Page 1
HBCF Complaint and
Dispute Handling
Procedures
Version 7.0
This document has been prepared by icare HBCF:
Insurance and Care NSW (icare) provides services in the administration of the Home Building
Compensation Fund for the NSW Self Insurance Corporation.
Printed copies of this document are uncontrolled.
ABN 97 369 689 650
Post GPO Box 4052
Sydney NSW 2001
Phone (02) 9216 3224
Email [email protected]
Web www.icare.nsw.gov.au
Page 2
[email protected]
02 9216 3224
icare.nsw.gov.au
icareTM | Insurance & Care NSW HBCF Complaint and Dispute Handling Procedures Page 2 of 31
Document control
Version Revision Description Date Author
1.0 20 Dec 2010 HWIF Risk Manager
1.1 4.1 Notice of Periodic Reviews 1 Nov 2011 HWIF Risk Manager
1.2 Changed all references to Consumer
Trader, Tenancy Tribunal (CTTT) to NSW
Civil and Administrative Tribunal (NCAT).
Also changes in line with amendments to
the ‘Claims Manual’ and ‘Claims
Information for Homeowners’ documents
1 Jul 2014 HWIF Risk Manager
2.0 Change all references to the Home
Warranty Insurance Fund (HWIF) to the
Home Building Compensation Fund
(HBCF). Other changes effecting because
of commencement of the Home Building
Amendment Act 2014
15 Jan 2015 HBCF Industry
Liaison Officer
3.0 Re-designed as per the icare style guide
icare Legal Review
19 June 17 HBCF Contract
Performance
Manager
3.1 Content refresh by HBCF team/Deloitte 9 Sep 2017 HBCF Contract
Performance
Manager
4.0 Content edited to reflect appointment of
new Claims and Eligibility Risk Managers
20 Sep 2018 HBCF Risk Manager
5.0 Revision for 2019 SIRA submission Content
edited to reflect:
having one Eligibility Risk Manager
restructured underwriting appeals process
removing duplication of content between
this document and the Eligibility Manual /
Underwriting Procedures Manual
8 Aug 2019 HBCF Risk Manager
HBCF Underwriting
Manager
6.0 Revision for 2020 SIRA submission 1 January 2021 HBCF claims
manager
HBCF Underwriting
Manager
Page 3
icareTM | Insurance & Care NSW HBCF Complaint and Dispute Handling Procedures Page 3 of 31
Version Revision Description Date Author
7.0 Updates based on Customer Advocate
recommendations to rewrite content in
plain English.
Changed service standards for the claim
manager’s response from two to five days
for:
▪ Receipt of claim if prescribed claims
information is complete
▪ Receipt of claim if prescribed claims
information is incomplete requirements
Note: SIRA has already approved the
change from two to five days.
June 2021 icare HBCF
Technical Writer
Page 4
icareTM | Insurance & Care NSW HBCF Complaint and Dispute Handling Procedures Page 4 of 31
Table of contents 1 Introduction .................................................................................................................................. 6 2 Objectives and scope .................................................................................................................. 6
2.1 Objectives ......................................................................................................................... 6 2.2 Scope ................................................................................................................................. 6 2.3 Supporting references ......................................................................................................7
2.3.1 Public documents ......................................................................................................................... 7
2.3.2 Scheme agent documents........................................................................................................ 7
2.3.3 NSW Fair Trading documents................................................................................................. 7
2.3.4 Law and justice policy ............................................................................................................... 7
2.3.5 State Insurance Regulatory Authority (SIRA) documents ............................................ 7
2.4 Definitions ..........................................................................................................................7
2.4.1 Complaint ....................................................................................................................................... 7
2.4.2 Dispute ............................................................................................................................................ 7
3 Process .......................................................................................................................................... 8 3.1 Service level – complaint & dispute handling process ............................................... 8 3.2 Underwriting – complaint & dispute handling process ............................................... 8 3.3 Overview of the service standards for the eligibility risk manager .......................... 8 3.4 Claims – complaint & dispute handling process .......................................................... 11 3.5 Overview of the service standards for the claims manager ...................................... 11
4 Complaints ................................................................................................................................... 14 4.1 Referral of disputes to icare HBCF ............................................................................... 15 4.2 Complaints registers ....................................................................................................... 15 4.3 Overview of the claim complaint and dispute handling process ............................. 15
4.3.1 Claim decisions by the claims manager .............................................................................. 15
4.3.2 Complaints by claimants ......................................................................................................... 16
4.3.3 Claims manager internal dispute resolution (IDR) system .......................................... 16
4.3.4 Referral of disputes to icare HBCF claims committee .................................................. 16
4.4 Overview of the underwriting complaint and dispute handling process ................ 17
4.4.1 Underwriting decisions by the eligibility risk manager .................................................. 17
4.4.2 Complaints by builders or brokers ....................................................................................... 17
4.4.3 Eligibility risk manager underwriting committee ............................................................ 17
4.4.4 Premium determinations by icare HBCF ........................................................................... 18
4.4.5 Referrals of complaints and disputes to icare HBCF ..................................................... 18
5 Roles & constitution of underwriting, internal dispute resolution (IDR) & claims committees ............................................................................................................................................. 19
5.1 Eligibility risk manager underwriting committee ....................................................... 19
5.1.1 Constitution .................................................................................................................................... 19
5.1.2 Complaints ..................................................................................................................................... 19
5.1.3 Other matters ............................................................................................................................... 19
5.2 icare HBCF underwriting committee ........................................................................... 20
5.2.1 Constitution .................................................................................................................................. 20
5.2.2 Complaints and disputes ........................................................................................................ 20
5.2.3 Other matters ............................................................................................................................. 22
5.3 Claims manager internal dispute resolution (IDR) .................................................... 22
5.3.1 Constitution .................................................................................................................................. 22
Page 5
icareTM | Insurance & Care NSW HBCF Complaint and Dispute Handling Procedures Page 5 of 31
5.3.2 Complaints ................................................................................................................................... 22
5.3.3 Other matters ............................................................................................................................. 22
5.4 icare HBCF claims committee ...................................................................................... 23
5.4.1 Constitution ................................................................................................................................. 23
5.4.2 Disputes........................................................................................................................................ 23
5.4.3 Other matters ............................................................................................................................. 23
6 icare HBCF underwriting committee – management and record keeping ........................ 24 6.1 Quorum ............................................................................................................................ 24 6.2 Presiding member .......................................................................................................... 24 6.3 Voting .............................................................................................................................. 24 6.4 Minutes ............................................................................................................................. 24 6.5 Transaction of business outside meetings or by telephone or other means......... 24 6.6 Managing conflicts of interest ...................................................................................... 24 6.7 Confidentiality ................................................................................................................ 25 6.8 First meeting ................................................................................................................... 25
7 Summary and service standards .............................................................................................. 25 7.1 Service level complaints – scheme agents ................................................................. 25 7.2 Service level complaints – icare HBCF ........................................................................ 25 7.3 Eligibility risk manager underwriting committee – operation & service standards 26 7.4 icare HBCF underwriting committee – operation & service standards .................. 27 7.5 Claims manager internal dispute resolution (IDR) – operation & service standards 28 7.6 icare HBCF claims committee – Operation and Service Standards ........................ 29
8 State Insurance Regulatory Authority (SIRA) ........................................................................ 30 8.1 Requests for regulator compliance review (claims) ................................................. 30 8.2 Other complaints about icare HBCF (claims) ............................................................ 30 8.3 Requests for regulator compliance review ................................................................ 30 8.4 Other complaints about icare HBCF (eligibility) ....................................................... 30
Page 6
icareTM | Insurance & Care NSW HBCF Complaint and Dispute Handling Procedures Page 6 of 31
1 Introduction
Insurance and Care NSW (icare) provides services in the administration of the Home Building
Compensation Fund for the NSW Self Insurance Corporation (icare HBCF). icare HBCF uses an
outsourced service model, with contractual arrangements with scheme agents. Gallagher Bassett
Services Pty Ltd is the claims manager and manages claims on behalf of the icare HBCF. Corporate
Scorecard is the eligibility risk manager and assesses builder eligibility on behalf of the icare HBCF.
icare HBCF is a licensed provider of insurance under Part 6 of the Home Building Act 1989, also
known as home building compensation (HBC) insurance. The State Insurance Regulatory Authority
(SIRA) regulates the market for this insurance, including the licensing of providers and oversight of
the operation of the home building compensation scheme.
