OFFICIAL DOCUMENT 1

Standard Operating Procedure

For Internal Use Only

The contents of this document are OFFICIAL.

Complaints Resolution and Oversight Template

Guide

Complaints Resolution and Oversight Template Guide ………………cccceeeeceececeeeeeeeeeeeeeeeeeees 1 PR =) on C0) es 3 1.1 SMS Allert Options ……….. 2… cece cece cece eee eeccec ce eeeccceaeeeeeeeceeeeeeeseaeeeseeeseeesseeeeseeeseeees 4 1.2 Contact Attempt 1, 2 or 3 - PhOne ..22.. o.oo ccc cee eecce cece eecceceeeeeeeeeeneeeeeees 6 1.3 Contact Attempt — Email ……… o.oo ccc c cece cece cee eeeeeceeeeecceeeeeeeeeeeececeeseeseeeeeeeeeeeeeeeeeea 7 1.4 Contact Established . 20.0.0… ceeceeceseeeeeeeeeeeeeeeeeeeeeeeeeeeeeeaeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeees 7 1.5 Contact between Complaints Officers for complaint/s carriage ……………………… 10 1.6 Verbal Consent Obtained …0……… eee eee ec ceecce eee e cece eeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeees 10 2. Follow-up Interactions …………… 02… cccceeeeeeee ce eeee cee eeeeeneeeceeeeeeeeeeeeeeeeeaeeeeeseeeeeeeeeeeaeees 11 3. Request for Action (RFA)………………cc:cceeeeseeeeeeeeceeeeeeeeeneeeeeeeaceaeeeneseeeeeeeeaeeeeeeeeeeeeees 13 3.1 Create a RFA in CRM .00… oo… ceeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeneeeneeteeees 13 3.2 Create an off-system (manual) RFA………………….ccccccccceceeeccecceeeeeeeceseeeseeeeeeeeeees 15 3.3 RFA endorsement email to COMPLAINTS.INTERNAL inbox for Senior Complaints Officer/Team Leader endorsement…………………….eeccceceeeeeceeeeeeeeeeees 19 3.4 CMT - RFA Escalation template ………0….. 2. cecccecccececcceeeeeeeeeeceeceeeeeeeeeeeeseeeees 19 4. Request for explanation Of a CECISION ……….. 2… eee eeeceeeeeceeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeees 21 5. Payment Enquiries …………….0…cccceecceceeceeeeeeeeeeeeeeeeeceeeeeeseeeeeeeeeeeeeenseeeeeeeeeeseeeeeeeeeeees 21 6. Recording complaints outcome in the Outcome sub-tile …………….0….. ee 22 6.1 Complainant uncontactable — unable to progress ……………… 2. ceeeceeeeeeeeeceeeeeeeeees 22 6.2 Able to progress COMplaint ………… 2… ce cece cee cce cee ce eee eeeeceeeeeceeeeeeeeseeseeeeeeseeeaeeeees 22 7. Email templates …2…………. ccc ec cece eececeeeceeeeeceeeeeeneeeeeeeeeneeeeeeeeeeeeeeeseseeeeeeeeeeeeeseeeeeeas 24 7.1 Email to the NDIS Fraud Team 2.20.0… eeeeeeeeeeeeeeeeeeeeeeeeeeeeeneeeneeenenseeeneeseeseeeene 26 7.2 Send an SMS Via Outlook …2…. 2… eeeeeeeeeeeeeeee eee e eee eeeeeeeeeeeeeeeeeeeeneeeeeeeeeeee 27

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7.3 Email Contact Attempt 1 or 2 …………………………………………………………………….28

7.4 Email/Phone - Unable to contact – unable to progress complaint ………………….. 28

7.5 Email/phone – Unable to contact - complaint progressed …………………………….. 29

7.6 Email/phone – Complaint Progressed after contact (use this if complainant wants an email confirmation of the discussion) …………………………………………………….30

7.7 Reassigning Complaint to another Complaints Officer (Internal only) …………….. 30

7.8 Payment Enquiry …………………………………………………………………………………….31

7.9 Respond to complainant - Feedback referred to Review Team ……………………… 33

7.10 Response for Staff Complaint ……………………………………………………………………34

7.11 Response to complainant – Internal Review Declined – Mainstream services available ………………………………………………………………………………………………..36

