Complaint and Dispute Handling Procedures - icare.nsw.gov.au · complaints handling process which...

© State of New South Wales through the NSW Self Insurance Corporation 2019 Complaint and Dispute Handling Procedures 1

Complaint and Dispute Handling ProceduresVersion 4.0

This document has been prepared by:

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

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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

Content refresh by HBCF team/Deloitte

19 June 17 HBCF Contract Performance Manager

3.1 Content edited to reflect appointment of new Claims and Eligibility Risk Managers

9 Sep 2017 HBCF Contract Performance Manager

4.0 Revised to conform with SIRA Guidelines 20 Sep 2018 HBCF Risk Manager

Table of contents1 Introduction � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � �4

2 Objectives and Scope � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � �4

2.1 Objectives . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4

2.2 Scope . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4

2.3 Supporting References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4

2.4 Definitions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5

3 Process Flow� � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 5

3.1 Service level – Complaint & Dispute Handling Process . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5

3.2 Underwriting – Complaint & Dispute Handling Process . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6

3.3 Claims – Complaint & Dispute Handling Process . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6

3.4 Overview of the service standards for the Eligibility Risk Manager . . . . . . . . . . . . . . . . . . . . . . . 7

4 Complaints � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � �11

4.1 Referral of Disputes to HBCF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11

4.2 Registering Complaints. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12

4.3 Overview of the Underwriting Complaint and Dispute Handling Process . . . . . . . . . . . . . . . . 12

4.4 Overview of the Claim Complaint and Dispute Handling Process . . . . . . . . . . . . . . . . . . . . . . . 13

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5 Roles and Constitution of Underwriting, Internal Dispute Resolution (IDR) and Claims Committees � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 15

5.1 Eligibility Risk Manager Underwriting Committee . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15

5.2 HBCF Underwriting Committee . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15

5.3 Claims Manager Internal Dispute Resolution (IDR) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17

5.4 HBCF Claims Committee . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18

6 HBCF Underwriting Committee - Management and Record Keeping � � � � � � � � � � � � � � � � � � � � � � � � � 19

6.1 Quorum. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19

6.2 Presiding member . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19

6.3 Voting . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19

6.4 Minutes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19

6.5 Transaction of business outside meetings or by telephone or other means . . . . . . . . . . . . . . 19

6.6 Managing Conflicts of Interest . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19

6.7 Confidentiality. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19

6.8 First Meeting . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .20

7 Summary and Service Standards � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � �20

7.1 Service Level Complaints - Scheme Agents. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .20

7.2 Service Level Complaints - HBCF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .20

7.3 Eligibility Risk Manager Underwriting Committee - Operation and Service Standards. . . . .20

7.4 HBCF Underwriting Committee - Operation and Service Standards. . . . . . . . . . . . . . . . . . . . . 21

7.5 Claims Manger Internal Dispute Resolution (IDR) - Operation and Service Standards . . . . . 22

7.6 HBCF Claims Committee - Operation and Service Standards. . . . . . . . . . . . . . . . . . . . . . . . . . . 23

8 State Insurance Regulatory Authority (SIRA) � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � �24

8.1 Requests for Regulator Compliance Review (Claims) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24

8.2 Other Complaints About icare HBCF (Claims) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24

8.3 Requests for Regulator Compliance Review (Eligibility). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24

8.4 Other Complaints About icare HBCF (Eligibility) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24DRAFT


1 IntroductionInsurance and Care NSW provides services in the administration of the Home Building Compensation Fund for the NSW Self Insurance Corporation (icare HBCF). An outsourced service model, via contractual arrangements with Scheme Agents , is utilised by icare HBCF for the assessment of builder eligibility and management of claims. Gallagher Bassett Services Pty Ltd is the Claims Manager and Corporate Scorecard is the Eligibility Risk Manager.

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 (formerly home warranty 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 should their builder be 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 for failure to comply with a NSW Civil and Administrative Tribunal (NCAT) or Court order to pay compensation to the homeowner.

2 Objectives and Scope

2�1 Objectives The primary objective of this document is to provide a detailed guideline for the handling of complaints and disputes in relation to service level standards, claim decisions and applications for, or a review of, eligibility (including a Project Application for a Certificate of Insurance for a specific project) and any aspect of a premium determination.

The document is to provide for the establishment, constitution and operation of Claims and Underwriting Committees by Scheme Agents and HBCF for the handling of escalated disputes. The establishment of Underwriting and Claims

Committees is an important component of HBCF’s complaints handling process which aims to ensure appropriate management of complaints and escalated disputes.