HBC insurance is an integral component of the government’s consumer protection strategy for
homeowners having building work undertaken in New South Wales. It provides a safety net for
homeowners when their builder is unable to meet their obligations under the building contract due
to insolvency, death, or disappearance. The safety net is also provided where the builder’s licence is
suspended because they fail to comply with an NSW Civil and Administrative Tribunal (NCAT) or
Court order to pay compensation to the homeowner.
2 Objectives and scope
2.1 Objectives
This document provides detailed guidelines for handling complaints and disputes about:
• claim decisions
• service level standards
• eligibility applications
• eligibility reviews
• certificate of insurance applications
• premium determination.
The document defines how scheme agents handle complaints about their claim decisions and how
scheme agents and icare HBCF establish, constitute and operate claims and underwriting
committees to handle escalated disputes.
Underwriting and claims committees are an important component of icare HBCF’s complaints
handling process. This process ensures that icare HBCF and their designated agents manage
complaints and escalated disputes appropriately.
2.2 Scope
Where a builder or homeowner is unhappy with an underwriting or claims decision, the level of
service provided by a scheme agent, or their service providers or brokers, it is important that a
consistent set of guidelines and procedures are established and followed to manage complaints and
any escalated disputes.
Where appropriate, the scheme agent may refer some matters as disputes to icare HBCF and icare
HBCF’s underwriting or claims committees will review those disputes to reach an outcome.
The primary scope of this document will cover:
• The handling of complaints about claims decisions
• The handling of complaints and disputes about service level standards.
• The role of the scheme agents, icare HBCF’s underwriting team, and icare HBCF’s
underwriting and claims committees in handling complaints and escalated disputes.
• Determining when matters should be referred to icare HBCF’s underwriting team.
• Determining when matters should be referred to icare HBCF’s underwriting or claims
committees.
Page 7
icareTM | Insurance & Care NSW HBCF Complaint and Dispute Handling Procedures Page 7 of 31
• The membership and constitution of icare HBCF’s underwriting and claims committees.
• Meeting management, record keeping and governance.
• Accessing complaint and/or dispute resolution processes provided by SIRA.
2.3 Supporting references
2.3.1 Public documents
Published by icare HBCF and available on its website at www.icare.nsw.gov.au.
• HBCF Eligibility Manual
• HBCF Claims Information for Homeowners
• HBCF Homeowner Fact Sheet
• HBCF Claims Fact Sheet
2.3.2 Scheme agent documents
• HBCF Underwriting Procedures Manual
• HBCF Claims Manual
• HBCF Eligibility Manual
2.3.3 NSW Fair Trading documents
Published by NSW Fair Trading and available on its website at www.fairtrading.nsw.gov.au
• NSW Guide to Standards and Tolerances 2017
• Consumer Building Guide
2.3.4 Law and justice policy
Published by the NSW Department of Communities and Justice and available on its website at
www.justice.nsw.gov.au.
• NSW Government’s Model Litigant Policy
2.3.5 State Insurance Regulatory Authority (SIRA) documents
• Home building compensation (claims handling) insurance guidelines
• Home building compensation (eligibility) insurance guidelines
• Home building compensation (premium) insurance guidelines
• Home building compensation (prudential) insurance guidelines
• HBC standard licence conditions for insurers
• NSW Self Insurance Corporation conditions – Home building compensation regulation.
Published by SIRA and available on its website at www.sira.nsw.gov.au.
2.4 Definitions
2.4.1 Complaint
Any expression of dissatisfaction with a product or service offered or provided by icare HBCF or its
scheme agents including the scheme agent’s service providers.
2.4.2 Dispute
A complaint that icare HBCF or a scheme agent has considered and/or responded to but the
complainant is not satisfied with the outcome.
Page 8
icareTM | Insurance & Care NSW HBCF Complaint and Dispute Handling Procedures Page 8 of 31
3 Process
3.1 Service level – complaint & dispute handling process
Figure 1: Service Level complaint and dispute handling process
3.2 Underwriting – complaint & dispute handling process
Figure 2: Underwriting complaints and dispute handling process
3.3 Overview of the service standards for the eligibility risk manager
The eligibility risk manager’s focus is on customer service, responding technically correctly and in a
timely manner to all customer and other stakeholder enquiries – technical and procedural.
Page 9
icareTM | Insurance & Care NSW HBCF Complaint and Dispute Handling Procedures Page 9 of 31
The quantitative service standards apply, as detailed below.
Table 1: Eligibility assessment and review service standards
Eligibility assessment and review Eligibility risk manager requirement for
completion
Issue notice to the builder commencing an
eligibility review process and requesting provision
of information and documentation by specified due
date (periodic eligibility reviews - PER- only).
Notice issued at least 40 business days
before the due date
Acknowledge receipt of eligibility application or
review documents
Within two business days of receipt of the
documents
The application/review documents have been
received but are deficient and further information
is required from the builder to progress the
application/ review.
Within seven business days of receipt of
the documents
Complete eligibility assessment/review and
communicate Eligibility profile, terms, and
conditions to the builder (via the distributor).
Within 10 business days of receipt of
complete information
Finalise an eligibility assessment Within 40 business days of communicating
eligibility profile, terms, and conditions to
the builder (via the distributor) unless:
▪ the builder provides evidence they are
taking steps to meet one or more
conditions of eligibility but will not satisfy
the condition(s) within this timeframe
▪ the builder has lodged a complaint
and/or dispute about the eligibility
profile, terms and conditions in
accordance with the Complaint and
Dispute Handling Procedures
Table 2: Project applications service standard
Project Applications Service Standards Eligibility risk manager requirement for
Assess whether additional information is required
and/or builder profile change and if required
request information or initiate review.
Within two business days of receipt of the
application for a certificate
Underwrite application for certificate of insurance
and advise the builder through their distributor of
decision including any proposed conditions on the
approval, for example security, Building Contract
Review Program (BCRP).
Within five business days of receipt of
complete information or completion of
review (whichever later)
Issue decision via CIMS to distributor Within two business days of receipt of
builder accepting underwriting conditions
Page 10
icareTM | Insurance & Care NSW HBCF Complaint and Dispute Handling Procedures Page 10 of 31
Table 3: Response to enquiries service standards
Enquiries Service Standards Eligibility risk manager requirement for
completion
Responding to queries from icare HBCF, SIRA or
NSW Fair Trading (for example, the eligibility risk
manager may regularly receive enquiries from icare
HBCF, SIRA or Fair Trading. Some may be of an
eligibility-specific nature while others may be
related to scheme policy)
Within two business days for general
requests
Within four business hours for urgent
queries (such as where there is ministerial
involvement)
Page 11
icareTM | Insurance & Care NSW HBCF Complaint and Dispute Handling Procedures Page 11 of 31
Note: The eligibility risk manager must communicate immediately with the builder’s
distributor where it believes it cannot meet the service standards before the due date for
delivery. The eligibility risk manager is to advise of the reasons for the delay and the
expected actual delivery date. Communication of a delay does not alter the builder or
distributor’s rights regarding a complaint or the process or obligations otherwise detailed in
this document.
3.4 Claims – complaint & dispute handling process
Figure 3: icare HBCF Claims - Complaints and Disputes Handling Process
3.5 Overview of the service standards for the claims manager
icare HBCF expects the claims manager to meet the following standards:
Table 4: Claims manager service standards
Action Service standard Claims manager
requirement for
completion
Response to the
claimant’s initial
enquiry
The claims manager will send the claimant a claim
form
Within two business
days
Receipt of
notification
The claims manager will acknowledge receipt of a
notification and advise that the prescribed claims
information is required before claim can be
assessed
Within two business
days
The claims manager will register the notification on
the system
Within two business
days
Page 12
icareTM | Insurance & Care NSW HBCF Complaint and Dispute Handling Procedures Page 12 of 31
Action Service standard Claims manager
requirement for
completion
Receipt of claim
if prescribed
claims
information is
incomplete
The claims manager will notify the claimant in
writing that all information has not been received
and advise exactly what further information is
required to process the claim
Within five business
days
The claims manager will register the incomplete
claim as a notification on the system
Within five business
days
The claims manager will raise an initial case reserve
on the system
Within five business
days of registration
Follow up of
prescribed
claims
information
If the claims manager has not received all the
prescribed claim information from the claimant
within five business days of receiving some
prescribed claim information, the claims manager
will inform the claimant in writing of the additional
information that is required to process the claim
Within 24 hours after
the expiration of five
business days from the
initial request
Receipt of claim
if prescribed
claims
information is
complete
The claims manager will acknowledge receipt of a
claim and advise of the next steps to be taken to
assess the claim.