7.12 Response to complainant – Where case is at ART …………………………………….. 37

7.13 Response to complainant – Referred to National Delivery (use this with the follow-up process where resolution will take more than 21days) ……………………. 38

7.14 Response to complainant – Complaints for the NDIS Quality and Safeguards Commission ……………………………………………………………………………………………39

7.15 Restream Request ………………………………………………………………………………….39

7.16 Maintain privacy ……………………………………………………………………………………..40

7.17 Email to the NDIS Fraud Team …………………………………………………………………40

7.18 Complaint regarding fraud allegation ………………………………………………………….41

7.19 Managing multiple complaints about same issue from same complainant ………. 42

7.20 Managing restrictions on unreasonable behaviour ………………………………………. 43

Temporary measure ONLY ………………………………………………………………………….46

8.1 Where complaint is regarding the SDA Pricing Review 2023-24 and the new SDA rates effective 1 July 2023 ………………………………………………………………………..46

8.2 Where complaint is about Provider staff and/or services ………………………………. 47

Oversight Complaints Email Templates ………………………………………………………. 49

9.1 NDIS Quality & Safeguards Commission email templates ……………………………. 50

9.2 Commonwealth Ombudsman email templates ……………………………………………. 52

9.3 NSW Ageing and Disability Commission (ADC) email template …………………….. 54

Feedback ………………………………………………………………………………………………………… 55

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Version control …………………………………………………………………………………………………55

This document provides templates for use by Complaints Officers in:

 Documenting complaints actions

 Requests for action

 Email and verbal communication with complainants.

Templates provide for consistency in documenting actions and written advice, as well as efficiency for staff in having a readily available guide for use.

Use Record, view and update a complaint SOP to help record, view and update complaints in CRM using My Requests tile.

Select the topic in the Interaction templates, Request For Action (RFA) templates or Email templates tables below to move to the relevant template:

o Use Interaction templates to record all contact and activities in CRM to action/resolve complaints.

o Use Request For Action templates to request information or action from another NDIA business area (or areas) to support resolution of a complaint.

o Use Email templates/Oversight Complaints Email templates when communicating with participant and third parties on the behalf of the participant. These templates cover most standard scenarios encountered during the complaint process and are a reference tool (not mandatory) for Complaints Officers.

1. Interactions

Recording interactions in the NDIS Business System (CRM) is mandatory. It is essential for information gathering, record keeping and a nationally consistent service delivery approach.

Interactions

For further guidance on creating, using and searching for interactions refer to Guide to Interactions in the NDIS Business System and Standard Operating Procedure – Create, assign, search and edit an interaction.

Note: Generally, one interaction will be created for a Complaint. All subsequent interactions to be added to the main interaction by using the Edit button.

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For sensitive complaints, create Interactions within the complaint in My Request tile. This way it will not be visible directly from interactions list, but will be from the specific complaint work item.

Interaction Topic	Context
SMS prior to Contact Attempt by Phone	SMS prior to all attempts to contact by phone
SMS post Contact Attempt by Email	SMS after attempts to contact by email
Contact Attempt 1, 2 or 3 - Phone	First, second and third contact attempt via phone
Contact Attempt 1 or 2 — Email	First and second contact attempt via email
Contact Established — with Participant OR Child Representative OR Nominee updated OR Unauthorised Representative	Contact established with a participant, nominee, child representative OR a person who is not an authorised representative, or whose identity is unable to be verified.
Contact between Complaints Officers for complaint/s Carriage	Confirmation on which Complaint Officer is to take carriage of the complaint when there are multiple complaints received simultaneously.
Verbal Consent Obtained	Record verbal consent provided by participant, nominee, child representative or court/tribunal
Follow-up Interactions	Create follow-up interactions following the Follow-up Process
Recording outcome in Outcomes sub-tile	Record information prior to closing complaint

Table caption: Table with links to templates to record contact with complainant in CRM.

1.1 SMS Alert Options

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It is mandatory to send an SMS alert prior to phone contact attempt and after attempting to make contact via email. Do not edit the templates as they are the approved NDIA SMS alerts. Send SMS message email from redacted: s47E(d) - certain operations of agencies email. Delete your signature section within the email when composing the message.

When sending the SMS the Complaints Officer is to allow at least a 15-30 minute window from the time the SMS is sent to the phone call being made to allow the Complainant time to prepare for the phone call.

Once contact is established you are not required to send the SMS alert for subsequent phone calls with the complainant.