2�2 ScopeWhere a Builder or homeowner is dissatisfied with the level of service provided by a Scheme Agent, or their service providers or brokers, about an underwriting or claims decision, it is important that a consistent set of guidelines and procedures are established and followed to manage complaints and any escalated disputes.

Where appropriate, this may result in some matters being referred as a dispute from the Scheme Agent to HBCF. In some instances, such disputes may be reviewed by HBCF’s Underwriting or Claims Committees to reach an outcome.

In this context, the primary scope of this document will cover:

• The handling of complaints and disputes regarding service level standards

• The role of the Scheme Agents’ and HBCF’s Underwriting and Claims Committees in handling complaints and escalated disputes

• Determining when matters should be referred to HBCF’s Underwriting or Claims Committees

• The membership and constitution of 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 ReferencesPublic Documents

• HBCF Eligibility Manual

• HBCF Claims Information for Homeowners

Published by icare HBCF and available on its website at www.icare.nsw.gov.au.

Only to Scheme Agents

• HBCF Underwriting Procedures Manual

• HBCF Claims Manual

NSW Fair Trading

• Guide to Standards & Tolerances

• Consumer Building Guide

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Published by NSW Fair Trading and available on its website at www.fairtrading.nsw.gov.au

Law and Justice

• NSW Government’s Model Litigant Policy

Published by the NSW Department of Justice and available on its website at www.lawlink.nsw.gov.au.

State Insurance Regulatory Authority (SIRA)

• 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 DefinitionsComplaint:

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.

Dispute:

A complaint that has been considered and/or responded to by the Scheme Agent and the complainant is not satisfied with the outcome.

3 Process Flow

3�1 Service level – Complaint & Dispute Handling Process

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3�2 Underwriting – Complaint & Dispute Handling Process

3�3 Claims – Complaint & Dispute Handling Process

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3�4 Overview of the service standards for the Eligibility Risk ManagerThe Eligibility Risk Manager’s focus is to be upon customer service, responding technically correctly and in a timely manner to all customer and other stakeholder enquiries – technical and procedural.

The following quantitative service standards, detailed in Table 1 and Table 2 of the HBCF Underwriting Procedures Manual, are to apply:

Table 1 Service Standard for Eligibility Assessment and Review

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 prior to due date

Acknowledge receipt of eligibility application or review documents

Within 2 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 7 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

Table 2 Service Standard for Project Application

Project Applications Service Standards Eligibility Risk Manager Requirement for completion

Assess whether additional information required and/or Builder Profile Change and if required request information or initiate review

Within 2 business days of receipt of the application for a Certificate

Underwrite application for certificate of insurance and advise the Builder through their broker of decision including any proposed conditions on the approval, e.g. security, Building Contract Review Program (BCRP)

Within 5 business days of receipt of complete information or completion of review (whichever later)

Issue decision via CIMS to distributor Within 2 business days of receipt of builder accepting underwriting conditions

Note: The Eligibility Risk Manager must communicate immediately with the builder’s Distributor where it believes it cannot meet the service standards prior to the due date for delivery. The Eligibility Risk Manager is to advise of the reasons for the delay and the expected actual delivery date.

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3�5 Overview of the service standards for the Claims Manager

The expectation is that the Claims Manager will meet these standards to the extent that is sufficient to achieve maximum compliance with its KPIs.

Action Service Standard Claims Manager Requirement for Completion

Response to initial claimant enquiry

The Claims Manager will forward a claim form to the claimant

Within 2 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


The Claims Manager will register the notification on the system


Receipt of claim, if prescribed claims information* is incomplete

*SIRA Home Building Compensation (Claims Handling) Guidelines

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


The Claims Manager will register the incomplete claim as a notification on the system


The Claims Manager will raise an initial case reserve on the system

Within 5 business days of registration

Follow up of prescribed claims information

If the Claims Manager has not received all of the prescribed claim information from a claimant within five business days of receiving some prescribed claim information, the Claims Manager will inform the claimant in writing of the further prescribed claim information that is required

Scheme Agent will register the notification on the system

Within 24 hours after the expiration of 5 business days from the initial requestDRAFT



Receipt of claim, if prescribed claims information* is complete

* SIRA Home Building Compensation (Claims Handling) Guidelines

The Claims Manager will acknowledge receipt of a claim, advise of the next steps to be taken to assess the claim and inform the claimant that the claim will be deemed as accepted after 90 days from date of receipt unless the claim is accepted or declined earlier, or the claimant otherwise agrees to an extension or as otherwise provided by the Act