The claims manager will inform the claimant that
the claim will be deemed as accepted or declined
within 90 days, unless the claimant agrees to an
extension of time for the claims manager to
determine the claim.
Within five business
days
The claims manager will register the claim on the
system
Within five business
days
The claims manager will raise an initial case reserve
on the system
Within five business
days of registration
Determination
of builder’s
status
If at any time the claims manager forms the view
that the policy has not been triggered, the claims
manager will inform the claimant in writing and
provide details of the source of that view
Within five business
days
The claims manager will inform the claimant
whether it accepts that the status of the builder has
been established so that the policy is triggered or
alternatively whether further information is required
Within 30 business
days of receipt of
claim
Page 13
icareTM | Insurance & Care NSW HBCF Complaint and Dispute Handling Procedures Page 13 of 31
Action Service standard Claims manager
requirement for
completion
Appointment of
service provider
The claims manager will appoint any necessary
technical consultant
Within five business
days of registration of
the claim
After appointing any service provider, the claims
manager will notify the claimant and provide the
contact details for the provider
Within five business
days
Determination
of claim
The claims manager will either accept or deny the
claim
Within 90 days after
receipt of all
prescribed claims
information
Supply of
consultants
reports to
claimants
The claims manager will provide the claimant with
copies of reports from service providers that are
relied upon to reject a claim or reduce the liability
in respect of a claim.
There is no requirement to disclose information
where:
▪ it is confidential information provided by third
parties
▪ the information cannot be disclosed under law
▪ the information is subject to legal professional
privilege.
Within 10 business
days of receiving a
written request
Review of case
reserves
The claims manager will review case reserves whilst
investigations are continuing, and evidence is being
obtained to enable a determination of indemnity
and liability to be made
Every four weeks or
within five business
days of receipt of new
information
Review of claim The claims manager will review the claim Every four weeks or
within five business
days of receipt of new
information
Communication
with claimant
The claims manager will return all telephone calls
with the claimant or their representative
Within one business
day
The claims manager will keep the claimant informed
about the progress of the claim in writing
Every month
Page 14
icareTM | Insurance & Care NSW HBCF Complaint and Dispute Handling Procedures Page 14 of 31
Action Service standard Claims manager
requirement for
completion
The claims manager communicates to the claimant
at least three days before the expiry of a service
standard when it believes that it cannot meet its
claim service standards and will indicate its likely
response time and the way in which the claim will
be handled
At least three days
prior to expiration of
service standard
Claim dispute or
complaint
The claims manager is to consider the claimant’s
escalated complaints disputes through their internal
IDR
Within 15 business
days of lodgement of
the dispute
icare HBCF claims committee must consider any
escalated complaints
Within 10 business
days of receiving a
request to review a
complaint
Payments The claims manager will action the payment of
accounts and settlements
Within 10 business
days or within the
timeframes specified
by NCAT or a Court
Actioning icare
HBCF
instructions
The claims manager is to action any instructions
issued by icare HBCF
Within two business
days of the instruction
being issued
Responding to
queries from
icare HBCF,
SIRA or NSW
Fair Trading
The claims manager may regularly receive enquiries
from icare HBCF, SIRA or NSW Fair Trading. Some
may be of a claims specific nature while others may
be related to scheme policy
Within two business
days of general
requests
Within four business
hours for urgent
queries (such as where
there is Ministerial
involvement)
Finalisation The claims manager will finalise a claim:
▪ once the claim has been fully investigated
▪ when they have determined the liability and
amount (if any)
▪ when they have paid the claimant and relevant
service providers.
Within 14 days of last
action on claim
4 Complaints
A homeowner can make a complaint about a claim decision by asking the claims manager to refer
the decision to the claims manager’s internal dispute resolution (IDR) process. Homeowners must
make this request within 30 days of receiving their written claim decision.
A homeowner, builder, or a distributor on behalf of the builder can complain about the level of
service provided by icare HBCF or on behalf of icare HBCF by a scheme agent, provided they do
this within reasonable timeframes.
To start with, the scheme agent should handle complaints about service standards (other than a
Page 15
icareTM | Insurance & Care NSW HBCF Complaint and Dispute Handling Procedures Page 15 of 31
complaint about icare HBCF itself) in accordance with their internal complaint and dispute handling
procedures.
The scheme agent’s response to the complainant should also provide information about how to
access and use icare HBCF’s dispute handling process.
4.1 Referral of disputes to icare HBCF
If a complainant is not satisfied with the outcome of the scheme agent’s review of the original
complaint they may ask the scheme agent to refer the matter to icare HBCF for review.
The scheme agent will submit a written referral to icare HBCF, asking them to undertake a review.
When the scheme agent submits the referral for review, they will also submit all case information.
This includes supporting documentation submitted by the complainant and the scheme agent’s
underwriting committee eligibility decision if the original complaint has been reviewed and
responded to.
icare HBCF will consider the complainant’s and scheme agent’s submissions and then determine the
dispute and notify the complainant of the decision. The decision is final and binding and the scheme
agent will implement the decision as soon as practicable.
4.2 Complaints registers
Each scheme agent must establish a register of complaints or disputes and record the nature of
each complaint or dispute and how and when it was resolved. This register should include all details
of how each complaint or dispute was managed in accordance with the process listed in section
Service level complaints – scheme agents on page 25.
Each scheme agent must make information from their complaints and disputes registers available to
icare HBCF when requested.
Note: Complaints and enquiries are
treated differently. A complaint will only arise for the purposes of reporting to icare HBCF
where the person making the complaint requests it to be registered or to be referred to the
scheme agent’s internal dispute handling process. A scheme agent that receives a
complaint must ask the complainant whether that person wishes the complaint to be
registered or referred to the internal dispute settlement process.
4.3 Overview of the claim complaint and dispute handling process
4.3.1 Claim decisions by the claims manager
The claims manager will provide documented reasons for its decisions on indemnity and liability to
the claimant. The claims manager will document in writing to the claimant its decision to do one of
the following:
• Accept the claim and on what conditions
• Reject the claim, in whole or part
• Reduce its liability in respect of a claim.
The claims manager will promptly advise the claimant of the decision and the reasons for the
decision. The claims manager will also advise the claimant of the availability of its internal dispute
handling procedure and the rights of the claimant to appeal the decision through the NSW Civil and
Administrative Tribunal (NCAT) or the District Court where the amount involved exceeds the
$500,000, jurisdictional limit of the Tribunal.
The claims manager should ensure that it advises its decision in such a manner that the claimant is
able to exhaust all internal review processes before needing to appeal to NCAT or the court to
avoid cost and unnecessary stress.
The claimant is to be advised to refer any dispute in relation to a decision by a claims manager on a
claim to the claims manager internal dispute handling system, not later than 30 days after written
notice of the decision on the claim was given to the claimant, to ensure that this avenue is not
available indefinitely.
The claims manager will also advise the claimant that:
Page 16
icareTM | Insurance & Care NSW HBCF Complaint and Dispute Handling Procedures Page 16 of 31
• Any appeal to the NSW Civil and Administrative Tribunal (NCAT) or District Court must be
lodged within 45 days of final written notification by the claims manager that the claim has
been ultimately rejected following the exhaustion of the claim review processes
• It will not seek to impose any time constraints upon the claimant until the internal review
processes and any review sought through icare HBCF have been exhausted. This means that
the 45-day time limit to appeal (to NACT or a Court) does not start until all icare review
processes have been completed.
• The claimant can by-pass the dispute handling procedures and has the right to appeal the
decision immediately to NCAT or a court (it is important a claimant is aware of, and able to
exercise, their rights and obligations under the Home Building Act 1989).
4.3.2 Complaints by claimants
The claims manager has its own internal complaint and dispute handling procedures that are
approved by icare HBCF and comply with relevant SIRA Guidelines.
icare HBCF’s Claims Manual requires the claims manager to establish an internal disputes resolution
process to deal with a range of matters including all complaints by claimants about claims
decisions.
The claimant is to have the opportunity, within 30 days after written notice of the decision on the
claim, to make a submission to the claims manager responding to the reasons for the initial claim
decision.
4.3.3 Claims manager internal dispute resolution (IDR) system
Unless there are special circumstances, a claimant should refer any dispute about a claim decision
to the claims manager’s internal dispute resolution system, not later than 30 days after the claimant
received written notice of the decision.
The claims manager will maintain its own IDR area (or equivalent) for consideration and
determination of disputes and complaints that require escalation because the claimant is
dissatisfied with the claims manager’s claim decision.
Complaints about a claim (whether lodged personally, by telephone or in writing) should be
directed to the claims manager for referral to its IDR area for consideration and determination.