You may choose to send the SMS alert for follow up conversations however is it not mandatory to do so.

SMS prior to Contact Attempt by Phone

Category 1: Pathway

Category 2: General

Category 3: Complaint or Compliment received

Channel: Phone

Status: Completed

Link Transaction: Yes

Process Type Group: COMPLAINT RELATED

Transaction ID: [Enter My Request ID e.g. 8100XXXXX]

In the Notes section, record the details.

Copy and Paste the following from your Sent email (from your sent email, press Forward button to get the following content) *

From: CO Name On Behalf Of COMPLAINTS.INTERNAL Sent: Friday, 4 November 2022 2:55 PM To: 04XXXXXXXX@directsms.com.au Subject: Important Message: A representative from the NDIA will call you at am/pm on dd/mm/yyyy regarding Complaint ID 81XXXXXXXX from a private number. [SEC=UNOFFICIAL]

SMS post Contact Attempt by Email

Category 1: Pathway

Category 2: General

Category 3: Complaint or Compliment received

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Channel: Email

Status: Completed

Link Transaction: Yes

Process Type Group: COMPLAINT RELATED

Transaction ID: [Enter My Request ID e.g. 8100XXXXX]

In the Notes section, record the details.

Copy and Paste the following from your Sent email (from your sent email, press Forward button to get the following content) *

From: CO Name On Behalf Of COMPLAINTS.INTERNAL Sent: Friday, 4 November 2022 2:55 PM To: 04XXXXXXXX@directsms.com.au Subject: Important Message: A representative from the NDIA has sent you an email regarding Complaint ID 81XXXXXXXX on dd/mm/yyyy. Please check your email inbox. [SEC=UNOFFICIAL]

1.2 Contact Attempt 1, 2 or 3 - Phone

Category 1: Pathway

Category 2: General

Category 3: Complaint or Compliment received

Channel: Phone

Status: Completed

Link Transaction: Yes

Process Type Group: COMPLAINT RELATED

Transaction ID: [Enter My Request ID e.g. 8100XXXXX]

In the Notes section, record the details.

Attempt 1 or Attempt 2 Template

Contact attempt 1 with: <relationship – nominee/child rep/guardian/participant>

Date: DD-Month- 2022 Time: XX.XXam/pm number

Contact attempted to discuss complaint, no answer, no message was left/a voicemail was left with Complaints Officer’s name.

Next steps: Will attempt to contact <this afternoon/tomorrow> again.

Attempt 3 Template

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Contact attempt 3 with: <relationship – nominee/child rep/guardian/participant>

Date: DD-Month-2022 Time: XX.XXam/pm number

Contact attempted to discuss complaint, no answer, no message was left/a voicemail was left with Complaints Officer’s name.

Next steps: Will send an email if available) to advise <how their complaint will be progressed/complaint will be closed due to unable to contact>.

Select Submit

1.3 Contact Attempt – Email

Category 1: Pathway

Category 2: General

Category 3: Complaint or Compliment received

Channel: Email

Status: Completed

Link Transaction: Yes

Process Type Group: COMPLAINT RELATED

Transaction ID: [Enter My Request ID e.g. 8100XXXXX]

In the Notes section,

Contact with: <relationship – nominee/child rep/guardian/participant>

Email address:

Date and time:

Attempt 1 template

Email contact attempted to discuss the complaint. Copy/paste text of email sent.

Attempt 2 template

Follow up email sent due to no response to the initial email sent on (date original email sent). Copy/paste text of email sent.

Next steps informed: Will attempt phone contact <input Day/Date>.

Select Submit

1.4 Contact Established

Category 1: Pathway

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Category 2: General

Category 3: Contact with Participant or Nominee Updated or Child Representative Updated or Contact - Unauthorised representative

Channel: Phone or Email

Status: Completed

Link Transaction: Yes

Process Type Group: COMPLAINT RELATED

Transaction ID: [Enter My Request ID e.g. 8100XXXXX]

In the Notes section, record the details of your conversation and/or copy and paste email communication.