The Claims Manager will register the claim on the system


The Claims Manager will raise an initial case reserve on the system

Within 5 business days of registration

Determination of status of builder

If at any time the Claims Manager forms the view that the policy has not been triggered, the claimant will be informed in writing and provided with details of the source of that view


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 days of receipt of claim

Appointment of service provider The Claims Manager will appoint any necessary technical consultant

Within 5 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


Determination of claim The Claims Manager will either accept or deny the claim

Within 90 days after receipt of all prescribed claims information

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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, or

° 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 4 weeks or within 5 business days of receipt of new information

Review of claim The Claims Manager will review the claim

Every 4 weeks or within 5 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 1 business day

The Claims Manager will keep the claimant informed about the progress of the claim in writing

Every month

The Claims Manager communicates early to the claimant 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 3 days prior to expiration of service standard

Claim dispute or complaint The Claims Manager is to consider claimants’ escalated complaints disputes through their Internal IDR

icare HBCF Claims Committee must consider any escalated complaints

Within 15 business days of lodgement of the dispute

Within 10 business days of receiving a request to review a complaint

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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

Incorrect payments The Claims Manager will notify icare HBCF of any incorrect payments made to either a vendor or claimant

Within 24 hours of becoming aware of any incorrect payments

Actioning of icare HBCF instructions

The Claims Manager is to action any instructions issued by icare HBCF

Within 2 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 claim specific nature while others may be related to scheme policy

Within 2 business days of general requests

Within 4 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, liability and quantum (if any) determined, the excess paid by the insured and any payments have been made to the beneficiary and service providers

Within 14 days of last action on claim

4 ComplaintsA homeowner, Builder, or a broker on behalf of the Builder, is to have the opportunity, within reasonable timeframes, to complain about the level of service provided by HBCF or on behalf of HBCF by a Scheme Agent.

In the first instance, complaints regarding service standards (other than a complaint about HBCF itself) should be handled by the Scheme Agent in accordance with their internal complaint and dispute handling procedures.

The response to the complainant should also provide information about the dispute handling process of HBCF and how to access the process.

4�1 Referral of Disputes to HBCFWhere 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 to HBCF for review.

A referral to HBCF is to be formally submitted by the Scheme Agent in writing and be accompanied by all case information, including supporting documentation submitted by the complainant, for a review to be undertaken.

HBCF will consider the submissions of the complainant and Scheme Agent and then determine the dispute and notify of the decision. 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 of the decision and include contact details for HBCF. The Scheme Agent is also to provide information regarding dispute mechanisms external to HBCF, offered by SIRA and available on their website at www.sira.nsw.gov.au.

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4�2 Registering ComplaintsEach 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 7.1.

Each Scheme Agent must make available to HBCF information from the register in respect of complaints as and when requested.

Note: A complaint is to be distinguished from an enquiry. A complaint will only arise for the purposes of reporting to HBCF where the person making the complaint requests it to be registered or to be referred to the internal dispute handling process of the Scheme Agent. A Scheme Agent that receives a complaint must enquire of the complainant whether that person wishes the complaint to be registered or referred to the internal dispute settlement process.

4�3 Overview of the Underwriting Complaint and Dispute Handling ProcessUnderwriting 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 non-financial matters. They are to exercise prudent business practices in their determinations.

Underwriting decisions by the Eligibility Risk Manager in relation to applications for eligibility and a Certificate of Insurance or reviews of eligibility including decisions to cancel, suspend or modify an existing eligibility to the detriment of a Builder, are to be notified to the Builder, or a broker on behalf the Builder, with written reasons for the decision. The notification of the decision is to also include information regarding the Eligibility Risk Manager’s internal complaint and dispute handling procedures and HBCF’s dispute handling process.

Where the Eligibility Risk Manager proposes to cancel or modify an existing eligibility to the detriment of the Builder, the Agent will firstly do so under the appropriate authority level and shall give the Builder at least 10 business days’ notice of the decision.

Complaints by Builders or Brokers

The Eligibility Risk Manager has its own internal complaint and dispute handling procedures for the handling of complaints and disputes.

HBCF’s Underwriting Procedures Manual 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 broker 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.

Eligibility Risk Manager Underwriting Committee

Complaints by, or on behalf of a Builder, regarding 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 and consider all supporting documentation and information provided by, or on behalf of, the Builder. The Eligibility Risk Manager will notify the Builder or broker 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 provided to HBCF’s Risk Manager and Underwriting Manager

The response to the Builder or broker will also provide information about the dispute handling process of 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 broker that it be treated as a dispute for referral by the Eligibility Risk Manager for further investigation by HBCF.

