Complaints Resolution Policy

As at September 2018

Our Objective

Westfund’s Board and Executive Management recognise that careful and considered handling of complaints and disputes is good management practice. A robust complaints resolution policy enables our organisation to achieve organisational objectives and forms an integral part of sound risk management.

An effective complaints policy can lead to:

  • an opportunity to maintain and enhance member loyalty;
  • reviewed and enhanced products and services; and
  • improvements in the interaction with members.

Westfund aims to resolve complaints efficiently and within set timeframes. Our staff aim to be able to resolve the majority of complaints at the initial point of contact.

Lodging a complaint

Westfund encourages our members and providers to lodge any complaint with us directly. You are able to lodge a complaint through the following channels:

In person – Our Care Centre locations can be found here

Email – complaints@westfund.com.au

Mail – Complaints Officer, PO Box 235, Lithgow NSW 2790

Phone – 1300 937 838

Online Form – www.westfund.com.au/contact-us/online/

Our procedure

Westfund aims to resolve complaints efficiently and within set timeframes.

Upon receipt of your complaint, you will receive an acknowledgement from the staff member you first made contact with. Westfund will aim to have your complaint resolved within 3 business days.

If your complaint is unable to be resolved at the first point of contact or requires further consideration, it will be escalated to the relevant team manager. You will be contacted within 14 business days in an effort to resolve your complaint.

If your complaint is still not resolved, the matter will then be referred to our Complaints Officer. The Complaints Officer will acknowledge receipt of the complaint (either by phone, mail or email) and has 21 business days from the time of acknowledgement or when all information is received regarding the complaint, to resolve the matter. If resolved, the Complaints Officer will contact you through your preferred channel with advice of the resolution.

Commonwealth Ombudsman

If you are not satisfied with the outcome of our investigation, you can lodge your complaint with the Commonwealth Ombudsman. The Commonwealth Ombudsman can be contacted on 1300 362 072 or you can write to:

Commonwealth Ombudsman
GPO Box 442
CANBERRA ACT 2601

More information can be found online at ombudsman.gov.au.

Privacy

You can also make a complaint in relation to Westfund breaching the Australian Privacy Principles (APPs) or the Westfund Privacy Policy.

In the first instance, you should lodge your complaint with Westfund following the procedures stated in our Privacy Policy. If you are not satisfied with the outcome, you can take your complaint to the Office of the Australian Information Commissioner (OAIC).

Information on how to make a complaint with the OAIC can be found here.

Eye Care and Dental

If your complaint refers to a matter relating to our Dental or Eye Care Centres, you can contact the Executive Manager Health Care Services at casmirie@westfund.com.au.

If you are not satisfied with the outcome of our processes, then you can refer it to the relevant governance board.

State Governing board
NSW Health Care Complaints Commission
QLD Office of the Health Ombudsman
All other states Australian Health Practitioner Regulation Agency

 

Private Health Insurance Code of Conduct

Westfund is a signatory to the Private Health Insurance Code of Conduct.
The code is designed to help you by providing clear information and transparency in your relationships with health funds.
Private Health Insurance Code of Conduct Logo View the Code of Conduct documents