workers Compensation, Compulsory Third Party ('CTP'), and Home Building Compensation. They make sure insurance services are fair and work well. SIRA also keeps an eye on insurance companies and helps solve disputes between people making claims and insurers, especially for motor accidents.
What types of complaints can you make?
CTP Insurers: CTP insurance is required for all vehicle owners in NSW. It covers injuries to people in motor vehicle accidents. Common complaint types include:
- Delays in Claims Processing: If your claim is delayed without updates.
- Unfair Claim Denials: If your claim is denied without clear reasons.
- Disputes Over Liability: If the insurer incorrectly determines fault.
- Inadequate Settlement Offers: If the offered compensation doesn't cover your losses.
- Non-Compliance with Medical Costs: If the insurer refuses to cover necessary medical expenses.
- Premium Calculation Disputes: If your premium increases without a clear reason.
- Insurer Communication: If the insurer fails to respond or provide updates.
- Handling of Personal Information: If your personal data is mishandled.
Workers Compensation Insurers: Workers Compensation insurance covers employees injured or ill due to work. Common complaint types include:
- Claim Denials: If your claim is denied without valid reasons.
- Delayed Claim Processing: If your claim takes too long, causing financial hardship.
- Disputes Over Medical Treatments: If the insurer refuses necessary treatments.
- Inadequate Compensation: If the benefits don't cover lost wages or medical costs.
- Premium Disputes: If your business is unfairly classified, affecting premiums.
- Non-Compliance with Return-to-Work Programs: If the insurer or employer doesn't support your return to work.
- Failure to Inform: If you're not informed about your rights or the claims process.
- Mishandling of Claims: If there are administrative errors in your claim.
Home Building Compensation Insurers and Providers: This insurance covers homeowners for defective or incomplete building work. Common complaint types include:
- Inaccurate Coverage: If the policy doesn't match what was agreed upon.
- Delayed Claim Processing: If your claim is delayed, affecting your construction plans.
- Denial of Legitimate Claims: If your legitimate claim is unjustly denied.
- Underpayment of Claims: If the compensation is insufficient for your losses.
- Mismanagement of Claims: If your claim is poorly handled, affecting outcomes.
Jurisdiction:
SIRA oversees complaints about the practices and decisions of insurers operating under NSW's mandatory insurance schemes, including Workers Compensation, CTP, and Home Building Compensation.
Time Limitations:
- SIRA typically will not investigate complaints if the issue occurred more than six months prior, unless exceptional circumstances exist.
- Complainants should first attempt to resolve the issue directly with the insurer involved.
SIRA will not deal with complaints about:
- SIRA does not handle complaints related to the general operations of insurers not directly related to policy management, claim processing, or compliance with state regulations.
- Complaints already under legal action in court or tribunal are excluded unless special conditions apply.
- Complaints about employment matters within insurance companies or broader financial strategies not affecting policyholders are beyond SIRA’s remit.
- SIRA may not investigate if the complaint is considered frivolous, if the complainant has not suffered significant injustice, or if an investigation would not be a productive use of resources.
- SIRA is not the relevant body for specific complaints about delays or communication problems with insurers. These issues are better addressed by the IRO. SIRA focuses on broader systemic issues and regulatory compliance.
Additional Information:
When dealing with workers' compensation issues, it is crucial to direct your complaint to the appropriate body:
- Independent Review Office ('IRO'): For specific complaints about delays and communication issues with insurers.
- State Insurance Regulatory Authority ('SIRA'): For addressing systemic issues and ensuring insurers comply with regulations.
- Personal Injury Commission ('PIC'): For formal dispute resolution if informal complaints do not resolve the issue.
Who can you make a complaint against?
You can make a complaint against:
- Insurance Companies: Provide Workers Compensation, CTP, or Home Building Compensation coverage.
- Employers (for Workers Compensation): Involved in workplace injury claims.
- Licensed Builders or Contractors (for Home Building Compensation): Responsible for home construction or renovation.
- Medical Providers (for Workers Compensation and CTP): Offer medical and rehabilitation services to claimants.
- Claims Adjusters or Agencies: Handle claim assessments and processing.
- Agents or Brokers: Manage insurance policies and advise clients.
- Third-Party Administrators ('TPAs'): Handle claims processing and benefits administration.
SIRA will not deal with complaints about:
- Government Agencies
- Non-managerial Employees
- Private Citizens/Customers
- Legal Advisors
- Unregulated Service Providers
- International Entities
Are you eligible to make a complaint?
Individuals, employers, or any party affected by insurers' actions under SIRA-regulated schemes in NSW.
Before you lodge a complaint:
- Direct Contact: Try resolving the issue directly with the insurer first.
- Documentation: Gather all relevant documents to support your complaint.
Making a Complaint on Someone’s Behalf:
You can complain on behalf of someone with their consent or legal authority (e.g., legal guardian, power of attorney).
Additional Information:
- Multiple Avenues: If SIRA can't handle your complaint, they may redirect you to another authority.
- Follow-up: Stay engaged with the process, provide additional information if needed, and participate in resolution processes.
- Public Interest: SIRA may prioritise complaints with broader implications for public safety or systemic issues.
What can this body do to help?
The SIRA may do one or more of the following:
- Rectification: Correct errors in claim handling.
- Compensation: Provide monetary compensation for losses.
- Apology: Require the insurer to issue a formal apology.
- Policy or Process Change: Implement changes to prevent future issues.
- Training or Supervision: Enhance staff training and supervision.
- Warning or Censure: Issue warnings to deter future misconduct.
- Penalties: Impose fines for serious infractions.
- License Modification or Revocation: Modify or revoke the insurer's license for severe non-compliance.
How to prepare your complaint
Format:
Phone:
Email:
, in writing, or email.
If you need assistance:
- National Relay Service: For the hearing impaired.
- TIS National: For translation services.
Personal Details:
Your complaint must include your name, contact information, and age range.
Respondent’s Details:
Include the name of the insurance company or service provider.
Relevant Facts:
Provide a detailed description of the complaint, follow-up actions, desired resolution.
Supporting Documents:
Ensure to attach any relevant supporting documents.
What NOT to Include:
False or misleading statements.
Additional Information:
- Sharing Details: SIRA may share complaint details with the insurer for investigation.
- Withdrawal: You can withdraw your complaint anytime.
- Continued Inquiries: SIRA may continue to investigate even if you withdraw your complaint.
Lodging your complaint and next steps:
Where to Lodge Your Complaint:
- Online Form: SIRA Complaint Form found here.
- Email: contact@sira.nsw.gov.au.
- Post: State Insurance Regulatory Authority, Locked Bag 2906, Lisarow NSW 2259.
- Phone: 13 10 50 (8:30 am to 5 pm, Monday to Friday).
Receipt/Acknowledgement:
SIRA aims to address most complaints within 20 working days, complex complaints within 90 days.
Initial Assessment:
SIRA will confirm their ability to handle the complaint and inform you if they can't.
Addressing the Complaint:
SIRA may take various actions, including making formal inquiries, providing information, or asking the insurer to resolve the issue.
Provide Outcomes and Reasoning:
SIRA will inform you about decisions, reasons, and options for review if they take no further action.
More information:
Refer to the factsheet provided below for more information.