Premium Determinations By HBCF

Complaints by, or on behalf of a Builder, regarding any aspect of a premium determination (i.e. quantum, risk-based weighting etc). should in the first instance be directed to HBCF for internal review and decision.

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HBCF is to acknowledge receipt of the complaints within 3 business days. Complaints will be investigated, and a response provided in writing within 15 business days of receipt advising of the outcome and explaining the reasons the decision.

Any aspect of a premium determination by HBCF that continues to be disputed by a builder following an internal review by HBCF may also be requested by a Builder (or a broker on behalf of a Builder) to be referred by HBCF for review by its Underwriting Committee.

Referral of Disputes to HBCF Underwriting Committee

Where a Builder is not satisfied with the outcome of the Eligibility Risk Manager’s review of the original underwriting decision, the Builder or broker may in some instances request the matter to be referred to HBCF’s Underwriting Committee for review.

A referral to HBCF’s Underwriting Committee is to be formally submitted by the Eligibility Risk Manager in writing to HBCF’s Underwriting Manager. 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 broker), for an assessment and review to be undertaken.

Disputes arising from an underwriting decision of an Eligibility Risk Manager in relation to a matter that is within the scope of the Underwriting Procedures Manual or any instructions, guidelines or written directions given by HBCF are not generally to be referred to HBCF or considered by HBCF’s Underwriting Committee unless directed or otherwise agreed by HBCF.

However, decisions to decline, cancel, suspend or negatively modify a Builder’s eligibility or to refuse to provide cover for a specific project based on a subjective assessment may be requested by a Builder or a broker to be referred to HBCF for review by HBCF’s Underwriting Committee. Any aspect of a premium determination by HBCF that continues to be disputed by a builder following an internal review may also be referred for review by HBCF’s Underwriting Committee.

HBCF’s Underwriting Committee will consider the submissions by the Eligibility Risk Manager and by, or on behalf of, the Builder and make a

recommendation to HBCF’s General Manager, Builders Warranty who will then determine the dispute and 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. The Eligibility Risk Manager is also to notify the Builder’s broker of the decision and include contact details for HBCF should information be required about the decision.

The Eligibility Risk Manager is also to provide information regarding dispute mechanisms external to HBCF, offered by SIRA and available on its website at www.sira.nsw.gov.au.

4�4 Overview of the Claim Complaint and Dispute Handling ProcessClaim 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 prior to needing to appeal to the Tribunal 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.

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The Claims Manager will also advise the claimant that:

• 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 HBCF have been exhausted

• The claimant can by-pass the dispute handling procedures and has the right to appeal the decision immediately to the Tribunal or Court (it is important a claimant is aware of, and able to exercise, their rights and obligations under the Home Building Act 1989).

Complaints by Claimants

Each Claims Manager has its own internal complaint and dispute handling procedures for the handling of complaints and disputes that are approved by HBCF and is required to comply with relevant SIRA Guidelines.

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.

Claims Manager Internal Dispute Resolution (IDR) System

Unless there are special circumstances, a claimant should refer any dispute in relation to a decision by a Claims Manager on a claim to the Claims Manager’s internal dispute resolution system, not later than 30 days after written notice of the decision on the claim was given to the claimant.

The Claims Manager is to maintain its own IDR System for consideration and determination of complaints and disputes that require escalation due to the dissatisfaction of a claimant with the Claims Manager’s decision on a claim.

Complaints by, or on behalf of a claimant, arising from the rejection, either in full or in part, of a claim (whether lodged personally, by telephone or in writing) should in the first instance 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. A copy of that notification is to be attached to the claim file.

The response to the claimant will also provide information about the dispute handling process of HBCF and how to access the dispute handling process. The response should also advise that any request for referral of a dispute to HBCF should occur within 30 days after written notice of the outcome of the review by the Claims Manager’s Claims Committee is provided to the claimant and that the claimant can by-pass 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 Manager for further investigation by HBCF.

Referral of Disputes to 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 request the matter to be referred to HBCF’s Claims Committee for review. A referral to HBCF’s Claims Committee is to be submitted by the Claims Manager in writing and, 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.

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HBCF’s 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 Claims Manager is to implement the decision, which is final and binding, as soon as practicable. The Claims Manager is also to notify the claimant of the decision and include contact details for 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 the $500,000, jurisdictional limit of the Tribunal) must be lodged within 45 days of written notification by the Claims Manager of the outcome of the review by HBCF Claims Committee.