With Participant, Child Representative or Nominee

Contact with: <relationship – nominee/child rep/guardian/participant>

POI Confirmed:

Introduced self as Complaints Officer that will manage complaint regarding [complaint theme/discussion/request]

For example:

 Delay in approval of AT, Plan reivew

 Staff complaint

Additional information sought to progress complaint or clarification of issue raised:

Next steps informed: <Add steps/process discussed including timeframe>

Select Submit

With Unauthorised Representative

Contact with: <relationship with participant such as provider/social worker/support coordinator>

Consent and POI Confirmed:

Introduced self as Complaints Officer that will manage complaint regarding [complaint theme/discussion/request]

<Request/s> Actions: Explain any action you have taken such as contacting the participant, their nominee, child representative or court/tribunal appointed decision maker to confirm consent.

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Consent confirmed with <participant/nominee> on DD/MM/YYYY via <email/phone>

If no consent provided: Unable to provide information as <participant/nominee> did not provide consent to share information.

Complaint themes: (for example)

 Delay in approval of AT, Plan reivew

 Staff complaint

Next steps informed: <Add steps/process discussed including timeframe>

Select Submit

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1.5 Contact between Complaints Officers for complaint/s carriage

Category 1: Pathway

Category 2: General

Category 3: Complaint or Compliment received

Channel: Internal Notes

Status: Completed

Link Transaction: Yes

Process Type Group: COMPLAINT RELATED

Transaction ID: [Enter My Request ID e.g. 8100XXXXX]

In the Notes section, record the following and/or copy and paste email correspondence with the Complaint Officer.

Communicated via [Teams/email/phone] with CO that they will take carriage of complaint along with the complaint they are currently handling.

CO to assign the complaint to receiving staff member.

Category 1: Pathway

Category 2: General

Category 3: Verbal consent obtained

Channel: Phone

Status: Completed

Link Transaction: Yes

Process Type Group: COMPLAINT RELATED

Transaction ID: [Enter My Request ID e.g. 8100XXXXX]

In the Notes section, record the details of your conversation.

Include details of who is giving verbal consent (the participant, their nominee, child representative or court/tribunal appointed decision maker). Include the name and contact details of the organisation or individual who has been provided with consent.

Include details of the purpose for consent, any limits to the consent and for how long consent is provided.

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2. Follow-up Interactions

Create a Follow-up Interaction

To create a Follow-up interaction please follow the Recording complaint discussions as interactions procedure and apply the specific categories as outlined below.

Follow-up interaction categories:

 For follow up interactions created within the My Customer Request app select the following: Category 1: Pathway

  **Category 2:** Monitoring

  **Category 3:** Ongoing Monitoring

  **Channel:** Internal Notes

  **Status:** Open

  **Notes:** Complaint ID: [8100XXXXXX]

 **RFA Response:** RFA sent to <business area> on DD-MM-2022; assigned to <insert staff
   login> to complete request.

  **Action to be completed:** [summary of action e.g., AT for wheelchair to be approved by
   planner].

 **Due date for action to be completed:** DD-MM-YYYY

 For follow up interactions created via the My NDIS (Participant) or My Organisations (Provider) apps select the following and link it to the specific My Customer Request ID. Category 1: Pathway

  **Category 2:** Monitoring

  **Category 3:** Ongoing Monitoring

  **Channel:** Internal Notes

  **Status:** Open

  **Link Transaction:** Yes

 **Process Type Group:** COMPLAINT RELATED

  **Transaction ID:** complaint number (e.g., 810000000)

  **Notes:**

 **RFA Response:** RFA sent to <business area> on DD-MM-2022; assigned to <insert staff
   login> to complete request.

  **Action to be completed:** [summary of action e.g., AT for wheelchair to be approved by
   planner].

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 **Due date for action to be completed:** DD-MM-YYYY

On both occasions above, make sure the interaction status is recorded as Open Do not update the Status of the interaction to Completed. Selecting Open will place the interaction as a task to complete in the employee and/or team responsible inbox.

Assign the submitted Follow-up interaction to the CR PF CR B1/CR PF CR B1 Complaints Resolution Bay 1 inbox.

Click Assign

Select Submit

If follow-up contact is required in less than 28 calendar days

If the outstanding actions require follow-up prior to the 28 calendar days, the follow-up interaction will need to be recorded as per the previous steps and a shared calendar invite will be added on the date the Complaints Officer has agreed to follow-up.

To record a shared calendar invite:

Open the Complaint Internal Inbox calendar in Microsoft Outlook If you do not have access to the Complaints Internal calendar email Complaints Inbox

Select the date and time you are required to contact the person.

Double click to open the appointment screen. The Appointment screen will open.