The claims manager’s IDR area will investigate the complaint and consider all supporting
documentation and information provided by, or on behalf of, the claimant. The claims manager will
notify the claimant of the outcome of the IDR’s consideration of the complaint and provide written
reasons for its decision. The claims manager will attach a copy of that notification to the claim file.
The response to the claimant will also provide information about icare HBCF’s dispute handling
process and how to access it. The response will also advise the claimant that if they wish to refer
the dispute to icare HBCF, they must request this referral within 30 days after receiving the written
notice of the review outcome.
If the claimant is dissatisfied with the claims manager’s response to a complaint they may escalate
the complaint and request that it be treated as a dispute for referral by the claims manager for
further investigation by icare HBCF.
The claims manager will inform the claimant that they can bypass the process of referring the
dispute to icare HBCF and immediately appeal the decision to the NSW Civil and Administrative
Tribunal (NCAT) or District Court.
4.3.4 Referral of disputes to icare HBCF claims committee
Where a claimant is not satisfied with the outcome of the claims manager’s review of the original
claim decision, the claimant may ask the claims manager to refer the matter to the icare HBCF
claims committee for review. For an assessment and review to be undertaken, the claims manager
must submit a written referral (to the icare HBCF claims committee) that is accompanied by the
claim manager’s recommendation or submission and all case information, including supporting
documentation submitted by, or on behalf of, the claimant
The icare HBCF claims committee will consider the submission by the claims manager and by, or on
behalf of, the claimant and will then determine the dispute and notify the claims manager of the
decision. The decision is final and binding. The claims manager will implement the decision as soon
Page 17
icareTM | Insurance & Care NSW HBCF Complaint and Dispute Handling Procedures Page 17 of 31
as practicable. The claims manager will also notify the claimant of the decision and include contact
details for icare HBCF if the claimant requires information about the decision.
The claims manager will advise the claimant that all internal dispute handling mechanisms have now
been exhausted and that any appeal to the NSW Civil and Administrative Tribunal (NCAT) (or the
District Court where the amount involved exceeds the $500,000, jurisdictional limit of the Tribunal)
must be lodged within 45 days of the claimant receiving written notification of the review outcome
from the icare HBCF claims committee.
The claims manager is also to provide information regarding dispute mechanisms external to icare
HBCF, offered by SIRA and available on its website at www.sira.nsw.gov.au.
4.4 Overview of the underwriting complaint and dispute handling
process
4.4.1 Underwriting decisions by the eligibility risk manager
The eligibility risk manager is not limited to applying standard factors to their underwriting
assessments and may consider other matters, including relevant non-financial matters. They are to
exercise prudent business practices in their determinations.
When the eligibility risk manager makes an underwriting decision, they must notify the builder (or a
distributor on behalf the builder). The decision may be about:
• a certificate of insurance
• eligibility reviews
• eligibility applications.
This includes decisions to cancel, suspend or change an existing eligibility. The notification must be
in writing and include written reasons for the decision.
The decision notification must include information about complaint and dispute handling
procedures for:
• the eligibility risk manager
• icare HBCF
• SIRA.
Where the eligibility risk manager proposes to cancel or modify an existing eligibility, the Agent will
only do so in accordance with their appropriate delegated authority. They will give the builder at
least the minimum required notice period of the decision (notice periods are defined in the
Underwriting Procedures Manual).
4.4.2 Complaints by builders or brokers
The eligibility risk manager has its own internal complaint and dispute handling procedures.
icare HBCF requires the eligibility risk manager to establish an underwriting committee to deal with
a range of underwriting matters including all complaints by builders about underwriting decisions.
The builder, or a distributor on behalf of the builder, is to have the opportunity, within reasonable
timeframes, to make a submission to the eligibility risk manager responding to the reasons for the
initial underwriting decision.
4.4.3 Eligibility risk manager underwriting committee
Complaints by, or on behalf of, a builder regarding the eligibility risk manager’s underwriting
decisions should in the first instance be directed to the eligibility risk manager for referral to its
underwriting committee for consideration and determination.
The underwriting committee is to be constituted so that its collective members have the necessary
skills, knowledge and experience to be able to consider and make informed determinations in
relation to all builder eligibilities.
The underwriting committee will investigate the complaint.
Where the eligibility risk manager’s committee reviews a dispute raised by a builder, the committee
is to consider the matter on its merits based on all the relevant information available and provided
Page 18
icareTM | Insurance & Care NSW HBCF Complaint and Dispute Handling Procedures Page 18 of 31
by, or on behalf of, the builder. This includes any further information submitted to the committee by
the builder, following notification of the original decision. The Committee is also to seek further
information or clarification of information provided from the builder where considered appropriate.
The eligibility risk manager’s committee should determine whether to support, overturn or modify
the original eligibility decision.
The eligibility risk manager will notify the builder, or their distributor, of the outcome of the
underwriting committee’s consideration of the complaint and provide reasons for its decision. A
copy of that notification is to be uploaded into the builder’s assessment file in the Builders Eligibility
Assessment Tool (BEAT).
The response to the builder or distributor will also provide information about the icare HBCF and
SIRA dispute handling processes and how to access them.
If the builder is dissatisfied with the eligibility risk manager’s response to a complaint, in some
instances, they may be able to escalate the complaint through their distributor. The builder should
ask their distributor to refer the issue to the eligibility risk manager as a dispute for further
investigation by icare HBCF.
4.4.4 Premium determinations by icare HBCF
Complaints by, or on behalf of a builder, regarding any aspect of a premium determination (that is,
quantum, risk-based weighting, etc.) should be directed to icare HBCF for internal review and
decision.
icare HBCF is to acknowledge receipt of complaints within three business days. icare HBCF will
investigate complaints and provide a written response within 15 business days of receipt of the
complaint. The response will advise the builder of the outcome and explain the reasons for the
decision.
4.4.5 Referrals of complaints and disputes to icare HBCF
The builder or distributor may ask the eligibility risk manager to refer the matter to icare HBCF for
determination, when a builder:
• disputes the outcome of the eligibility risk manager’s review of the original underwriting
decision; or
• makes a complaint about an underwriting decision made by icare HBCF.
The eligibility risk manager will submit all referrals in writing to icare HBCF’s underwriting manager.
For icare HBCF to undertake an assessment and review, the eligibility risk manager should also
provide a recommendation, the eligibility risk manager’s underwriting committee outcome, and a
summary of issues (including a submission of case information and including supporting
documentation submitted by the builder or distributor and reviewed by the ERM).
Complaints and disputes arising from an underwriting decision in relation to a matter that is within
the scope of the Underwriting Procedures Manual or any instructions, guidelines or written
directions given by icare HBCF are not generally to be referred to icare HBCF unless directed or
otherwise agreed by icare HBCF.
A builder or their appointed distributor can ask the eligibility risk manager to refer the following
types of decisions to icare HBCF’s underwriting committee for review:
• Decline a builder’s application for eligibility
• Cancel a builder’s eligibility
• Suspend a builder’s eligibility
• refuse to provide cover for a specific project based on a subjective assessment
Where a quorum of the icare HBCF underwriting committee cannot be convened in person in a
reasonable time, icare HBCF may in its discretion have the underwriting committee make a decision
‘out of session’ by providing recommendations based on papers circulated outside meetings.
While the above matters may be routinely referred to icare HBCF’s underwriting committee, icare
HBCF may in its absolute discretion determine an underwriting matter without first having received
a recommendation from icare HBCF’s underwriting committee.
Page 19
icareTM | Insurance & Care NSW HBCF Complaint and Dispute Handling Procedures Page 19 of 31
Situations where icare HBCF may act without a recommendation include, but are not limited to:
• Where an urgent response is required
• Where the complaint or dispute arises from an underwriting decision in relation to a matter
that is entirely within the scope of the Underwriting Procedures Manual or any instructions,
guidelines or written directions given by icare HBCF
• Where icare HBCF’s underwriting committee is unable to agree on a recommendation
• Where icare HBCF is concerned, on reasonable grounds, that the committee or a member of
the committee may be prejudiced in relation to a matter.
icare HBCF (or icare HBCF’s underwriting committee as applicable) will consider the submissions by
the eligibility risk manager and by, or on behalf of, the builder.
Where a complaint or dispute has been determined by icare HBCF, without reference to the icare
HBCF underwriting committee, the icare HBCF underwriting manager will:
• Determine the matter
• Communicate the decision to the builder, or their broker, and provide information regarding
dispute mechanisms external to icare HBCF, offered by SIRA and available on its website at
www. sira.nsw.gov.au.