The Claims Manager is also to provide information regarding dispute mechanisms external to HBCF, offered by SIRA and available on its website at www.sira.nsw.gov.au.

5 Roles and Constitution of Underwriting, Internal Dispute Resolution (IDR) and Claims Committees

5�1 Eligibility Risk Manager Underwriting CommitteeConstitution

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.

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.

Other Matters

The Eligibility Risk Manager’s Underwriting Committee is also able to consider matters which fall outside the scope of HBCF’s Underwriting Procedures Manual or any instructions, guidelines or written directions given from time to time by HBCF as well as underwriting decisions relating to high risk Builders [i.e. 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 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 HBCF, the NSW Government and broader Government policy, such as a decision that may affect or be inconsistent with 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 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 HBCF Underwriting CommitteeConstitution

HBCF is required to have an Underwriting Committee. The membership of HBCF’s Underwriting Committee is to comprise of the HBCF’s:

• Underwriting Manager [Chairperson]

• Risk Manager [Deputy Chairperson]

• Claims Manager.

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Other members comprise of a Senior Underwriter (or equivalent) from the Eligibility Risk Manager and 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 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.

All members will be required to enter into a Confidentiality Agreement acknowledging and agreeing that:

• The information provided to members of HBCF Underwriting Committee is to be used exclusively for enabling the Underwriting Committee to effectively and efficiently carry out its role and functions

• No amendments will be made to the information provided

• Confidential information obtained as a member of HBCF’s Underwriting Committee will not be disclosed without the express permission of HBCF

• The confidentiality requirements extend beyond the term of 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 HBCF’s Underwriting Committee has finished.

Disputes

Where a Builder is not satisfied with the outcome of the Eligibility Risk Manager’s review of the original underwriting decision, the Builder or a broker on behalf of the Builder may in some instances request the matter to be referred by the Eligibility Risk Manager to HBCF’s Underwriting Committee for review.

A referral to HBCF’s Underwriting Committee is to be formally submitted by the Eligibility Risk Manager in writing to HBCF’s Underwriting Manager. 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 broker), for an assessment and review to be undertaken.

Disputes arising from an underwriting decision of the Eligibility Risk Manager in relation to a matter that is within the scope of the Underwriting Procedures Manual or any instructions, guidelines or written directions given from time to time by HBCF and which is based on factual evidence are not generally to be referred to HBCF or considered by HBCF’s Underwriting Committee unless directed or otherwise agreed by HBCF.

However, decisions to decline, cancel, or negatively modify a Builder’s eligibility or to refuse to provide cover for a specific project based on a subjective assessment may be requested by a Builder (or a broker on behalf of a Builder) to be referred by the Eligibility Risk Manager to HBCF for review by its Underwriting Committee.

Any aspect of a premium determination by HBCF that continues to be disputed by a builder following an internal review by HBCF may also be requested by a Builder (or a broker on behalf of a Builder) to be referred by HBCF for review by its Underwriting Committee.

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.

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 (e.g. by a director, partner, officer, broker, accountant, solicitor etc.).

HBCF’s Underwriting Committee will review the Eligibility Risk Manager’s decision or recommendation to ensure that the Eligibility Risk Manager acted reasonably and in accordance with HBCF’s Underwriting Procedures Manual, Eligibility Manual, relevant legislative provisions, relevant SIRA Guidelines etc. HBCF’s Underwriting Committee will then make a recommendation to HBCF’s General Manager, Builders Warranty who will determine the dispute and HBCF will then notify the Eligibility Risk Manager of the decision.

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The Eligibility Risk Manager is to implement the decision, which is final and binding, as soon as practicable. Where the decision of HBCF is different to that made previously by the Eligibility Risk Manager, the outcome of the dispute shall be amended by the Eligibility Risk Manager to reflect the decision of HBCF.

The Eligibility Risk Manager is to notify the Builder’s broker of the decision and include contact details for HBCF should further information be required about the decision. The Scheme Agent is also to provide information regarding dispute mechanisms external to HBCF, offered by SIRA and available on its website at www.sira.nsw.gov.au.

Other matters

The Eligibility Risk Manager must also refer to 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 HBCF’s Underwriting Procedures Manual or any instructions, guidelines or written directions given from time to time by HBCF may also be referred to HBCF.

Other matters or classes of matters may also be referred to the committee by HBCF (or by the Eligibility Risk Manager when instructed in writing to do so by HBCF) from time to time for consideration.

While the above matters may be routinely referred to HBCF’s Underwriting Committee, HBCF may in its absolute discretion determine an underwriting matter without first having received a recommendation from HBCF’s Underwriting Committee.