In the Subject field, type and fill in the following:

  Follow-up interaction - Complaint ID <Complaint ID> Interaction ID <Interaction ID>
Name to Contact: <First and Last name>.

Select the Appointments tab, then Invite Attendees tile.

Click on To and invite Complaints.Internal (for Track and Triage team to do the contacting) to the meeting invitation.

From the Categorise drop down menu, select Categorise colour green – labelled as Follow-up interaction, then select OK

Select Send to send and save the reminder to the calendars.

Email Classification pop up screen will appear. Select Official as per the Agency’s classification policy and select Send

The reminders will now be saved in your calendar and the Complaints Internal calendar.

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3. Request for Action (RFA)

For Level 2 complaints, all RFAs must be endorsed before creating them in CRM.

Complaints Officers must use the relevant RFA template and RFA endorsement email and email at redacted: s47E(d) - certain operations of agencies jo x for SCO/TL endorsement.

Interaction Topic	Context
Create on system Request for Action (RFA)	Create CRM based RFA to request information from business area
Create off-system/manual Request for Action (RFA)	Create a manual RFA to request information from business area
RFA Endorsement	To get Senior Complaints Officer/Team leader to endorse RFA prior to creating it in CRM
RFA Escalation	To escalate RFA to the relevant business area
Payment Enquiries RFA	Create and refer payment related complaints to the Payment Escalations team

Table caption: Table of RFA Interactions to be recorded in CRM.

3.1 Create a RFA in CRM

Select the Complaint from within the My Requests Tile. Open the Transaction ID that requires a Request for Action. Then select the Request for Action tab. Select Create from the bottom right hand corner.

Complete the below and copy and paste it the Requested Action free text box

Complaint ID: <8100XXXXXxX>

Response Due: DD/MM/YY* (By this date, we require confirmation that your team will take carriage of this matter and the steps to resolve it)

*<List reasons if less than 5 business days are provided to a business area for a response for low/medium risk RFA>

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The CMT team is investigating a complaint that requires the support of your business area to resolve.

NOTE - Please leave the Complaint assigned to the Complaints Officer - only complete the RFA outcome area with the actions undertaken – Do not close the Complaint - this prevents the Complaints Officer from completing necessary processes

Participant:

Complaint Summary and concerns raised: Complainant <Participant/Complainant Name> has made a complaint around <delay in plan approval/delay in AT approval/issue with Service Booking/delay with planning meeting/contact from the planner>

List all concerns raised by the Participant/Complainant

CO Investigation: Summarise CO investigation from Interactions/attached documents/R&N justifications in plan

Examples below *

             Interaction No. [insert number] mentions plan meeting

             occurred on DD/MM/YY however plan still not approved.
             Interaction No. [insert number] mentions

              participant/nominee/SC called to follow up on plan approval
             Interaction No. [insert number]/ Planning Conversation tool

            mentions AT was discussed in the planning meeting on date

                  [insert date]…
             Interaction No. mentions AT quote received…
             Interaction No. mentions participant/nominee tried to contact

             planner and left a message for them
            Document Name, date attached, mentions...
            R&N justification mentions ….

Action/s required: Can business area please: <List actions required from the business area such as –

              Make contact with the participant to arrange for a planning

              meeting
              Time frame for plan approval

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 Create Service booking meeting for participant  Arrange planner explanation of decision to decline the support  Any other>

Please contact me if you require any further information or clarification.

Thank you for your assistance.

Kind regards,

Field	Value
Internal Acknowledgement due* (Date RFA is created by CO)	Click or tap to enter a date.
Response due* (Date RFA response is due back from the business area)	Click or tap to enter a date.
Resolution due* (Date resolution is required by. Resolution may mean that the matter is completely finalised, the risk has been mitigated or the next steps are clear and/or confirmed to be underway)	Click or tap to enter a date.

Form caption: RFA Template.

- Enter Date fields manually, making sure they are in line with the Escalation Prioritisation Matrix

Note: If you are unsure on the dates to record based on risk level or action required, please liaise with your Senior Complaints Officer.

3.2 Create an off-system (manual) RFA

Note: Add all off-system RFAs on CRM and assign to redacted: s47F - personal privacy (login Y40) CRM inbox as a holding bay. No further action is required until the RFA is responded to by the relevant business area.

Subject: For Action: Complaint ID [8100XXXXX] RFA [Low/Medium/High/Extreme] Risk; Due by: [Response Due Date] [NDIS Number] [Participant Name]

Good <Morning/Afternoon> (insert team/member name here),

The Complaints and Participants Incident team has received a complaint from (source/name of complainant) and we require your support to resolve this complaint.