• Notify the eligibility risk manager of the decision.
The eligibility risk manager is to implement the decision, which is final and binding, as soon as
practicable.
Where a complaint or dispute is referred to icare HBCF’s underwriting committee, and the
underwriting committee makes a recommendation on the complaint or dispute, icare’s General
Manager, General Lines Underwriting will:
• Determine the matter
• Communicate the decision to the builder, or their broker, and provide information regarding
dispute mechanisms external to icare HBCF, offered by SIRA and available on its website at
www. sira.nsw.gov.au
• Notify the eligibility risk manager of the decision.
The eligibility risk manager is to implement the decision, which is final and binding, as soon as
practicable.
5 Roles & constitution of underwriting, internal dispute
resolution (IDR) & claims committees
5.1 Eligibility risk manager underwriting committee
5.1.1 Constitution
The eligibility risk manager’s underwriting committee is to be constituted so that its collective
members have the necessary skills, knowledge and experience to be able to consider and make
informed determinations in relation to all builder eligibilities.
Additionally, its members must be available such that meetings of the underwriting committee can
be convened within 10 business days of receipt of a complaint, with complete information at hand
to decide no later than 5 business days after the committee has met and considered the complaint.
5.1.2 Complaints
Complaints by, or on behalf of, a builder regarding the eligibility risk manager’s decision in relation
to an application for, or a review of, eligibility including an application for a certificate of insurance
for a specific project, are to be submitted in the first instance to the eligibility risk manager’s own
underwriting committee for consideration and determination.
5.1.3 Other matters
The eligibility risk manager’s underwriting committee is also able to consider matters which fall
outside the scope of icare HBCF’s Underwriting Procedures Manual or any instructions, guidelines
Page 20
icareTM | Insurance & Care NSW HBCF Complaint and Dispute Handling Procedures Page 20 of 31
or written directions given from time to time by icare HBCF as well as underwriting decisions
relating to high risk builders (that is, those that are or may be required to be—depending on the
view taken by the committee—subject to intensive monitoring) and any other matter or class of
matters that may be referred to it by icare HBCF from time to time.
The eligibility risk manager is, always, to be conscious of the potential broader implications that an
underwriting decision may have for icare HBCF, the NSW Government and broader government
policy, such as a decision that may affect or be inconsistent with icare HBCF’s legislative objectives.
Any such matters, even if they fall within the eligibility risk manager’s authority or functions, are to
be reported to icare HBCF as soon as practicable.
The eligibility risk manager’s underwriting committee must also continually assess the quality of its
underwriting decisions, based in part on any inordinate level of dispute emanating from an
individual underwriter’s decisions within the eligibility risk manager’s operations.
5.2 icare HBCF underwriting committee
5.2.1 Constitution
icare HBCF is required to have an underwriting committee. The membership of icare HBCF’s
underwriting committee is to comprise:
• icare HBCF’s Underwriting Manager [Chairperson]
• icare HBCF’s Risk Manager [Deputy Chairperson]
• icare HBCF’s Claims Manager
• a minimum of two building industry experts.
The building industry experts will be nominated by the Housing Industry Association (HIA) and
Master builders Association (MBA). The associations are to be requested by icare HBCF to
nominate two experienced builders (being a member and a deputy). The building industry experts
are appointed to the committee because of their building industry knowledge and expertise and are
not appointed as representatives of the Associations.
icare HBCF may invite one senior underwriter from the eligibility risk manager to attend an icare
HBCF underwriting committee in some circumstances (for example the matter being considered by
the icare HBCF underwriting committee is a dispute of an eligibility decision made by the eligibility
risk manager).
All icare HBCF underwriting committee members, and attendees at icare HBCF underwriting
committee meetings, will be required to enter into a confidentiality agreement acknowledging and
agreeing that:
• The information provided to members of icare HBCF underwriting committee is to be used
exclusively for enabling the underwriting committee to carry out its role and functions
effectively and efficiently.
• No amendments will be made to the information provided.
• Confidential information obtained as a member of icare HBCF’s underwriting committee will
not be disclosed without the express permission of icare HBCF.
• The confidentiality requirements extend beyond the term of icare HBCF underwriting
committee’s operations.
• The member accepts liability for any breach of the confidentiality agreement.
• The member will erase information from any storage system once their appointment to icare
HBCF’s underwriting committee has finished.
5.2.2 Complaints and disputes
The builder or distributor may request the matter to be referred to icare HBCF for determination,
when a builder:
• Disputes the outcome of the eligibility risk manager’s review of the original underwriting
decision
• Makes a complaint about an underwriting decision made by icare HBCF
Page 21
icareTM | Insurance & Care NSW HBCF Complaint and Dispute Handling Procedures Page 21 of 31
The eligibility risk manager should also provide a recommendation, outcome made by the ERM’s
underwriting committee and a summary of issues (including a submission of case information and
including supporting documentation submitted by the builder or distributor), for an assessment and
review to be undertaken by icare HBCF.
Complaints and disputes arising from an underwriting decision in relation to a matter that is within
the scope of the Underwriting Procedures Manual or any instructions, guidelines or written
directions given by icare HBCF are not generally to be referred to icare HBCF unless directed or
otherwise agreed by icare HBCF.
A builder or distributor may ask for the following decisions to be referred to icare HBCF’s
underwriting committee for review:
• Decline a builder’s application for eligibility
• Cancel a builder’s eligibility
• Suspend a builder’s eligibility
• Refuse to provide cover for a specific project based on a subjective assessment
While the above matters may be routinely referred to icare HBCF’s underwriting committee, icare
HBCF may in its absolute discretion determine an underwriting matter without first having received
a recommendation from icare HBCF’s underwriting committee.
Situations where icare HBCF may act without a recommendation include, but are not limited to:
• Where an urgent response is required.
• Where it is not possible to obtain a quorum for a meeting of the icare HBCF underwriting
committee within a reasonable period of time.
• Where the complaint or dispute arises from an underwriting decision in relation to a matter
that is within the scope of the Underwriting Procedures Manual or any instructions, guidelines
or written directions given by icare HBCF.
• Where icare HBCF’s underwriting committee is unable to agree on a recommendation.
• Where icare HBCF is concerned, on reasonable grounds, that the committee or a member of
the committee may be prejudiced in relation to a matter.
icare HBCF’s underwriting committee will meet as required. Reviews of underwriting decisions may
be undertaken out-of-session by way of telephone and email with recommendations confirmed at
the next formal meeting of the committee.
icare HBCF’s underwriting committee shall make its recommendations considering prudent
insurance industry practice and after giving due consideration to the submissions and/or
recommendations of the eligibility risk manager involved as well as submissions by, or on behalf of,
the builder. Submissions on behalf of the builder may be submitted by the building entity or on its
behalf (for example by a director, partner, officer, broker, accountant, solicitor etc.).
Where a complaint or dispute has been determined by icare HBCF, without reference to the icare
HBCF underwriting committee, the icare HBCF Underwriting Manager will:
• Determine the matter.
• Communicate the decision to the builder, or their distributor, and provide information
regarding dispute mechanisms external to icare HBCF, offered by SIRA and available on its
website at www.sira.nsw.gov.au.
• Notify the eligibility risk manager of the decision.
The eligibility risk manager is to implement the decision, which is final and binding, as soon as
practicable.
Where a complaint or dispute is referred to icare HBCF’s underwriting committee, and the
underwriting committee makes a recommendation on the complaint or dispute, icare’s General
Manager, General Lines Underwriting will:
• Determine the matter.
• Communicate the decision to the builder, or their distributor, and provide information
Page 22
icareTM | Insurance & Care NSW HBCF Complaint and Dispute Handling Procedures Page 22 of 31
regarding dispute mechanisms external to icare HBCF, offered by SIRA and available on its
website at www.sira.nsw.gov.au.
• Notify the eligibility risk manager of the decision.
The eligibility risk manager is to implement the decision, which is final and binding, as soon as
practicable.
5.2.3 Other matters
The eligibility risk manager must also refer to icare HBCF any underwriting matters, required to be
so referred under the Delegation of Underwriting Authorities (DUA), as soon as practicable for
decision. In such circumstances, the referral should be accompanied by the recommendation of the
eligibility risk manager together with a supporting submission incorporating relevant background
material.
Matters which fall outside the scope of icare HBCF’s Underwriting Procedures Manual or any
instructions, guidelines or written directions given from time to time by icare HBCF may also be
referred to icare HBCF.