Situations where HBCF may act without a recommendation include, but are not limited to:

• Where an urgent response is required

• Where HBCF’s Underwriting Committee is unable to agree on a recommendation

• Where HBCF is concerned, on reasonable grounds, that the committee or a member of the committee may be prejudiced in relation to a matter

• Where HBCF make changes to Underwriting Procedures Manual and Eligibility Manual

The role of HBCF’s Underwriting Committee may also include reviewing HBCF’s Underwriting Procedures Manual and Eligibility Manual and providing advice and recommendations to HBCF on any proposed changes to those procedures.

5�3 Claims Manager Internal Dispute Resolution (IDR)Constitution

The Claims Manager’s Internal Dispute Resolution (IDR) area is to utilise 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 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.

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.

Other matters

The Claims Manager is, always, to be cognisant of the potential broader implications that a claim decision may have for HBCF, the Government and broader Government policy, such as a decision that may affect or be inconsistent with HBCF’s legislative objectives. Any such matters, even if they fall within the Claims Manager’s authority or functions, are to be reported to 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.

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5�4 HBCF Claims CommitteeConstitution

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 HBCF has established a HBCF Claims Committee. The membership of HBCF’s Claims Committee is to comprise of HBCF’s General Manager, Builders Warranty (Chairperson) and the HBCF Claims Manager. The committee may access independent technical and/or legal advice as and when required.

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 HBCF’s Claims Committee for review. A referral to HBCF’s Claims Committee is to be formally submitted by the Claim Manager in writing to 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.

HBCF’s 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.

HBCF’s 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 (e.g. by a director, partner, officer, strata managing agent, owners corporation executive, building consultant, solicitor etc.).

HBCF’s 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, HBCF’s Claims Manual and Claims Information for Homeowners, relevant SIRA Guidelines, and the NSW Government’s Model Litigant Policy etc. HBCF’s 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 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 HBCF. The Claims Manager is also to notify the claimant of the decision and include contact details for 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 the $500,000 jurisdictional limit of the Tribunal) must be lodged within 45 days of written notification by the Claims Manager of the outcome of the review by HBCF’s Claims Committee.

The Scheme Agent is also to provide information regarding dispute mechanisms external to HBCF, offered by SIRA and available on its website at www.sira.nsw.gov.au.

Other matters

The Claims Manager must also refer to 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 together with a supporting submission incorporating relevant background material.

Matters which fall outside the scope of HBCF’s Claims Manual or any instructions, guidelines or written directions given from time to time by HBCF may also be referred to HBCF.

Other matters or classes of matters may also be referred to the committee by HBCF (or by the Claims Manager when instructed in writing to do so by HBCF) from time to time for consideration.

The role of HBCF’s Claims Committee also includes reviewing HBCF’s Claims Manual and Claims Information for Homeowners and providing advice and recommendations to HBCF on any proposed changes to those documents.

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6 HBCF Underwriting Committee - Management and Record Keeping

6�1 QuorumThe quorum for meetings of 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 memberMeetings of 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 VotingA recommendation supported by a majority of the votes cast at a meeting of HBCF’s Underwriting Committee at which a quorum is present is the recommendation of HBCF’s Underwriting Committee.

6�4 MinutesHBCF’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 meansHBCF’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 HBCF’s Underwriting Committee and is to be recorded in the minutes of the meetings of the committee.

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 InterestThe Eligibility Risk Manager representative on HBCF’s Underwriting Committee is to abstain from any vote on a recommendation by the committee to HBCF in relation in relation to a matter involving a dispute over an underwriting decision by the Eligibility Risk Manager.

A member of 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 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 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 ConfidentialityAll members of HBCF’s Underwriting Committee 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.

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6�8 First MeetingThe first meeting of HBCF’s Underwriting Committee is to be called in such manner as 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 3 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 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 HBCF for review

• Referral of a dispute to HBCF by a Scheme Agent is to occur within 3 business days of the Scheme Agent being notified of the complainant’s request that the dispute be referred to HBCF

• A referral to HBCF is to be formally submitted by the Scheme Agent in writing to 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 - HBCF• HBCF will contact the complainant within

5 business days of receiving a dispute to acknowledge receipt and to provide a contact name for enquiries and a timeframe for determining the matter

• HBCF must ensure that the matter is considered by an appropriate officer within 10 business days of receipt by HBCF of the dispute

• HBCF will consider the submissions by the Scheme Agent and by, or on behalf of, the complainant

• HBCF will then formally determine the dispute (via a sign-off by HBCF’s General Manager, Builders Warranty or Group Executive, Insurance for NSW) 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 3 business days of its receipt of the decision and include contact details for HBCF should information be required about the decision. The Scheme Agent is also to provide information regarding dispute mechanisms external to HBCF, offered by SIRA and available on its website at www.sira.nsw.gov.au.

