A guide to the complaints process and common terms
When you first contact us
When you contact us to make a complaint, we’ll ask you for:
- your name and contact details
- the name and contact details of your authorised representative, if you have one
- which provider and service your complaint is about
- the details of the complaint and what happened when you complained to the provider
- the outcome you want.
First, we’ll decide if we’re able to deal with your complaint. A common reason we cannot take a complaint is because you haven’t tried to resolve it with your provider first. If we can’t deal with your complaint, we’ll register your contact as an Enquiry. We may also:
- refer your Enquiry to your provider if you haven’t discussed the issue with them. They have 15 business days to respond.
- refer you to another organisation that can deal with your complaint.
If you’ve already contacted your provider to try to resolve your complaint, we’ll register your contact as a complaint and make what we call a Referral.
A Referral is when we send your provider information about your complaint and ask it to contact you to discuss the complaint and how to resolve it. Until your complaint is resolved, your provider must stop credit management action on any charges you are disputing.
Providers generally have 10 days to respond to you. The timeframes are different for any issues that:
- are urgent because of a medical safety risk – providers have two business days
- you became aware of more than two years ago – providers have 20 business days.
If your provider does not contact you
If your provider does not contact you within the Referral timeframe, tell us. We may give your provider two more business days to contact you and show us that your complaint has been resolved.
If you’re not happy with their response
If your complaint isn’t resolved after the referral timeframe, tell us. We’ll ask you why you aren’t happy with the provider’s response and decide whether it’s reasonable for us to keep handling your complaint. If we decide to:
- stop handling your complaint, we’ll tell you why. You can ask us to review this decision.
- keep handling your complaint, we’ll move it to the next stage of the complaint process.
If Referral doesn’t resolve your complaint and we can’t resolve it quickly with your provider, a TIO Case Manager will discuss your complaint with you and decide which Case Management approach to use to resolve it, either Conciliation or Investigation.
In Conciliation, we work with you and your provider to find a resolution, either by conference call or by talking to each of you separately. First, we might ask you (and/or the provider) to give us extra information. If we decide to use a conference call, we will set a time that suits you both.
In an Investigation, we’ll ask you and your provider for more information about your complaint, such as billing information, contracts, and records of your correspondence with each other. We’ll analyse this information to decide how we think the complaint should be resolved.
If you and your provider agree on a resolution during Conciliation or Investigation, we will close the complaint as ‘resolved’. But if you and the provider can’t agree, the Case Manager may make an Assessment of how your complaint should be resolved. They will take into account factors including:
- relevant laws
- industry guidelines and good practice
- what is fair and reasonable in the circumstances.
We will send the Assessment to you and the provider and ask if you accept it.
- If you both accept the Assessment, we expect you and the provider to carry out the agreed actions, and we will close the complaint as ‘resolved’.
- If you don’t respond, we will close our file. The provider won’t have to carry out the actions and we will not consider your complaint any further.
- If you reject the Assessment, you must tell us why within 10 business days. A senior officer will review the assessment and either confirm it and close the file; decide that more Investigation is needed; or work with you and the provider to try to agree a resolution. If you reject the reviewed Assessment, we will close our file and the provider won’t have to carry out the actions. You may choose to take your complaint to another forum.
- If your provider rejects the Assessment, they must tell us why within 10 business days. We may investigate further or escalate the complaint to the Ombudsman.
Ombudsman’s Proposed Resolution
If we escalate the complaint to the Ombudsman, they will propose a resolution. We will send the Proposed Resolution to you and the provider and ask you to accept or reject it within 15 business days.
- If you both accept the Proposed Resolution, we expect you and the provider to carry out the agreed actions. We will close the complaint as ‘resolved’. You must agree not to take your complaint to another forum if the provider carries out the agreed actions.
- If you reject the Proposed Resolution or don’t respond, we will close our file. The provider won’t have to carry out the actions and we will not consider your complaint any further.
- If your provider rejects the Proposed Resolution or doesn’t respond, the Ombudsman will make a Decision. First, they may consider the response to the Proposed Resolution and investigate further.
If the Ombudsman decides the outcome to the complaint, you and the provider will have 15 days to respond.
- If you accept the Decision, your provider must follow the Ombudsman’s directions. You must agree not to take the complaint to any other forum if the provider follows the Ombudsman’s directions.
- If you reject the Decision or don’t respond, we will close our file. The provider won’t have to carry out the actions and we will not consider your complaint any further.
If your provider doesn’t do what was agreed
If your provider doesn’t do what was agreed between you or decided by the Ombudsman, we will tell them to take action within five days. If the provider doesn’t show that they have done what was agreed or decided, we will refer them to the regulator, the Australian Communications and Media Authority, for enforcement. We may also publish details of the non-compliance.
When we will stop handling a complaint
At any time during the Case Management process we will stop handling a complaint if you ask us to, or if it’s resolved by agreement. We may also decide to stop handling a complaint if:
- you can’t be contacted, or are not participating in the resolution process
- you refuse to pay undisputed charges
- your complaint is frivolous or vexatious
- you are acting unreasonably
- we can’t take the complaint because it is out of our jurisdiction
- another body or forum is more appropriate to deal with the complaint.
If we decide to stop handling your complaint, you can ask for the decision to be reviewed by a senior officer.