Complaints
Most complaints to ACC are managed by Customer Support Service and the Office
of the Complaints Investigator. Government Services also manage complaints
received through the ACC Minister. To minimise complaints you must understand
your obligations and responsibilities under the Code of ACC Claimants’ Rights.
Policy
Complaints rules
Responsibilities
Code of Claimants' Rights
Ministerial queries
Process
Managing complaints
Complex complaints
Investigate ministerial
Reference
Writing an apology guidelines
Manage systemic advocacy
Explain process
Dissatisfied clients
Policy
Complaints policies are:
Complaints rules
Responsibilities
Code of Claimants' Rights
Ministerial queries
Rules for managing complaints
Introduction
ACC must meet its obligations when managing complaints. The actions and timeframes that apply to
the Office of the Complaints Investigator (OCI) and the Customer Support Service (CSS) complaint
processes are outlined in the following table. See als
o Managing issues and complaints and
Resolving complex or escalated complaints.
The…
must…
within…
two working day of receiving the
CSS and the managing
complaint. If we cannot contact the client
contact the client
business unit
by phone within this timeframe we must
try again within two working days
four working days, or more if agreed to by
the client. If we need more time and the
client refuses an extension we must
escalate the issue to the OCI
CSS and/or the managing try to resolve the issue or non-
We must monitor and report daily on
business unit
formal/non-code complaint
time extensions beyond four days
If we are not able to resolve
complaints at the CSS or local level
we must escalate them to the OCI
register and escalate formal or
CSS
the same day we receive the complaint
Code complaints to the OCI
send the client a
one working day of registering the
OCI
COM03 We have received your complaint
complaint (35K) letter
ask the business unit, AE or
TPA to complete the
one working day of registering the
OCI
ACC711 Complaint response
complaint
template (117K)
send a completed
managing business unit,
accredited employer (AE)
ACC711 Complaint response
five working days of receiving the request
or third party
template (117K), and
for information
administrator (TPA)
supporting information, to the
complaints investigator
send an
ACC712 Summary of events
OCI
(108K),(SOE) to the client and no set timeframes apply
the business unit manager, AE
or TPA for comment
client, managing business respond to the
seven working days of receiving the SOE,
The…
must…
within…
unit, AE or TPA
or at the investigator’s discretion
ACC712 Summary of events
(108K)
issue decision letter when the 4 to 6 weeks, or the timeframe in the
OCI
investigation is complete
acknowledgement letter
managing business unit, implement remedies as
seven working days after the client
AE or TPA
directed
receives the decision letter
Responsibility for managing complaints
Introduction
Different ACC groups are responsible for managing different types of complaints. This policy outlines
the roles, responsibilities and expected outcomes for each group, and the rules about ownership of
complaint information and assigning complaints. See als
o Managing issues and complaints and
Resolving complex or escalated complaints.
Rules
ACC business units, accredited employers (AEs) and third party administrators
(TPAs)
Role
Try to resolve al client issues.
Responsibility
You must:
respond positively to issues referred from other areas
work collaboratively with the Customer Support Service (CSS) or Office of the Complaints
Investigator (OCI) to resolve client problems, concerns and Code of ACC Claimants’ Rights
(Code) complaints.
You must then issue a decision on the complaint.
Expectation
Within one working day of being approached by the CSS about a client issue or complaint, you must:
make contact with the client
resolve the issue to the client’s satisfaction within the parameters of the legislation, if possible
report to the CSS, detailing what action has been taken and whether the client is satisfied with
the outcome
you must use Eos to report to the CSS, not email.
Customer Support Service
Role
Help clients, business units, AEs and TPAs achieve an outcome for the client’s problems and
concerns
Administer and refer Code complaints to the OCI.
Responsibility
You must:
get information from the client to clarify their issue and identify the solution they would like
check any information in Eos
consider policy, procedures and legislation
advise the business units, AEs and TPAs of the issue and confirm process, expectations, and
timeframes for its outcome.
Expectation
You must achieve an outcome when:
the issue is straightforward, can be dealt with easily and resolved by making one or two phone
calls
the issue involves an urgent matter relating to entitlements or treatment
it’s not clear which business unit or case owner should manage the issue.
You must escalate unresolved or Code complaints to the OCI.
You must escalate complaints when a client al eges a service failure or requests formal investigation.
Office of the Complaints Investigator
Role
Conduct investigations into Code or non-code complaints.
Responsibility
You must investigate and determine whether ACC or its agent has:
met its responsibilities in terms of the Code of ACC Claimants’ Rights
taken reasonable actions to manage entitlement.
Expectation
You must:
deal with and make decisions on complaints in a fair and impartial manner, taking into
consideration the evidence and the client’s and ACC’s views
if necessary, decline to investigate complaints that should be dealt with by another agency, such
as the Health and Disability Commissioner.
Ownership of complaint information
then they are considered to be the complainant
If the issue or complaint is from…
and…
the information is owned by the client
a client
the documents will be visible in Eos at the party
level
the information is owned by the client
a client’s representative, authorised to act on
behalf of the client
the documents will be visible in Eos at the party
level
the information is owned by the party
a party, who is not the client and not authorised
to act on behalf of the client
the documents will be visible in Eos at the party
level or claim level
the information is owned by the party
a party, who is not the client and not authorised the documents will be visible in Eos at the party
level
to act on behalf of the client, and who doesn’t
exist in Eos
a contact or document may be loaded to the client
record if it pertains to their claim, noting that the
person is not authorised
Assigning complaints
You must assign all complaints involving an alleged breach of the Code of ACC Claimants’ Rights to
the OCI to investigate.
Where possible, address and resolve issues at a local level before they escalate to a complaint. If
clients are not satisfied with the steps taken to resolve the issue, advise them how to lodge a
complaint.