7�3 Eligibility Risk Manager Underwriting Committee - Operation and 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

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• Oral complaints will be acknowledged immediately and written complaints within 3 business days advising the Builder (or broker 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/broker 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 broker on behalf of the Builder) within 5 business days of the committee having considered the complaint

• All decisions must be consistent with HBCF’s Underwriting Procedures Manual or any instructions, guidelines or written directions given from time to time by HBCF

• The response to the Builder or broker is to include written reasons for the decision and a copy of the response is to be provided to HBCF

• The response to the Builder or broker is to also include information about the dispute handling process of HBCF including advice as the type of matters which may be referred to 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 broker that it be treated as a dispute for referral by the Eligibility Risk Manager for further investigation by HBCF

• Referral of a dispute to HBCF by the Eligibility Risk Manager is to occur within 3 business days of the Eligibility Risk Manager being notified of the Builder’s or broker’s request that the dispute be referred to HBCF

• A referral to HBCF’s Underwriting Committee is to be formally submitted by the Eligibility Risk Manager in writing to 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 broker), for an assessment and review to be undertaken

• The Eligibility Risk Manager’s Underwriting Committee is also able to consider:

° matters which fall outside the scope of HBCF’s Underwriting Procedures Manual or any instructions, guidelines or written directions given from time to time by HBCF

° underwriting decisions relating to high risk Builders [i.e. those that are or may be required to be (depending on the view taken by the Committee) subject to intensive monitoring]

° any other matter or class of matters that may be referred to it by 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 HBCF Underwriting Committee - Operation and Service StandardsHBCF is to have an Underwriting Committee in operation. The membership of HBCF’s Underwriting Committee is to be constituted as follows:

• HBCF Underwriting Manager [Chairperson]

• HBCF Risk Manager [Deputy Chairperson]

• HBCF Claims Manager

• a Senior Underwriter, or equivalent, from the Eligibility Risk Manager

• a minimum of two building industry experts {nominations from the Housing Industry Association (HIA) and Master Builders Association (MBA)}.

• All members of HBCF’s Underwriting Committee 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.

• 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

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° any aspect of a premium determination by HBCF that is disputed by a builder

° underwriting matters required to be referred to HBCF by the Eligibility Risk Manager under the Delegation of Underwriting Authorities

° other matters or classes of matters referred from time to time by HBCF (or by the Eligibility Risk Manager when instructed in writing to do so by HBCF)

° reviewing and recommending changes to the Eligibility Manual and Underwriting Procedures Manual as requested by HBCF.

• HBCF will contact the Builder (or broker on behalf of the Builder) within 5 business days of receiving a dispute to acknowledge receipt and to provide a contact name for enquiries and a timeframe for determining the matter.

• HBCF (via the HBCF Underwriting Manager) will initially review disputes referred to it to determine if the original assessment was based on factual evidence or professional subjective discretion.

• A dispute arising from an underwriting decision of the Eligibility Risk Manager in relation to a matter that is:

° within the scope of HBCF’s Underwriting Procedures Manual and Underwriting Eligibility Manual or any instructions, guidelines or written directions given from time to time by HBCF and which is based on factual evidence is not generally to be referred to HBCF or considered by HBCF’s Underwriting Committee unless directed or otherwise agreed by HBCF

° where HBCF is of the view that a dispute should not be referred to its Underwriting Committee because the decision is in relation to a decision that is within the scope of the Underwriting Procedures Manual or any instructions, guidelines or written directions given from time to time by HBCF and which has been based on factual evidence it will advise the Eligibility Risk Manager in writing of its decision within 10 business days of the receipt of the dispute.

• A dispute referred to HBCF arising from an underwriting decision of the Eligibility Risk Manager to decline, cancel, suspend or negatively modify a Builder’s eligibility or to refuse to provide cover for a specific project based on a subjective assessment may be referred by HBCF to its Underwriting Committee for review.

• HBCF’s Underwriting Committee is to meet as required but must meet within 10 business days of receipt by HBCF of a dispute referred to the committee by HBCF, upon HBCF determining that a quorum is available.

• HBCF’s Underwriting Committee will consider the submissions by the Eligibility Risk Manager and by, or on behalf of, the Builder and make a recommendation to HBCF’s General Manager, Builders Warranty .