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Please see below RFA providing detail on the issue and actions requested.

Please respond to this request by <DD/MM/YYYY> or contact me to advise if there will be a delay in your response.

If you require further information, please do not hesitate to contact me.

Thank you for your assistance.

Kind regards,

Request for Action

Please make sure the requested action is completed to avoid further escalation.

Risk Present	Prioritisation Rating
Choose an item.	Choose an item.
Participant’s Name	NDIS Number (if known)	State

Complainant’s Name	Complaint ID	Relationship to Participant
		Choose an item.
Response Due	Resolution Due	Partner Organisation
Click or tap to enter a date.	Click or tap to enter a date.
Issue Category	SELECT ISSUE CATEGORY
Issue Summary	Clearly summarise the issue in this section

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Issue Category	SELECT ISSUE CATEGORY
	• Interaction No. [insert number] mentions plan meeting occurred on DD/MM/YY however plan still not approved. • Interaction No. [insert number] mentions participant/nominee/SC called to follow up on plan approval • Interaction No. [insert number]/ Planning Conversation tool mentions AT was discussed in the planning meeting on date [insert date]… • Interaction No. mentions AT quote received… • Interaction No. mentions participant/nominee tried to contact planner and left a message for them • Document Name, date attached, mentions… • R&N justification mentions ….
Requested Action	• Make contact with the participant to arrange for a planning meeting • Time frame for plan approval • Create Service booking meeting for participant • Arrange planner explanation of decision to decline the support • For reporting Fraud - Fraud Team to provide Case ID number by due date DD/MM/YY • Any other>
Is a response required to a	<YES/NO>

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Issue Category	SELECT ISSUE CATEGORY
Complaints Officer?
Action to be completed by?	Complete this section - if less than 5 business days are provided to a business area for a response for low/medium risk RFA. Click or tap to enter a date.
CRM ‘Action Complete’ Interaction	<If response required - Please respond to complaints officer by action completed date> RFA Completed: <Date action completed, filled in by external business area> Completed by:


RFA sent to	Enter team name
RFA sent on	Click or tap to enter a date.
RFA sent by	Enter Complaint Officer Name

Table caption: Off System RFA Template

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3.3 RFA endorsement email to COMPLAINTS.INTERNAL inbox for Senior

Complaints Officer/Team Leader endorsement

Subject: For Endorsement: Complaint Number [8100XXXXXX] [Low/Medium/High/Extreme] Risk [NDIS Number]

Hi <SCO/TL name>

Please endorse this RFA today so it can be sent to .

Alternately, please let me know if any other steps are required to resolve this complaint.

Investigation: I have researched the following areas prior to creating the RFA:

Choose the most relevant one/s and provide reasoning *  Participant plan:  Service Bookings:  Payments:  Quotes:  Interactions:  Attachments:  Previous complaints:

Thank you for your assistance.

Kind regards,

3.4 CMT - RFA Escalation template

Complaints Officers must complete the RFA Escalation template where:

 -  concerns remain unresolved;

 -   additional information is required;

 -  proposed action does not adequately address the concerns raised; or

 -  RFA is overdue and Complaints Officer has followed it up with business area at least
  once after it is 24hours overdue.

The RFA Escalation template must include the action undertaken/advice provided by the business area and outcome sought for consideration by your Senior Complaints Officer/Team Leader.

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Use the email template to send RFA escalation to COMPLAINTS.INTERNAL inbox for endorsement by your Senior Complaints Officer/Team Leader.

Subject: For Action: Complaint ID [8100XXXXX] RFA [Low/Medium/High/Extreme] Risk; Due by: [Response Due Date] [NDIS Number] [Participant Name]

Hi <SCO/TL name>

Please see below RFA Escalation template for your endorsement.

Reason for escalation: RFA is overdue/ complaint becoming overdue /extreme risk to participant’s health/funding exhausted in plan/etc.

Thank you for your assistance.