Working with the Code of ACC
Claimants’ Rights
Introduction
To minimise complaints, especial y about our service, communication and behaviour, you must
understand your obligations and responsibilities under th
e Code of ACC Claimants’ Rights (17K). See
als
o Rules for managing complaints an
d Responsibility for managing complaints.
Rules
Applying the Code of ACC Claimants’ Rights
When dealing with clients ACC must fulfil its obligations in the Code of ACC Claimants’ Rights (the
Code).
Accredited employers and agents of ACC are subject to the Code and must provide the highest
practicable standard of service and fairness.
The Rights
The Injury, Prevention, Rehabilitation, and Compensation (Code of ACC Claimants’ Rights) Notice
2002 specifies eight rights.
Clients have:
the right to be treated with dignity and respect
the right to be treated fairly and have their views considered
the right to have their cultures, value and beliefs respected
the right to a support person or persons
the right to effective communication
the right to be fully informed
the right to have their privacy respected
the right to complain.
ACC philosophy
You must comply with ACC's philosophy for dealing with client problems, concerns or complaints.
This philosophy supports the Code.
When a client raises a concern or complaint, you must:
take the concern or complaint seriously
commit to settling it in a fair, open and respectful manner
resolve it as quickly as possible
treat the client with courtesy
keep the client informed at all stages
take responsibility for working with the client until the issues are settled.
You must not discriminate against a client because they have raised a concern or complaint.
Clients who raise a concern or file a complaint must not be disadvantaged in any way.
The purpose of the Code
The purpose of the Code of ACC Claimants' Rights is to meet clients' reasonable expectations about
how ACC should deal with them. The Code provides a framework that enables us to deliver a high
standard of service and fairness to clients. The Code achieves these objectives by conferring rights
on clients and imposing obligations on ACC.
The spirit of the Code
The Code encourages positive relationships between ACC and clients. For ACC to assist clients, a
partnership based on mutual trust, respect, understanding and participation is critical. Clients and
ACC need to work together, especially in the rehabilitation process. The Code is about how ACC wil
work with clients to make sure they receive the highest practicable standard of service and fairness.
Exceptions
The ACC Code of Claimants’ Rights does not apply to:
dealings with clients before 1 February 2003
disputes about cover and entitlements, including treatment and compensation, which are
addressed in the AC Act 2001
the provision of treatment services. Treatment services are covered by the Code of Health and
Disability Services Consumers’ Rights
treatment and disability services purchased by ACC. Services purchased by ACC are covered by
the Health and Disability Sector Standards and th
e Health and Disability Services (Safety) Act
2001.
The client has the right to review a decision made about their complaint under the Code of ACC
Claimants’ Rights. However
, AC Act 2001, Section 149(3) prohibits any further appeal to the District
Court against that review decision.
The Office of the Complaints Investigator (OCI) can investigate these matters and issue a Non Code
finding, which will not contain review rights.
Ministerial queries and correspondence
Introduction
When someone writes to a government minister to raise an issue about ACC, ie a ministerial query, it
is forwarded to ACC's Government Services for investigation and reply. This policy outlines the rules
branches and business units must follow when Government Services requests information to help
them respond to a ministerial query.
Rules
Administering requests for information
Any information relating to a ministerial query belongs to the Minister, who is also responsible for
deciding if it should be released
Members of Parliament may contact a branch or business unit on behalf of a local constituent.
You may respond directly to the Minister without going through Government Services
You must not send large and unedited extracts from the claim file to Government Services
Government Services must send requests for information to ACC branches in writing, ie by email
Information sent to Government Services by branch or business unit managers must be
complete, helpful and relevant to the ministerial query.
Example:
If you receive a social rehabilitation query, don't supply information about weekly compensation
payments.
You must forward all relevant reports, assessments and any additional documents to
Government Services with the ministerial information template.
Example:
When a client complains that their home help entitlement is insufficient, you must include the
assessor’s report on the client’s home help along with the template containing al the information
regarding the case.
Handling requests for information in Eos
You must keep al information relating to ministerial queries separate from individual claim files
You may add contact notes to record queries from Government Services but you must not record
the name of the Government Services advisor who sent the request
You must not scan letters to or from the Minister into Eos.
Timeframes and actions for supplying information
You must supply information for a ministerial reply on the template within three working days.
If you can't supply the information within three days the branch or business unit manager must explain
the delay to Government Services and supply a new timeframe.
Example:
Government Services requests information by the 15th of the month, but the case manager is not
meeting with the client until the 16th. The case manager must tel Government Services about this
meeting and arrange to supply the information on the 17th.
Process
Complaints processes are:
Managing complaints
Complex complaints
Investigate ministerial
Managing issues and complaints
This process must be used by the Customer Support Service (CSS) and ACC business
units to manage an issue or complaint. When we are first alerted to an issue or
complaint, CSS records the details then decides the best way to deal with it so that
we can reach a resolution that satisfies all parties.
CSS then attempts to resolve the complaint or asks an ACC business unit to review
and resolve it. Once the business unit has attempted resolution then it is referred
back to the CSS team. At the end of the process the CSS checks whether the
complainant is satisfied with the outcome.
Record issue or complaint
Responsibility
Customer Support Service (CSS)
When to use
Use this instruction to record the details when a client or other party contacts you with an issue or
complaint.
Instruction
Step 1
Search for a party record in Eos.
Step 2
If the issue or
then…
complaint…
register the new complaint record
is new
go to
Screen issue or complaint
add a contact in the 'Complaints' tab
record details of the conversation
is already in the
system
and notify the appropriate Customer Support Coordinator (CSC) or OCI
Investigator, advising of contact with the complainant
this process ends
Screen issue or complaint
Responsibility
Customer Support Service (CSS)
When to use
Use this instruction to determine the best way to deal with a new issue or complaint so that we are
likely to reach a resolution.