Other matters or classes of matters may also be referred to the icare HBCF underwriting committee
by icare HBCF (or by the eligibility risk manager when instructed in writing to do so by icare HBCF)
from time to time for consideration.
While the above matters may be routinely referred to icare HBCF’s underwriting committee, icare
HBCF may in its absolute discretion determine an underwriting matter without first having received
a recommendation from icare HBCF’s underwriting committee.
Situations where icare HBCF may act without a recommendation include, but are not limited to:
• Where an urgent response is required.
• Where it is not possible to obtain a quorum for a meeting of the icare HBCF underwriting
committee within a reasonable period of time.
• Where the complaint or dispute arises from an underwriting decision in relation to a matter
that is within the scope of the Underwriting Procedures Manual or any instructions, guidelines
or written directions given by icare HBCF.
• Where icare HBCF’s underwriting committee is unable to agree on a recommendation.
• Where icare HBCF is concerned, on reasonable grounds, that the committee or a member of
the committee may be prejudiced in relation to a matter.
The role of icare HBCF’s underwriting committee may also include reviewing icare HBCF’s
Underwriting Procedures Manual and Eligibility Manual and providing advice and recommendations
to icare HBCF on any proposed changes to those procedures, if required by icare HBCF.
5.3 Claims manager internal dispute resolution (IDR)
5.3.1 Constitution
The claims manager’s internal dispute resolution (IDR) area is to use employees with the necessary
skills, knowledge, and experience to be able to consider and make informed determinations in
relation to claims under contracts of insurance under icare HBCF (policies).
Under the Claims Manual and the service level standards a claims manager is required to consider a
claimant’s complaint through its IDR area within 15 business days of lodgement of the complaint.
5.3.2 Complaints
Complaints by, or on behalf of, a claimant regarding the claims manager’s decision in relation to a
claim are to be submitted in the first instance to the claims manager’s own IDR area for
consideration and determination.
5.3.3 Other matters
The claims manager is, always, to be cognisant of the potential broader implications that a claim
decision may have for icare HBCF, the government and broader government policy, such as a
decision that may affect or be inconsistent with icare HBCF’s legislative objectives. Any such
matters, even if they fall within the claims manager’s authority or functions, are to be reported to
Page 23
icareTM | Insurance & Care NSW HBCF Complaint and Dispute Handling Procedures Page 23 of 31
icare HBCF as soon as practicable.
The claims manager must also continually assess the quality of its claim decisions, based in part on
any inordinate level of dispute emanating from an individual claims officer’s decisions within its
operations and arising from the recommendations and/or advice of service providers engaged by
the claims manager.
5.4 icare HBCF claims committee
5.4.1 Constitution
icare HBCF is required under SIRA’s Home building compensation (claims handling) insurance
guidelines to have documented complaint and dispute processes. As part of these processes icare
HBCF has established a icare HBCF claims committee.
The membership of the icare HBCF claims committee is to comprise of icare HBCF’s General
Manager, GL Claims (Chairperson) and the icare HBCF claims manager. The committee may access
independent technical and/ or legal advice as and when required.
5.4.2 Disputes
Where a claimant is not satisfied with the outcome of the claims manager’s review of the original
claim decision, the claimant may request that the matter be referred by the claims manager to the
icare HBCF claims committee for review. A referral to the icare HBCF claims committee is to be
formally submitted by the claim manager in writing to icare HBCF and be accompanied by a
recommendation or a submission of the claims manager and all case information, including
supporting documentation submitted by, or on behalf of, the claimant, for an assessment and
review to be undertaken.
The icare HBCF claims committee will meet as and when required. Reviews of claims decisions may
be undertaken out-of-session by way of telephone and email with recommendations confirmed at
the next formal meeting of the committee.
The icare HBCF claims committee shall make its recommendations considering prudent insurance
industry practice and after giving due consideration to the submissions and/or recommendations of
the claims manager involved as well as submissions by, or on behalf of, the claimant. Submissions
on behalf of the claimant may be submitted by the individual claimant or on the claimant’s behalf
(for example by a director, partner, officer, strata managing agent, owners corporation executive,
building consultant, solicitor etc.).
The icare HBCF claims committee will review the claims manager’s decision or recommendation to
ensure that the claims manager acted reasonably and in accordance with the policy and relevant
legislative provisions, icare HBCF’s Claims Manual and Claims Information for Homeowners, relevant
SIRA Guidelines, and the NSW Government’s Model Litigant Policy etc. The icare HBCF claims
committee will then determine the dispute and notify the claims manager of the decision.
The claims manager is to implement the decision, which is final and binding, as soon as practicable.
Where the decision of icare HBCF is different to that made previously by the claims manager, the
outcome of the dispute shall be amended by the claims manager to reflect the decision of icare
HBCF.
The claims manager is also to notify the claimant of the decision and include contact details for
icare HBCF should information be required about the decision.
The claimant should also be advised that all internal dispute handling mechanisms have now been
exhausted and that any appeal to the NSW Civil and Administrative Tribunal (NCAT) (or the District
Court where the amount involved exceeds NCAT’s $500,000 jurisdictional limit) must be lodged
within 45 days of written notification by the claims manager of the outcome of the review by the
icare HBCF claims committee.
The claims manager is also to provide information regarding dispute mechanisms external to icare
HBCF, offered by SIRA and available on its website at www.sira.nsw.gov.au.
5.4.3 Other matters
The claims manager must also refer to icare HBCF any claim matters, required to be so referred
under the Delegation of Claims Handling Authorities, as soon as practicable for decision. In such
circumstances, the referral should be accompanied by the recommendation of the claims manager
Page 24
icareTM | Insurance & Care NSW HBCF Complaint and Dispute Handling Procedures Page 24 of 31
together with a supporting submission incorporating relevant background material.
Matters which fall outside the scope of icare HBCF’s Claims Manual or any instructions, guidelines or
written directions given from time to time by icare HBCF may also be referred to icare HBCF.
Other matters or classes of matters may also be referred to the committee by icare HBCF (or by the
claims manager when instructed in writing to do so by icare HBCF) from time to time for
consideration.
The role of the icare HBCF claims committee also includes reviewing icare HBCF’s Claims Manual
and Claims Information for Homeowners and providing advice and recommendations to icare HBCF
on any proposed changes to those documents.
6 icare HBCF underwriting committee – management and
record keeping
6.1 Quorum
The quorum for meetings of icare HBCF’s underwriting committee is a majority of its members for
the time being and must include a minimum of two building industry experts.
6.2 Presiding member
Meetings of icare HBCF’s underwriting committee are to be chaired by:
• The Chairperson of the committee
• In the absence of the Chairperson, the Deputy Chairperson.
The member chairing any meeting of the committee has a deliberative vote and, in the event of an
equality of votes, has a second or casting vote.
6.3 Voting
A recommendation supported by a majority of the votes cast at a meeting of icare HBCF’s
underwriting committee at which a quorum is present is the recommendation of icare HBCF’s
underwriting committee.
6.4 Minutes
icare HBCF’s underwriting committee must cause full and accurate minutes to be kept of the
proceedings and recommendations of each meeting of the committees.
6.5 Transaction of business outside meetings or by telephone or other
means
icare HBCF’s underwriting committee may, if it is of the view that it is appropriate to do so, transact
any of its business by the circulation of papers among all the members of the committee for the
time being. Papers may be circulated among members by email, facsimile or other transmission of
the information in the papers concerned.
A decision in writing approved by a majority of members is taken to be a recommendation of icare
HBCF’s underwriting committee and is to be recorded in the minutes of the meetings of the
committee.
icare HBCF’s underwriting committee may, if it is of the view that it is appropriate to do so, transact
any of its business at a meeting at which members (or some members) participate by telephone,
close-circuit television, or other means, but only if any member who speaks on a matter before the
meeting can be heard by the other members.
In the above cases the Chairperson, Deputy Chairperson and each member have the same voting
rights as they have at an ordinary meeting of the body.
6.6 Managing conflicts of interest
A member of icare HBCF’s underwriting committee who has a direct or indirect pecuniary interest
in a matter being considered or about to be considered at a meeting of the committee, and whose
interest appears to raise a conflict with the proper performance of the member’s duties in relation
Page 25
icareTM | Insurance & Care NSW HBCF Complaint and Dispute Handling Procedures Page 25 of 31
to the consideration of the matter, must, as soon as possible after the relevant facts have come to
the member’s knowledge, disclose the nature of the interest at a meeting of the committees.