• HBCF will then formally determine the dispute (via a sign-off by HBCF’s General Manager, Builders Warranty or Group Executive, Insurance for NSW) and notify the Eligibility Risk Manager in writing of the decision within 3 business days of the sign-off. The Eligibility Risk Manager is to implement the decision, which is final and binding, as soon as practicable.

• The Eligibility Risk Manager is also to notify the Builder’s broker in writing of the decision within 3 business days of its receipt of the decision and include contact details for HBCF should information be required about the decision.

• Decisions in relation to any aspect of a premium determination that is disputed by a builder will be notified to the Builder’s broker in writing by HBCF within 3 business days of the determination by HBCF’s General Manager, Builders Warranty or Group Executive, Insurance for NSW.

• Information regarding dispute mechanisms external to HBCF, offered by SIRA as detailed on its website at www.sira.nsw.gov.au should also be provided.

7�5 Claims Manger Internal Dispute Resolution (IDR) - Operation and 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 HBCF (policies).

• Oral complaints will be acknowledged immediately and written complaints within 3 business days advising the claimant of the complaint and dispute handling procedure. All complaints regarding a claim decision will be acknowledged in writing.

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• 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 5 business days of having considered the complaint.

• All decisions must be consistent with HBCF’s Claims Manual or any instructions, guidelines or written directions given from time to time by 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 HBCF and how to access the dispute handling process. The response should also advise that any request for referral of a dispute to 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 by-pass 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 Manager for further investigation by HBCF.

• Referral of a dispute to HBCF by the Claims Manager is to occur within 3 business days of the Claims Manager being notified of the claimant’s request that the dispute be referred to HBCF.

• A referral to HBCF’s Claims Committee is to be formally submitted by the Claims Manager in writing to 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 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 HBCF Claims Committee - Operation and Service StandardsHBCF is to have a Claims Committee and the membership of HBCF’s Claims Committee is to be constituted as follows:

• General Manager, Builders Warranty (Chairperson)

• HBCF Claims Manager.

• The committee may access independent technical and/or legal advice as and when required.

• HBCF’s 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 HBCF by the Claims Manager under the Delegations of Claims Handling Authorities

° other matters or classes of matters referred from time to time by HBCF (or by the Claims Manager when instructed in writing to do so by HBCF)

° reviewing and recommending changes to the Claims Manual and Claims Information for Homeowners when requested by HBCF.

• HBCF will contact the claimant within 5 business days of receiving a dispute to acknowledge receipt and to provide a contact name for enquiries and a timeframe for determining the matter.

• HBCF’s Claims Committee is to meet as required but must meet within 10 business days of receipt by HBCF of a dispute.

• HBCF’s Claims Committee will consider the submissions by the Claims Manager and by, or on behalf of, the claimant and make a decision.

• HBCF will then formally determine the dispute (via a sign-off by HBCF’s General Manager, Builders Warranty or Group Executive, Insurance for NSW) and notify the Claims Manager in writing of the decision within 3 business days of the Claims Committee having made its recommendation.

• The Claims Manager is to implement the decision, which is final and binding, as soon as practicable.

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• The Claims Manager is also to notify the claimant in writing of the decision within 3 business days of its receipt of the decision and include contact details for 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 the $500,000 jurisdictional limit of the Tribunal) must be lodged within 45 days of written notification by the Claims Manager of the outcome of the review by HBCF Claims Committee.

• Information should also be provided to the claimant regarding dispute mechanisms external to HBCF, offered by SIRA as detailed on its website at www.sira.nsw.gov.au.

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 Act, the Regulation, the 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 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, it must be provided to SIRA with the written complaint.

8�3 Requests for Regulator Compliance Review (Eligibility)• A contractor may request that SIRA undertake

a regulator compliance review to investigate potential breaches of the Act, the Regulation or the Insurance Guidelines by icare HBCF.

• A regulator compliance review is not a mechanism of appeal to review of the merits of a particular contractor’s eligibility and does not overturn eligibility decisions.

8�4 Other Complaints About icare HBCF (Eligibility)• A contractor also has the option of lodging a

complaint about icare HBCF with SIRA.

• icare HBCF is to provide SIRA’s contact details to a contractor so that they may seek a further review where they are not satisfied with the approach or outcome of the icare HBCF’s determination.

Contact Details – SIRA

Telephone: 13 10 50

Email: [email protected]

Postal & Business Address: Level 6, McKell Building, 2-24 Rawson Place, Sydney NSW 2000

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