Instruction
Step 1
If the complainant…
then…
get a description of the issue or complaint. See
Dealing
is on the phone
with a dissatisfied client
go to Step 5
scan document(s) for distribution and immediate action
sends a fax, letter
or ACC709
and upload them into Eos
Complaint form (122K)
go to Step 2
add a contact in Eos
sends an email
go to Step 2
Step 2
Phone the complainant.
If you…
then…
make contact on the first attempt
go to Step 4
try to contact them at least three more times over two
working days:
do not make contact on the first
attempt
if you make contact, go to Step 4
if you don't make contact, go to Step 3
Step 3
Send a CSS acknowledgement letter or email
Record the contact in Eos
Go to
Identify resolution steps.
Step 4
When you contact the complainant:
advise them we've received their issue or complaint. See
Dealing with a dissatisfied client
ask them how they want us to resolve the complaint and clear up any aspects of the issue or
complaint that are not clear
record the contact in Eos.
Step 5
Use the following table to decide how to manage the issue or complaint.
If…
then…
another organisation is responsible for managing the entire
go to Step 6
issue or complaint
we are responsible for managing the entire issue or complaint go to Step 7
go to Step 6 for the parts we don't
we are responsible for managing part of the issue or
manage
complaint
go to Step 7 for the parts we do
manage
Step 6
Phone the complainant:
advise them who they need to talk to and either:
transfer them to the relevant organisation
give them the organisation's contact details
Add a contact in Eos
update the 'General' tab of the 'Complaint' record
this process ends.
Step 7
If the issue is about…
then…
refer the complainant to the BSC Technical Advisors
levies
this process ends
send a task or email to the appropriate complaints investigator
advising them the client has made further contact or that we've
received more information
either:
an existing investigation
record the contact details in the 'Contacts' tab of the
'Complaint' record
upload the documents into Eos
this process ends
privacy
send a task or email to ACC Privacy Officer
If the issue is about…
then…
record the contact details in the 'Contacts' tab
this process ends
phone the complainant and tell them why we can't take the matter
matters that the complainant
further
is not authorised to discuss this process ends
another ACC matter
go to Step 8
Step 8
If the complaint is
then…
about…
a single ACC issue
go to Step 9
add a contact in Eos and outline the issues
generate a separate e-form for each issue in 'Complaint Type
a range of ACC issues
Details'
go to Step 9 and deal with each issue separately
Step 9
If we…
then…
tell the complainant what we wil do and get their consent to
the course of action
record the contact in Eos
can resolve the complaint
immediately
create a task in Eos
carry out agreed actions
close the 'Complaint'
cannot resolve the complaint
record the contact in Eos
immediately
go to
Identify resolution steps
What happens next
If the issue is about an existing investigation, the Office of the Complaints Investigator will go to
Resolving complex or escalated complaints.
Identify resolution steps
Responsibility
Customer Support Service (CSS)
When to use
Use this instruction to decide which resolution product(s) wil achieve the best outcome for both
parties when we can't resolve an issue or complaint at first contact.
Instruction
Step 1
Check the existing information in the Eos 'Contacts' tab. See
View a contact.
Step 2
Use the following table to decide how to resolve the issue or complaint.
If the issue or complaint is about…
then consider one or more of the following…
an entitlement or cover decision and:
we've received a review application, or one ask Customer Service Technical Support (CSTS) to
is imminent
test the decision
the decision is unclear
cultural concerns relating to Maori, Pacific Island refer to Cultural Services
or Asian clients
refer to facilitation or mediation
refer to Service Recovery (SR)
our service
escalate to the Office of the Complaints
Investigator (OCI)
refer to a Community (Trusted) Advocacy, eg:
a perceived lack of impartiality
Linkage Trust
Workplace Injury Advocacy Service
Step 3
Use the following table if you need further advice.
If…
then…
we can resolve the issue or complaint easily
go to Step 4
we need to repeatedly contact the complainant
refer to a CSS Team Manager
If…
then…
(TM)
the issue or complaint may have serious legal implications
ask the TM for direction
we need advice:
refer to CSTS for advice and testing
about relevant policy or legislation
of the decision then refer to the
appropriate business unit
to clarify a reviewable decision
we need advice from an independent third party and/or
refer to a Community (Trusted)
confirmation of a reviewable decision
Advocacy
the issue or complaint is about a Maori, Pacific Island or Asian
cultural matter and there is no identified business unit,
refer to Cultural Services
accredited employer (AE) or third party administrator (TPA)
the issue or complaint is about a cultural issue and a service or refer to both Cultural Services and
decision issue
the appropriate business unit
refer to the appropriate business unit
the issue or complaint is a service issue only
and consider requesting facilitation
or mediation
Step 4
Use the following table to decide who should manage the issue or complaint.
If…
then…
the issue or complaint:
can be dealt with easily
can be resolved by making one or two phone cal s
it should be managed by the CSS
is urgent and relates to entitlement or treatment
go to
Resolve issue or
is not specific to a particular business unit or claims
complaint
officer
the responsible business unit does not wish to engage with
the client, eg there is a contact restriction on the
communications plan
transfer it to the relevant business
the issue or complaint is specific to a particular business unit
unit
the issue or complaint relates to an accredited employer (AE) or contact the AE or TPA and try to
third party administrator (TPA)
resolve the issue or complaint
refer it immediately to the OCI for
the complainant has requested the issue or complaint be
Resolving complex or escalated
If…
then…
referred to the OCI because either:
complaints
they do not want the CSS or branch to be involved
it is an issue requiring a Code of Claimants
rights decision
Resolve issue or complaint
Responsibility
Customer Support Service (CSS)
When to use
Use this instruction to resolve an issue or complaint when we've determined that it should be
managed by the CSS.
