Complaints about service standards

Ombudsman SA is able to receive and assess complaints about breaches of the service standards under schedule 5 of the Return to Work Act 2014 (the Act) and administrative acts of the Return to Work Corporation (RTWSA) and self-insured employers that are Crown agencies under the Ombudsman Act 1972 that relate to their administration of the Return to Work scheme.

Who can complain?

Complaints about the ‘service standards’ can be made by workers and employers (schedule 5, part 3). The Ombudsman is able to investigate matters where the service standards have been breached by RTWSA, self-insured employers, the claims agents or service providers. Complaints about the administration of the scheme may be made by anyone directly affected by the administrative act.

What can I complain about?

A complaint can be made about:
(a)    breaches of the service standards
(b)    some decisions that are made by RTWSA in the administration of the scheme, e.g. not to register a service provider to provide equipment and services in connection with the assessment, treatment and recovery of injured workers
(c)    some decisions by self-insured Government agencies and RTWSA’s claims agents in the management of claims under the Act

The service standards outline what workers and employers can expect when they deal with the claims agents, RTWSA, self-insured employers and service providers. This also includes assisting a worker to lodge a claim for workers compensation.

The standards cover a range of areas including, recovery and return to work, expectations for early intervention, the manner in which employers and workers should be treated including maintaining confidentiality and providing avenues for feedback and making complaints.

Complaints about administrative acts by RTWSA and self-insured Government agencies [(b) and (c) above] are dealt with in accordance with the Ombudsman Act. Refer to link http://www.ombudsman.sa.gov.au/complaints/

How much does it cost?

There is no cost to lodge a complaint or have your matter investigated by the Ombudsman. The office can also organise for an interpreter so that you can discuss the complaint in your preferred language.

Can I have legal representation?

Yes, however there is no particular need for you to do so when lodging a complaint with the Ombudsman.

What powers does the Ombudsman have?

In accordance with the Ombudsman Act, the Ombudsman has the power to obtain documents and interview witnesses for the purpose of an investigation.   The Ombudsman is also able to make any recommendation he thinks appropriate to ensure compliance with the services standards and the agency that is the subject of the recommendation must comply with it.

The Ombudsman Act imposes obligations on parties to keep information about an investigation confidential. However, the Ombudsman may authorise the disclosure of information relating to an investigation if he considers it is in the public interest.

What is the complaint process?

A complaint can be lodged with Ombudsman SA by phone, email, letter or via the Ombudsman SA website. To lodge a complaint – refer to link    http://www.ombudsman.sa.gov.au/complaints/lodge-a-complaint/

Before the Ombudsman is able to determine to investigate a complaint, the complainant must demonstrate they have attempted to resolve the complaint with the agency concerned. Only in exceptional circumstances will the Ombudsman commence an investigation into a matter without the complainant having attempted to resolve it first with the agency.

Every investigation is conducted in private. An investigation will often include the following steps:

  1. Clarify the Complaint – When a complaint is received, the first step is to assess the complaint and identify the issues with the complainant.
  2. Gathering evidence – The complainant will be asked to provide evidence of the allegations or complaint. The gathering of this evidence may include the complainant being interviewed, being asked to provide documentary evidence and providing evidence of their attempts to resolve the matter with the respondent.
  3. Convey the complaint to the agency – Once the complaint has been clarified, the Ombudsman will then contact the respondent concerned. A complaint may be resolved by the office contacting the respondent via telephone, however if the matter is more complex, it is likely that the complaint will be raised with the respondent in writing. The respondent will be asked to respond to a range of questions in relation to the complaint. The Ombudsman will also likely request copies of relevant documentation and may interview witnesses to the complaint.
  4. Review the agency’s response – Once a response has been received from the respondent, the Ombudsman will determine if the response received adequately addresses the complaint and if so, the response will be provided to the complainant for their feedback.
  5. Investigate – In the course of an investigation an Ombudsman SA officer may visit the agency to examine documents. We may also consider it necessary to interview relevant witnesses. The way in which the investigation is undertaken is at the discretion of the Ombudsman and will vary according to the circumstances of the case.
  6. Decision – Once all information has been received, including feedback from the complainant (if any), the Ombudsman will determine whether the matter is able to be finalised at that point.
  7. Resolution – If the Ombudsman believes there has been a breach of the service standards, the Ombudsman will issue a recommendation to remedy the breach. Alternatively, if the Ombudsman believes that the agency has acted fairly he will express this view to the complainant and explain his reasoning.

How long will it take for my complaint to be resolved?

Depending on the nature of your complaint it may be resolved within a relatively short time frame, perhaps within a few days. However, some matters may take longer as the Ombudsman will need to wait for all relevant information about the complaint to be provided by the complainant. Further, the Ombudsman will also need to write to the respondent and ask them to provide a response to the complaint, provide any documentary evidence required and undertake any necessary interviews of witnesses. Finally, the Ombudsman will need to make some conclusions about the investigation and issue recommendations as appropriate.

What type of resolution to my complaint can I expect?

Schedule 5, part 7 of the Act outlines a number of remedies that the RTWSA, the claims agent or self-insured employer must do if it is clear that there has been a breach of one of the service standards. These include, providing a written apology, providing a written explanation, meeting with the worker or employer to achieve a resolution to the complaint or take any other reasonable steps to remedy the complaint. The Ombudsman can recommend any one or more of these actions be undertaken by a respondent.

Can I give feedback about my experience with the Ombudsman’s office?

Yes. The Ombudsman welcomes your feedback on the services provided. Your feedback may be provided by telephone 8226 8699, email ombudsman@ombudsman.sa.gov.au or post to PO Box 3651, Rundle Mall SA 5000

Where can I lodge my complaint in the first Instance?

ReturntoWorkSA – Service Improvement Unit:                                              8233 2463

Gallagher Bassett Service – Customer Feedback:                                         8394 4719

Employers Mutual Limited – Service Delivery Unit:                                        8127 1182

For complaints about self-insured employers, contact the case manager first.