A disclosure by a member of icare HBCF’s underwriting committee at a meeting of the committee
that the member is a member, or in the employment, of a specified company or other body, or is a
partner, or in the employment, of a specified person, or has some other specified interest relating to
a specified company or other body or to a specified person, is a sufficient disclosure of the nature
of the interest.
In such cases the member is to abstain from any discussion and vote on a recommendation on the
matter. Particulars of any such disclosure are to be recorded in the minutes of the proceedings of
the meeting.
6.7 Confidentiality
All members of icare HBCF’s underwriting committee, and all attendees at icare HBCF underwriting
committee meetings, are required to enter into a Confidentiality Agreement acknowledging and
agreeing to the confidentiality and security of information received as a member of the
underwriting committee.
6.8 First meeting
The first meeting of icare HBCF’s underwriting committee is to be called in such manner as icare
HBCF determines.
7 Summary and service standards
7.1 Service level complaints – scheme agents
Complaints regarding service standards (whether lodged personally, by telephone or in writing)
should be handled by the scheme agent in accordance with the scheme agent’s internal complaint
and dispute handling procedures.
• Oral complaints will be acknowledged immediately and written complaints within three
business days advising the complainant of the complaint and dispute handling procedure.
• Complaints will be investigated, and a response provided in writing within 15 business days of
receipt of the complaint provided the scheme agent has all the necessary information and
has completed any investigation that may be required.
• In cases where further information, assessment or investigation is required, reasonable
alternative timeframes will be agreed.
• Complainants will be kept informed of the progress of the response to their complaint.
• The response to the complaint should also provide information about the dispute handling
process of icare HBCF and how to access the dispute handling process.
• If a complainant is not satisfied with the outcome of the scheme agent’s review of the
original complaint they may request that the matter to be referred by the scheme agent to
icare HBCF for review.
• Referral of a dispute to icare HBCF by a scheme agent is to occur within three business days
of the scheme agent being notified of the complainant’s request that the dispute be referred
to icare HBCF.
• A referral to icare HBCF is to be formally submitted by the scheme agent in writing to icare
HBCF and be accompanied by all case information (including supporting documentation
submitted by, or on behalf of, the complainant) for a review to be undertaken.
7.2 Service level complaints – icare HBCF
icare HBCF will contact the complainant within five business days of receiving a dispute to:
• acknowledge receipt and to provide a contact name for enquiries and a timeframe for
determining the matter.
icare HBCF must ensure that the matter is considered by an appropriate officer within 10 business
days of receipt by icare HBCF of the dispute.
Page 26
icareTM | Insurance & Care NSW HBCF Complaint and Dispute Handling Procedures Page 26 of 31
icare HBCF will consider the submissions by the scheme agent and by, or on behalf of, the
complainant icare HBCF will then formally determine the dispute (via a sign-off by icare HBCF's
Underwriting Manager, or General Manager, General Lines Underwriting or Group Executive,
Prevention & Underwriting) and notify the scheme agent in writing of the decision within 3 business
days of the sign-off.
The scheme agent is to implement the decision, which is final and binding, as soon as practicable.
The scheme agent is also to notify the complainant in writing of the decision within three business
days of its receipt of the decision and include contact details for icare HBCF should information be
required about the decision. The scheme agent is also to provide information regarding dispute
mechanisms external to icare HBCF, offered by SIRA and available on its website at
www.sira.nsw.gov.au.
7.3 Eligibility risk manager underwriting committee – operation &
service standards
• The eligibility risk manager is to have its own underwriting committee.
• Members of the committee should be carefully selected based on sufficient skill, knowledge,
and experience.
• The established committee will consider complaints by, or on behalf of, a builder regarding a
decision by the eligibility risk manager in relation to an application for, or a review of,
eligibility (including an application for a Certificate of Insurance for a specific project).
• Such complaints are to be submitted, in the first instance, to the eligibility risk manager for
consideration and determination by its underwriting committee
• Oral complaints will be acknowledged immediately and written complaints within three
business days advising the builder (or distributor on behalf of the builder) of the •
complaint and dispute handling procedure. All complaints regarding an eligibility decision
will be acknowledged in writing.
• The committee is to convene within 10 business days of receipt of a complaint.
• In cases where further information, assessment or investigation is required, reasonable
alternative timeframes will be agreed, and the builder/distributor will be kept informed of the
progress of the response to their complaint.
• A determination is to be made and advised to the builder (or a distributor on behalf of the
builder) within five business days of the committee having considered the complaint.
• All decisions must be consistent with icare HBCF’s Underwriting Procedures Manual or any
instructions, guidelines or written directions given from time to time by icare HBCF.
• The response to the builder or distributor is to include written reasons for the decision and a
copy of the response is to be provided to icare HBCF.
• The response to the builder or distributor is to also include information about the dispute
handling process of icare HBCF including advice as the type of matters which may be
referred to icare HBCF and how to access the dispute handling process.
• If the builder is dissatisfied with the eligibility risk manager’s response to a complaint they
may, in some instances, be able to escalate the complaint and request via their distributor
that it be treated as a dispute for referral by the eligibility risk manager for further
investigation by icare HBCF.
• Referral of a dispute to icare HBCF by the eligibility risk manager is to occur within three
business days of the eligibility risk manager being notified of the builder’s or distributor’s
request that the dispute be referred to icare HBCF.
• A referral to icare HBCF’s underwriting committee is to be formally submitted by the
eligibility risk manager in writing to icare HBCF. The eligibility risk manager should also
provide a recommendation and a summary of issues (including a submission of case
information and including supporting documentation submitted by the builder or distributor),
for an assessment and review to be undertaken.
The eligibility risk manager’s underwriting committee is also able to consider:
Page 27
icareTM | Insurance & Care NSW HBCF Complaint and Dispute Handling Procedures Page 27 of 31
• matters which fall outside the scope of icare HBCF’s Underwriting Procedures Manual or any
instructions, guidelines or written directions given from time to time by icare HBCF
• underwriting decisions relating to high risk builders (that is, those that are or may be
required to be subject to intensive monitoring (depending on the view taken by the
Committee)
• any other matter or class of matters that may be referred to it by icare HBCF from time to
time.
• The eligibility risk manager’s underwriting committee must also continually assess the quality
of its underwriting decisions, based in part on any inordinate level of dispute emanating from
an individual underwriter’s decisions within the eligibility risk manager’s operations.
7.4 icare HBCF underwriting committee – operation & service standards
icare HBCF is to have an underwriting committee in operation. The membership of icare HBCF’s
underwriting committee is to be constituted as follows:
• icare HBCF Underwriting Manager (Chairperson)
• icare HBCF Risk Manager (Deputy Chairperson)
• icare HBCF claims manager
• a minimum of two building industry experts (nominations from the Housing Industry
Association (HIA) and Master Builders Association (MBA).
• All members of icare HBCF’s underwriting committee, and all attendees at icare HBCF
underwriting committee meetings, are to enter into a Confidentiality Agreement
acknowledging and agreeing to the confidentiality and security of information received as a
member of the underwriting committee.
• icare HBCF’s underwriting committee may consider the following types of matters:
◦ underwriting decisions by the eligibility risk manager and confirmed or modified by the
eligibility risk manager’s underwriting committee that continue to be disputed by a builder
◦ complaints regarding underwriting decisions made by icare HBCF
◦ any aspect of a premium determination by icare HBCF that is disputed by a builder
◦ underwriting matters required to be referred to icare HBCF by the eligibility risk manager
under the Delegation of Underwriting Authorities
◦ other matters or classes of matters referred from time to time by icare HBCF (or by the
eligibility risk manager when instructed in writing to do so by icare HBCF)
◦ reviewing and recommending changes to the Eligibility Manual and Underwriting Procedures
Manual as requested by icare HBCF.
• icare HBCF will contact the builder, or their distributor, within three business days of
receiving a complaint or dispute to acknowledge receipt and provide an indicative timeframe
for determining the matter.
• icare HBCF (by the icare HBCF Underwriting Manager) will initially review Complaints or
Disputes referred to it to determine if they will be determined by icare HBCF or referred to
the icare HBCF underwriting committee for a recommendation (see section 5.2).
• Where icare HBCF determines a complaint or dispute, without referral to the icare HBCF
underwriting committee, the icare HBCF Underwriting Manager will:
◦ advise the eligibility risk manager in writing of icare HBCF’s decision within five business
days of the determination of the complaint or dispute
◦ notify the builder’s distributor in writing of the decision within five business days of icare
HBCF determining the complaint or dispute and include contact details for icare HBCF
should information be required about the decision.