Before you begin
Read
Rules for managing complaints. The benchmark timeframe for resolving issues or complaints is
four working days.
Instruction
Step 1
Contact the complainant and try to resolve the matter, using the product(s) recommended in
Identify
resolution steps.
Step 2
If you…
then…
record the contact details in Eos
can resolve the matter within
close the complaint, using the description ‘resolved at first
one working day
contact’
this process ends
try to agree on a plan and a timeframe for resolution
cannot resolve the matter
record the contact details in Eos
within four working days
go to Step 3
If you…
then…
consult with the CSS manager and decide whether to refer it to
the Office of the Complaints Investigator (OCI)
cannot resolve the matter
record the details of your discussion in EOS
within 10 working days
if appropriate, create a ‘complaint referral for investigation’ task
and transfer it to the OCI work queue
this process ends
Step 3
Agree a revised plan and timeframe with the complainant.
If…
then…
record the contact details in Eos
you can agree
go to
Complete follow up task
you cannot agree
record the contact details in Eos
the complainant does not want to
close the complaint
pursue the matter
this process ends
record the contact details in Eos
you cannot agree
create a ‘complaint referral for investigation’ task and
you need to refer the matter for
transfer it to the OCI work queue
investigation
this process ends
Review and resolve issue or complaint
Responsibility
ACC business unit
When to use
Use this instruction to review and resolve an issue or complaint referred from the Customer Support
Service (CSS).
Before you begin
Read
Rules for managing complaints. The benchmark timeframe for resolving issues or complaints is
four working days.
Instruction
Step 1
Open the ‘complaint referral to business unit’ task or the CSS advisory email.
Step 2
Determine whether your business unit owns the issue or complaint.
If your business unit…
then…
owns the complaint
go to Step 3
does not own the
transfer the task or email back to the CSS advising the referral is
complaint
incorrect
Step 3
Determine whether you have enough information.
If you…
then…
have enough information
go to Step 4
don't have enough information request more information from the CSS
Step 4
Determine if the issue or complaint is straightforward or complex.
If…
then…
it is straightforward
go to Step 5
consider any:
it involves complex cover or
advice received from Customer Service Technical Support
(CSTS)
entitlement issues
recommendations from the CSS about appropriate resolution
products, eg referral to Cultural Services
Step 5
Try to resolve the matter to the complainant’s satisfaction.
Step 6
If you…
then…
can resolve the matter within four working days
record the contact details in Eos
If you…
then…
go to Step 8
agree on a plan and timeframe for resolution
cannot resolve the matter within four working days update the CSS team via email or task
Step 7
If…
then…
record the contact details in Eos
you cannot agree on a revised plan and timeframe transfer the task or email back to the CSS
this process ends
record the contact details in Eos
you agree a revised plan and timeframe
continue attempts to resolve the matter
Step 8
If the
and…
then…
complainant…
transfer the task or email back to the
is satisfied
no further action is needed
CSS
advise the CSS
change the date on the task
you agree a new plan and timeframe
continue attempts to resolve the
is not satisfied
matter
you cannot agree a new plan and
transfer the task or email back to the
timeframe
CSS
What happens next
If you've transferred the task to the CSS, go to
Complete follow-up task.
Complete follow-up task
Responsibility
Customer Support Service (CSS)
When to use
Use this instruction when either:
an issue or complaint is returned to the CSS
you need to check if a an issue or complaint is resolved to the complainant's satisfaction.
Instruction
Step 1
Open the follow-up task in Eos.
Step 2
Try at least twice to contact the complainant by phone.
Step 3
If…
then…
you make contact
go to Step 4
record the contact details in Eos
you don't make contact after two phone calls close the complaint
Step 4
If the complainant then…
is…
initiate a new issue or complaint and either:
not satisfied
return to
Record issue or complaint and restart this process
create a 'complaint refer to investigation’ task and transfer to the Office
of the Complaints Investigator (OCI)
close both the follow-up task and the complaint
email the relevant Business unit manager:
satisfied
information relating to the issue or complaint
details of how it was resolved
Resolving complex or escalated
complaints
The Office of the Complaints Investigator (OCI) and ACC business units use this
process to manage complex or escalated complaints. The process begins when the
OCI receives a complaint, either directly or by referral from another ACC group or
external agency.
Complaints usually relate to alleged breaches of the Code of ACC Claimants’ Rights,
complex matters or escalated complaints that cannot be resolved by another ACC
group.
Allocate the complaint
Responsibility
Office of the Complaints Investigator (OCI)
When to use
Use this instruction to al ocate a complaint to an investigator when you receive a complaint directly
from a client or by referral from another ACC group or external party, eg a client’s agent.
Instruction
Step 1
Decide who is responsible for managing the complaint.
If the complaint…
then…
relates to:
an al eged breach of th
e Code of
ACC Claimants’ Rights
the OCI is responsible
an existing investigation
go to Step 2
a complex investigation
a specific business unit, third party
administrator or accredited
employer
is:
the CSS is responsible
a new ‘non-code’ related issue or
send the CSS an email asking them to manage it
complaint
this process ends
straightforward
is the responsibility of an external
write to the complainant telling them ACC is not the
correct agency to manage their complaint and giving
agency
them the details of the correct agency
If the complaint…
then…
this process ends
Step 2
If you received
then…
notification via…
a ‘Refer for
go to Step 3
investigation task’
contact CSS and request that they either:
load the complaint as a ‘Refer for Investigation’ task and send it to the
an email
Eos ‘Office of the Complaints Investigator’ admin/work queue
load the complaint to a previous Eos complaint file and send a general
task to the investigator
Step 3
Allocate the complaint to the investigator:
open the ‘Complaints Monitoring’ spreadsheet and check the complaints assigned to each
investigator
allocate the complaint to the most suitable investigator from the ‘Office of the Complaints
Investigator’ admin/work queue
advise the Privacy group vi
a [email address] if the complaint includes issues relating
to Right 7
add the complaint details to the spreadsheet and save it.
Step 4
Transfer the task to the investigator:
open the ‘Refer for Investigation’ task and:
edit the task
delete the text
type in Capitals ‘NEW COMPLAINT ALLOCATED’
check the date on the task
transfer the task to the investigator allocated to the complaint.
Step 5
Update the manual exercise book: ‘Daily Complaint Record’.
What happens next
The OCI investigator wil advise interested parties using
Acknowledge the complaint and request
information.
Acknowledge complaint and request information
Responsibility
Office of the Complaints Investigator (OCI)
When to use
Use this instruction when you’ve been al ocated a complaint through a ‘Refer for Investigation’ task.
Before you begin
If you need help when completing this instruction, refer to ‘Investigator receives new complaint’ (OCI
I:\ drive document).
Instruction
Step 1
Open the ‘Refer for Investigation’ task and look for ‘New Complaint Al ocated’ in the title.
Step 2
Open the claim details and review the Customer Support Service (CSS) records, contacts and
documents for relevant information.
Step 3
Generate a
COM03 We have received your complaint (35K) letter and an ACCFS01 Complaints
- Getting your complaint investigated information sheet (245K)
Complete the description boxes and fields in the letter (refer to OCI I:\ drive document)
Send the completed letter and information sheet to the client and/or an authorised agent or third
party administrator (TPA).
Step 4
If you…
then…
go to
Investigate complaint
do not need more information this process ends
put the ‘Refer for Investigation’ task on hold
need more information
set a target date for 15 days
Step 5
Request more information.
If the issue or complaint is then…
from…
send them an email with the following documents attached:
a copy of the correspondence sent by the complainant, unless they
an accredited employer (AE)
complained verbally
or a TPA
a copy of the acknowledgement letter sent to the complainant
the blank
ACC711 complaint response template (117K)
add a ‘Complaint - Refer to business unit’ task in Eos
assign the task to the admin work queue of the complainant’s
business unit asking them to:
a business unit
return the information on th
e ACC711 (117K) complaint
response template
load the response to the ‘complaints tab’ at party level
Step 6
Load the complaint and
transfer the task (refer to OCI I:\ drive document):
generate a new task ‘Complaint – Refer to business unit’ and click the ‘assign to me’ tab
enter ‘follow-up ACC711’ in the description box of the ‘work details’ field and set the target date
for 5 days
add a sub-activity
click the ‘Recent’ tab and select ‘Complaint – Refer to business unit’, then click the ‘assign to me’
tab
open the ‘Template for tasks’ document in the related resources section and copy either the:
‘Request ACC711 from Branch’ section
‘Request ACC 711 from AE or TPA via email’ section
paste the copied information into the description box
change the ‘target date’ field to today’s date and the ‘Priority’ field to ‘High’
click 'Ok' then ‘transfer to department'.
Step 7
If you transfer the task to…
then…
select the appropriate branch ‘administration’ queue
any branch
except the Dunedin
click 'OK' then ‘Back’ to generate a new subtask pop-up
Service Centre
notification
click ‘Yes’
If you transfer the task to…
then…
select the ‘DSC – Quality Assurance’ queue
click 'OK' then ‘Back’ to generate a new subtask pop-up
the Dunedin Service Centre
notification
click ‘Yes’
Step 8
Prepare to return the ACC711:
change the ‘on hold until’ date to the date entered in the ‘Refer for Investigation’ task, ie the date
the ACC711 is due back
change the ‘on hold reason’ to ‘put task on hold’
click ‘OK’ then ‘Back’.
Step 9
Finalise the Eos changes:
open the task and click ‘Edit’
change the ’complaint status’ on the ‘General’ tab to ‘under investigation’, then click ‘OK’
highlight the ‘complaint type details’ eform and click ‘Open’
scroll down to the ‘Complaints Investigation’ section of the form and change ‘date
acknowledgement letter sent’ to today’s date
scroll down, click ‘OK’ then ‘close’.
What happens next
If…
then…
a business unit, branch, TPA or AE wil
Collate and send
you need new information
information
the OCI either:
has enough information
go to
Investigate complaint
is asked to investigate the
complaint
Collate and send information
Responsibility
ACC business units and branches
When to use
Use this instruction to collate information about an issue or complaint and return it to the Office of the
Complaints Investigator (OCI) within the correct timeframes.
Before you begin
See:
Working with the code of ACC claimants’ rights
Rules for managing complaints, for timeframes.
Instruction
Step 1
Open the ‘Complaint - Refer to business unit’ task in Eos.
Step 2
Check any information in Eos and related emails, eg dates of previous contact, supporting
documents.
Step 3
Read the complaint to identify the relevant issues and decide whether:
the client’s rights have been breached und
er the Code of ACC Claimants’ Rights
you’re able to address the issue or complaint through remedial action.
Step 4
Complete th
e ACC711 Complaint response template (117K) adding your findings from Steps 2 and 3.
Step 5
Upload the completed ACC711 to the ‘Complaint’ tab at party level.
Step 6
Load the ACC711 as a draft, then get an authorised manager to check it and change the status to
'complete'.
Step 7
Return the completed ACC711 to the OCI in a task.
What happens next
The OCI will
Investigate the complaint.