◦ provide the builder’s distributor with information regarding dispute mechanisms external to
icare HBCF, offered by SIRA as detailed on its website at www.sira.nsw.gov.au
• icare HBCF’s underwriting committee will consider submissions referred to it by the icare
HBCF Underwriting Manager and make a recommendation to icare’s General Manager,
General Lines Underwriting. icare HBCF will then formally determine the dispute (by sign- off
Page 28
icareTM | Insurance & Care NSW HBCF Complaint and Dispute Handling Procedures Page 28 of 31
by icare’s General Manager, General Lines Underwriting) and:
◦ advise the eligibility risk manager in writing of icare HBCF’s decision within five business
days of the determination of the complaint or dispute
◦ notify the builder’s broker in writing of the decision within five business days of icare HBCF
determining the complaint or dispute and include contact details for icare HBCF should
information be required about the decision.
◦ provide the builder’s broker with information regarding dispute mechanisms external to
icare HBCF, offered by SIRA as detailed on its website at www.sira.nsw.gov.au
• The eligibility risk manager is to implement icare HBCF decisions, which are final and binding,
as soon as practicable.
• Complaints or disputes referred to icare HBCF should generally:
◦ Be determined within 10 business days of receipt of the complaint or dispute from the
eligibility risk manager.
◦ Have icare HBCF’s determination of the complaint or dispute communicated to the eligibility
risk manager and builder’s distributor within 15 business days of receipt of the complaint or
dispute from the eligibility risk manager.
In cases where this is not possible (for example obtaining a quorum for a meeting with the icare
HBCF underwriting committee, further information or investigations being required) reasonable
alternative timeframes will be communicated and the builder’s distributor will be kept informed of
the progress of the response to the builder’s complaint or dispute.
• Decisions in relation to any aspect of a premium determination that is disputed by a builder
will:
◦ be notified to the builder’s distributor in writing by icare HBCF within five business days of
the determination by icare’s General Manager, General Lines Underwriting
◦ Be determined within 15 business days of receipt of the dispute.
7.5 Claims manager internal dispute resolution (IDR) – operation &
service standards
• The claims manager is to have its own IDR area.
• IDR staff should be carefully selected based on sufficient skill, knowledge, and experience to
be able to consider and make informed determinations in relation to claims under contracts
of insurance under icare HBCF (policies).
• Oral complaints will be acknowledged immediately and written complaints within three
business days advising the claimant of the complaint and dispute handling procedure. All
complaints regarding a claim decision will be acknowledged in writing.
• In cases where further information, assessment or investigation is required, reasonable
alternative timeframes will be agreed, and the claimant will be kept informed of the progress
of the response to their complaint.
• The claims manager is required to consider a claimant’s complaint through its IDR Area
within 15 business days of lodgement of the complaint.
• A determination is to be made and advised to the claimant within five business days of
having considered the complaint.
• All decisions must be consistent with icare HBCF’s Claims Manual or any instructions,
guidelines or written directions given from time to time by icare HBCF.
• The response to the claimant is to include written reasons for the decision.
The response to the claimant will also provide information about the dispute handling process of
icare HBCF and how to access the dispute handling process. The response should also advise that
any request for referral of a dispute to icare HBCF should occur within 30 days after written notice
of the outcome of the review by the claims manager’s IDR area is provided to the claimant and that
the claimant can bypass this process and immediately appeal the decision to the NSW Civil and
Administrative Tribunal (NCAT) or District Court.
• If the claimant is dissatisfied with the claims manager’s response to a complaint they may
escalate the complaint and request that it be treated as a dispute for referral by the claims
Page 29
icareTM | Insurance & Care NSW HBCF Complaint and Dispute Handling Procedures Page 29 of 31
manager for further investigation by icare HBCF.
• Referral of a dispute to icare HBCF by the claims manager is to occur within three business
days of the claims manager being notified of the claimant’s request that the dispute be
referred to icare HBCF.
• The claims manager must formally submit written referrals to the icare HBCF claims
committee. These referrals must be accompanied by a recommendation or a submission of
the claims manager and all case information (including supporting documentation submitted
by, or on behalf of, the claimant) for an assessment and review to be undertaken.
• The claims manager must also continually assess the quality of its claim decisions, based in
part on any inordinate level of dispute emanating from an individual claims officer’s decisions
within its operations and arising from the recommendations and/or advice of service
providers engaged by the claims manager.
7.6 icare HBCF claims committee – Operation and Service Standards
• icare HBCF is to have a claims committee and the membership of the icare HBCF claims
committee is to be constituted as follows:
◦ General Manager, GL Claims (Chairperson)
◦ icare HBCF claims manager.
• The committee may access independent technical and legal advice as and when required.
• The icare HBCF claims committee may consider the following types of matters:
◦ disputes over claims decisions by the claims manager and confirmed or modified by an IDR
decision that continue to be disputed by a claimant
◦ claim matters required to be referred to icare HBCF by the claims manager under the
Delegations of Claims Handling Authorities
◦ other matters or classes of matters referred from time to time by icare HBCF (or by the
claims manager when icare HBCF provides them with written instructions to do so)
◦ reviewing and recommending changes to the Claims Manual and Claims Information for
Homeowners when requested by icare HBCF.
• icare HBCF will contact the claimant within five business days of receiving a dispute to
acknowledge receipt and to provide a contact name for enquiries and a timeframe for
determining the matter.
• The icare HBCF claims committee is to meet as required but must meet within 10 business
days of icare HBCF receiving a dispute.
• The icare HBCF claims committee will consider the submissions by the claims manager and
by, or on behalf of, the claimant and make a decision.
• icare HBCF will then formally determine the dispute (by sign-off by icare HBCF’s General
Manager, General Lines Claims or Group Executive, Prevention & Underwriting) and send
written notification of the decision to the claims manager within three business days of the
Claims Committee having made its recommendation.
• The claims manager must implement the decision, which is final and binding, as soon as
practicable.
• The claims manager must provide the claimant with a written notification of the decision
within three business days of its receipt of the decision. This notification must include contact
details for icare HBCF so the claimant can get more information about the decision.
• icare HBCF should also advise the claimant that all internal dispute handling mechanisms
have now been exhausted. They must also advise that any appeal to the NSW Civil and
Administrative Tribunal (NCAT) (or the District Court where the amount involved exceeds
NCAT’s $500,000 jurisdictional limit) must be lodged within 45 days of receiving written
notification from the claims manager stating the outcome of the icare HBCF claims
committee review.
• icare HBCF should also provide the claimant with information about dispute mechanisms
(external to icare HBCF) offered by SIRA as detailed on its website at
https://www.sira.nsw.gov.au.
Page 30
icareTM | Insurance & Care NSW HBCF Complaint and Dispute Handling Procedures Page 30 of 31
8 State Insurance Regulatory Authority (SIRA)
8.1 Requests for regulator compliance review (claims)
• A claimant may request that SIRA review icare HBCF’s handling of a claim if the claimant
believes that icare HBCF has not complied with the Home Building Act 1989, the Home
Building Regulation 2014, the Home building compensation (claims handling) insurance
guidelines or its documented approach to complaint and dispute management.
• SIRA will assess icare HBCF’s compliance with the relevant obligations. SIRA will decide
appropriate action or make recommendations to icare HBCF in respect of any substantiated
non-compliance. A regulator compliance review is not a mechanism of appeal to review the
merits of a particular claim and does not overturn claims decisions.
8.2 Other complaints about icare HBCF (claims)
• A claimant may lodge a written complaint about icare HBCF with SIRA if they are not
satisfied with the service provided by, or the conduct of icare HBCF’s handling of the claim. If
the claimant has evidence to support the complaint, they must provide it to SIRA with the
written complaint.
8.3 Requests for regulator compliance review
• A contractor may request that SIRA undertake a regulator compliance review to investigate
potential breaches of the Act, the Regulation, or the Guidelines by icare HBCF.
• A regulator compliance review is not a mechanism of appeal to review the merits of a
particular contractor’s eligibility and does not overturn eligibility decisions.
8.4 Other complaints about icare HBCF (eligibility)
• A contractor can also lodge a complaint about icare HBCF with SIRA.
• icare HBCF must provide SIRA’s contact details to a contractor so that they may seek a
further review if they are not satisfied with the approach or outcome of the icare HBCF’s
determination.
SIRA Contact Details
• Telephone: 13 10 50
• Email: [email protected]
• Postal & Business Address: Level 6, McKell Building 2-24 Rawson Place, Sydney NSW 2000
Page 31
Insurance and Care NSW (icare)
ABN: 97 369 689 650
[email protected]
(02) 9216 3224
www.icare.nsw.gov.au