If the OCI…
then…
If the OCI…
then…
requests a summary of events
go to
Respond to Summary of Events
does not request a summary of events go to
Implement remedies as directed
Investigate complaint
Responsibility
Office of the Complaints Investigator (OCI)
When to use
Use this instruction to investigate a complaint and any responses, and prepare a summary of events
(SOE) if necessary.
Before you begin
Clients are entitled to view their own records. You must ensure nothing you record in emails, tasks,
documents and contacts could negatively impact ACC's reputation.
Instruction
Step 1
Check your tasks in Eos.
If you…
then…
have an ACC711
open the task and check loaded documents
notification task
open any complaint response documents or complete
d ACC711 Complaint
do not have an ACC71
1 response template (117K) that you've received by other means, eg email or
notification task
fax
Step 2
If you…
then…
can view all the documents
go to Step 3
click on the pencil icon in the ‘Complaints’ tab at Party
cannot view all the documents in the
level and note that you cannot view the documents
ACC711 notification task
return the task to the person who sent it to you
Step 3
If you…
then…
have the ACC711 form go to Step 4
check the 'refer to business unit' task is allocated from the branch
administration queue
phone the person the task is allocated to and ask when they will
do not have the
respond
ACC711 form
change your ‘target date’ and close the task
if you can't get the ACC711 in a reasonable timeframe, discuss it with
the business unit manager
Step 4
If you…
then…
need more information
go to Step 5
do not need more information go to Step 6
Step 5
Phone the Team Manager who completed the ACC711.
If you …
then…
record details of the contact in Eos
contact the Team Manager
go to Step 6
phone either:
the Case Manager
cannot contact the team manager
by phone
a Branch Manager or Area leader, if you need to
negotiate a resolution
record details of all contacts on the complaint
either:
send a task to the business unit administration queue
cannot contact the Team Manager,
using the ACC711 template
Case Manager, Branch Manager or
if the issues are significantly complex and you've
Area Manager by phone
already discussed them with the branch, email the
team manager who completed the ACC711
record details of all contacts on the complaint
Step 6
Open your ‘Fol ow up ACC711’ task to see if it's on hold.
If the 'Follow up ACC711'
then…
task is…
take it off hold and update the off hold reason to ‘take task off
hold’
on hold
edit the task to say 'complete investigation and issue findings’
change the target date to the day that you should be able to start
the investigation
not on hold
go to Step 7
Step 7
Complete the following:
review the client’s complaint and any responses
read al related Eos contacts, documents and tasks
identify areas where the parties agree or disagree
if you need clarification, contact the relevant business unit, AE, TPA, complainant or witnesses,
using step 5 as your guide.
Step 8
Use the following table to decide if you need a summary of events (SOE).
If…
then…
an AE manages the claim
you need an SOE
go to Step 9
a TPA manages the claim on behalf of ACC
the issues are complex
an SOE is optional
go to Step 9, if you want an SOE
there are multiple issues
you don't need an SOE
all parties agree
go to
Make decision and notify parties
Step 9
Complete a
n ACC712 Summary of events (108K).
Step 10
Send information to the parties.
If the party is
then…
and…
a…
If the party is
then…
and…
a…
send the SOE to the business unit admin
branch or
queue
create a task
business unit
the ACC branch or business unit wil
Respond to summary of events
complete the:
post a hard copy of both documents to the
complainant
COM05 Summary of events
complainant
letter to client (37.5K)
TPA or AE
ACC712 Summary of events
email both documents to the TPA or AE
form (108K)
Respond to summary of events
Responsibility
ACC business units and branches
When to use
Use this instruction to review and respond to an
ACC712 Summary of events (SOE) (108K) sent to
you by the Office of the Complaints Investigator (OCI).
Before you begin
You must complete and send your response within the timeframes i
n Rules for managing complaints .
Instruction
Step 1
Open the SOE and any supporting documents.
Step 2
Review the SOE and add your comments.
Step 3
Return the SOE with your comments to the OCI via a task within seven working days of receiving it.
What happens next
An OCI Investigator will review your response, then go to
Make decision and notify parties.
Make decision and notify parties
Responsibility
Office of the Complaints Investigator (OCI)
When to use
Use this instruction to make a decision about a complaint and notify al parties within the correct
timeframes.
Before you begin
See:
Rules for managing complaints for correct timeframes or if you need help completing this
instruction
Working with the Code of ACC Claimants’ Rights .
Instruction
Step 1
Make a decision after determining the following:
whether the Code of ACC Claimants’ Rights has been breached
whether any non-code issues are valid
the most appropriate remedy for the complainant, if any.
Step 2
Prepare
a COM01 Findings (35K) letter. Include the:
findings of the complaint
reasons for the decision
details of any remedy.
Step 3
Notify the parties.
If the party is a…
then…
upload the
COM01 Findings (35K)letter to the complaints tab in Eos
create an ‘action complaint remedy’ task and al ocate it to the
branch or business unit
appropriate branch admin queue
ask that the task is returned to the OCI once the remedy is
implemented
third party administrator
(TPA)
email the COM01 Findings letter to the TPA or AE
accredited employer
If the party is a…
then…
(AE)
client
post a hard copy of the COM01 Findings letter to the client
Step 4
If we…
then…
consul
t Writing an apology guidelines
need to apologise
write and send the apology letter
do not need to apologise go to Step 5
Step 5
Complete the following in Eos:
update the general tab ‘complaint status’ to ‘complete’
open the ‘complaint type details’ e-form and complete all relevant tabs under ‘complaints
investigation’
close the 'refer for investigation' task.
What happens next
The assigned business unit will
Implement remedies as directed.
Implement remedies as directed
Responsibility
ACC business units and branches
When to use
Use this instruction to implement any remedies as directed by the Office of the Complaints
Investigator (OCI).
Instruction
Step 1
Open the task and view the
COM01 Findings (35K) letter showing in the complaint tab at party level.
Step 2
Implement any remedies as directed, referring if necessary to th
e Writing an apology guidelines.
Step 3
Return the task to the OCI.
What happens next
The OCI will
Follow up remedial action.
Follow up remedial action
Responsibility
Office of the Complaints Investigator (OCI)
When to use
Use this instruction to check if remedies for complaints are implemented.
Instruction
Step 1
Check for evidence of remedial action, such as we sent an apology letter, in the Eos contacts,
documents and tasks.
Step 2
Close the ‘follow-up remedy’ task.
What happens next
This process ends.
Investigating a ministerial query
ACC business unit managers and technical advisors must use this process when
investigating a ministerial query. As most of the process is handled by Government
Services and the ACC Minister’s Office, only work that is handled at the branch,
centre or unit level is documented.
Receive ministerial query and investigate
Responsibility
Business Unit Managers and Technical Advisors
When to use
Use this instruction to investigate a ministerial query sent to you by ACC Government Services, eg a
query from the Minister’s office regarding a claim or client or a letter to the Minister from a client or
member of the public that is sent to ACC for a draft response.
Before you begin
Read the rules in the
Ministerial queries and correspondence policy.
Instruction
Step 1
Retrieve the Ministerial information template sent by the government services advisor.
Step 2
Review the information in:
the Ministerial information template
the physical claim file, Eos claim file and/or party record.
Step 3
Contact the government services advisor if you have any questions.
Step 4
Gather enough information from ACC staff to help you complete the Ministerial information template.
Step 5
Complete the Ministerial information template and any other documents you need to reply to the
query. When preparing your reply:
do not include large, unedited extracts from the claim file
only attach information that is relevant to the query
ensure al information you attach is listed, summarised and complete.
Step 6
Send your reply to the Business Unit authorised Manager, ie Technical Claims Manager or Quality
Assurance Manager, asking them to review the information and comment.
Step 7
When you have received and collated all the necessary information send your reply to the
government services advisor.
What happens next
Government Services wil compose a draft reply to the ministerial query, using the information you've
sent them. It wil be peer reviewed and signed by a Senior Manager from your business group before
they forward it to the ACC Minister’s Office.
Reference
Writing an apology guidelines
Managing systemic advocacy
Explaining the complaints process
Behaviours to uphold the Code of ACC Claimants’ Rights (66K)
Dealing with a dissatisfied client
Writing an apology
Introduction
Use these guidelines when writing an apology letter to a client after the findings of a Complaint have
been received, or when an error or service failure has been identified.
Why apologise?
When mistakes are made, often the person complaining only wants to be listened to, understood,
respected and, where appropriate, given a proper explanation and an apology. A prompt and sincere
apology for any misunderstanding is likely to work wonders. It will help to avoid the escalation of an
issue and the significant cost in time and resources involved in disputes.
How should an apology be worded?
The most appropriate way of communicating an apology is to use a well-structured letter. It should
cover the particular circumstances of the issue, the harm suffered, and the goal of the apology, eg
reconciliation to restore our reputation, acknowledging the wrong done, and giving an assurance that
a problem has been addressed and wil not recur.
The most effective apologies include the following nine elements, grouped under five headings –
recognition, responsibility, reasons, regret, and redress.
Element
Description
Describe the wrong – outline the problem, act, or omission that we are apologising
Recognition
for
Element
Description
Recognise the wrong – openly state that the action or inaction was incorrect, wrong,
inappropriate, unreasonable, harmful, etc
Acknowledge the harm – acknowledge that the affected person has suffered
embarrassment, hurt, pain, damage, or loss
Responsibility Accept responsibility – admit our part in the wrong done, and the harm caused
Explain how it happened – give a simple, plain English explanation for the cause of the
problem, or a promise to investigate the cause. Refer to any mitigating circumstances
Reasons
such as whether our action was unintentional, or was prescribed by policy or legislation
and, therefore, not discretionary
Apologise – express sincere sorrow, remorse, or express regret that the action or
inaction was wrong
Regret
Communicate sincerely – the way we communicate or apologise is very important
as it can indicate or emphasise the level of our sincerity
Specify the action taken or proposed – say what action has been taken or what
specific steps are proposed to address the problem
Redress
Promise not to repeat the mistake – give assurance that the action or inaction wil
not be repeated
Good apology letters - example
Excerpt 1
“I am writing to apologise for the unsatisfactory service you received from staff in this branch,
specifically the delay in calling you to discuss your weekly compensation concerns following your visit
to ACC on the 12th of May 2003.”
(Note: this includes recognition and description, responsibility.)
“Clearly the level of service was not of a standard that you have a right to expect. The requirement of
returning cal s within 24 hours of a request being made has been raised with al staff as a result of
your complaint.”
(Note: this includes acknowledgement, responsibility, action taken, and promise to not repeat.)
“I offer my sincere apologies that you did not receive the standard of service that ACC sets for its staff
and am confident that this situation will not arise again.”
(Note: this includes the promise to not repeat, sincerity, acknowledgement, and recognition.)
Bad apology letters - examples
The examples below lack sincerity. This means that even if they hold some of the required nine
elements, they read as if we are apologising through gritted teeth, or simply can’t be bothered (eg
excerpt 2). The reader would not see this as effective, would not be pacified, may feel we are being
condescending, and could, therefore, stil escalate an issue.
Excerpt 2
“Further to our letter dated 14/07/2006 ACC would like to apologise for the breach of rights 1, 2, 5 and
6.”
(Note: there is no recognition, responsibility acceptance, sincerity, explanation, or action taken.)
Excerpt 3
“In respect to the Rights that __branch has breached, ACC has directed __ branch to provide you with
a written apology. This letter from __branch is to apologise for the breaches established by the ACC
complaints investigator.”
(Note: this is clinical and un-empathic - there is no recognition, responsibility acceptance, sincerity,
explanation, or action taken. Further, its message is that we are only apologising as we’ve been
directed to, not because we’re accepting responsibility or taking future action.)
Excerpt 4
“I write further to the findings of the Office of the Complaints Investigator. The Investigator found that
ACC had breached Right 5 of the ACC Code of Claimant Rights – the right to effective
communication.”
(Note: this includes a description but provides no explanation or acceptance of responsibility.)
“ACC has been directed by the complaints investigator to follow a procedure in the future to prevent
communication problems, and we wil adopt these processes.”
(Note: action is taken but this implies that it’s only because we’re being forced to.)
“I would like to apologise for any distress caused to you by ACC’s failure to communicate with you to
the standard required.”
(Note: clinical, not sincere – compare with the final paragraph of the good letter example, above.)
Managing systemic advocacy
Introduction
Use this information when you need to take action after an advocate raises a systemic issue with you.
What is advocacy?
Advocacy is the process of representing and communicating a viewpoint in order to achieve a desired
goal. The difference between advocacy and simple communication is that an advocate attempts to
convince the other party of a point of view.
Advocacy can be divided into two main types:
Individual advocacy relates to the specific issues of a particular case or situation. In the ACC
context, individual issues are those issues related to actions taken by ACC in relation to an
individual client’s case.
Systemic advocacy is related to the desire to change or influence wider structural or systemic
issues or goals. In the ACC context, systemic issues are those issues that relate to the way the
ACC business works.
Advocacy should not be confused with making a complaint. For more information see
Managing
issues and complaints.
Examples of individual and systemic advocacy at ACC
Systemic or individual
Issue raised by advocate
issue?
The legislation is unfair, and this is not related to a particular case
Systemic
An ACC policy is unfair in relation to an individual case
Individual
An ACC branch is not on the ground floor and difficult to access for people Systemic
with a disability
An ACC policy about a particular matter is unfair to a group of people or in Systemic
general
A client’s weekly compensation payment is too low
Individual
Responding to systemic advocacy
When an advocate raises a systemic issue with ACC, the staff member receiving the issue refers the
query to their manager or technical claims manager (TCM). The manager or TCM attempts to resolve
the issue, and may refer the query to the Customer Service Technical Support team (CSTS) for
clarification.
The ACC unit receiving the systemic issue manages the relationship with the advocate while the issue
is being assessed. This process is similar to that in place for claims queries raised by a case manager
and referred through a TCM to the CSTS. If a systemic issue is referred to CSTS, it should be clearly
identified as a systemic issue.
Explaining the complaints process
Introduction
Use this information to help you understand the complaints' policies and processes.
How issues are raised
A client or their advocate, solicitor, or other representative may raise an issue about ACC’s dealings
with them by contacting any ACC office, branch or business unit, accredited employer or Customer
Support Service (CSS).
Contact can be by phone, email, letter, fax or in person.
Where issues are resolved
There are three key areas involved in managing complaints:
the business units, where issues arise
Customer Support Service (CSS)
ACC’s Office of the Complaints Investigator (OCI).
Business units
The role of the business unit is to take responsibility and attempt to resolve al client issues. Business
units must respond positively to issues that are referred to them from other areas and work
collaboratively with CSS to resolve client issues.
If a business unit is approached by CSS about a customer issue, within
four working day they
should:
make contact with the customer
if possible, resolve the issue to the customer’s satisfaction
report back to CSS that the issue has been resolved via email.
Customer Support Service
CSS’s role is to work with business units to achieve the resolution of client issues as quickly and
effectively as possible. Their role is a facilitative one between customers, business units and the OCI.
CSS is likely to attempt resolution without business unit involvement where either:
the issue is straightforward, can be dealt with easily, and can be resolved by making one or two
phone calls
it involves an urgent matter relating to entitlements or treatment
there is no clearly defined and/or identified managing business unit or case owner.
CSS wil gather information from the customer to clarify their issue and identify their desired solution.
They wil check in Pathway or Eos for additional information, phone the business unit to advise them
of the issue and confirm the details of the issue and timeframes for resolution with the business unit
via email.
If a business unit has attempted resolution and has not been successful, CSS wil receive the issue
back from the business unit and if appropriate pass it on to the OCI.
Office of the Complaints Investigator
The OCI is responsible for administering ACC’s responsibilities in terms of the Code of ACC
Claimants’ Rights. It conducts investigations into Code or non-code complaints where service
recovery has been unsuccessful or is refused by a customer. At the conclusion of an investigation it
issues findings and decisions and may direct ACC to undertake certain actions. It is a free service to
ACC customers.
The OCI investigates escalated complaints made by:
clients about services provided by ACC units or agents
levy payers and their dealings with the Business Service Centre
any other non-service matters eg, from a non-client.
Within the CSS complaints process, all issues are initial y sent to the Customer Support Service for
resolution unless the customer has stated otherwise.
Dealing with a dissatisfied client
Introduction
Use these guidelines when dealing with a dissatisfied client. Every communication with customers is
an opportunity for service recovery. This is particularly important when the communication is by
telephone. Always treat callers with respect.
Actions
Ask the caller to explain their concern or issue
Ask open and clarifying questions to establish the full story
Repeat the information to check that you understand what they have just told you
Inform the caller:
'My role is to help you work through the concerns or issues you have discussed with me.
What would resolve this issue for you?'
Inform the caller that there may be information that can be accessed to provide a history of the
issue, eg in Pathway, Access database, Remedy AR
Ask if they are happy for their information to be viewed at this stage.