Kind regards,

CMT — RFA Escalation Template


Participant / Provider Name
NDIS Number
Complaint ID
RFA ID #:
RFA Issued
RFA Due Date (To be taken from ‘Response Due’ in Request)
Risk Rating
State/Territory
RFA sent to CRM inbox and/or email
	List below in dot points
Summary of Complaint
Actions completed by business area/delegate to resolve the issue

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(response and next steps)
Outcome sought

Table caption: RFA Escalation Template

4. Request for explanation of a decision

Category 1: NCC Priority Enquiry

Category 2: NCC Priority Enquiry

Category 3: Request an explanation of a decision

Channel: Select from the drop-down menu how you received the request

Status: Open — until an explanation is given by the Plan Delegate and attached in the system

Notes: Record any relevant information from your conversation with the participant.

Date of request: DD/MM/YYYY.

Person making request: Include name and relationship to participant (if not participant).

If not the participant, does this person have the authority to act on behalf of the participant: Yes / No.

Caller Contact Number:

Approving Delegate name:

Details of the request:

Advise which decision/s need an explanation and give full details of what the participant enquiry is about and why they need an explanation. For example, participant was expecting additional hours of support, thought plan funding would be higher, why was the support declined etc.

5. Payment Enquiries

If you have a complaint that requires actions to be taken by the Payments Branch, a Payment Enquiry is required. These enquiries are created through the Payment Enquiries app. The templates required to be used for Payment Enquiries can be found in CMT — Interaction Templates Guide.

Step by step instructions on how to create and action a Payment Enquiry are outlined in the Standard Operating Procedure - Enter Escalations Payment Enquiry in NDIS Business System.

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6. Recording complaints outcome in the Outcome sub-tile

Complaints Officers must make a brief/one line note of any actions taken during complaint management. This will enable any other Complaints Officer to continue working on the complaint in your planned/unplanned absence.

6.1 Complainant uncontactable – unable to progress

DD/MM/YY – Complaints Officer’s Login

Complaint Summary:

Attempted contact with participant/complainant three times via email/phone as per the interactions/emails attached.

Unable to make contact with participant/complainant. Unable to progress complaint as need additional information – [insert information needed]. Unable to resolve and complaint closed.

6.2 Able to progress complaint

In the outcome notes section use below template to update complaint as it progresses:

DD/MM/YY – Complaints Officer’s Login - Investigation Commenced

Complaint Summary:

Where contact made with complainant: Contact made with [participant/complainant] via [email/phone] as per the interactions/emails attached. OR Where unable to contact complainant but were able to progress complaint: Unable to make contact with participant/complainant, attempted to contact X times. Able to progress complaint from the information provided.

[Insert Complaint Summary for e.g., Complaint about delay in AT approval/staff behaviour/no contact/awaiting planning meeting/unable to create Service Booking/payment delays, etc.

Actions:

DD/MM/YY - – e.g., Contacted complainant via phone/email as per interactions

DD/MM/YY - – e.g., RFA sent for endorsement

DD/MM/YY - – e.g., RFA endorsed and sent to

DD/MM/YY - – e.g., Overdue RFA reminder sent to

DD/MM/YY - – e.g., RFA response received and closed

Complaint Outcome: [insert actions completed/in train to resolve the complaint].

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Emailed participant/complainant to provide an update.

[No Further Action for Complaints team] or [Reconnect Follow Up created to monitor requested actions].

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7. Email templates

The following pages are email templates that staff can use to guide them when sending emails to complainants, team leader and other business areas. Includes email templates for Oversight team as well.

All correspondence must be in Plain English and follow the NDIS Writing Style Guide. Refer to NDIA Standard Words for wordings for more templates

Note: Copy/paste email texts in Interactions and not attach it in Inbound Documents

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Interaction Topic	Context
Send an SMS via Outlook	Send SMS via email prior to phone or email contact
Email Contact Attempt 1 or 2	First and second contact attempt via email
Email/Phone – UTC – unable to progress complaint	Email to advise unable to progress complaint as no contact established with complainant
Email/Phone – UTC – complaint progressed	Email to advise complaint progressed despite no contact established with complainant
Email/Phone – Complaint Progressed	Email response after contact with complainant and complaint progressed (to be used if complainant wants an email confirmation of the discussion)
Reassigning complaint to another Complaints Officer	Email to advise a CMT team member when reassigning a new complaint as a result of previous complaint that was handled/closed by them within 2 weeks prior
Payment Enquiry	Response to complainant or Provider (for self-managed or plan-managed participants) for payment enquiries
Feedback referred to Review team	Response to complainant who is unsatisfied with funded supports in plan and wants a plan review
Response for staff complaint	Response to complainant and template for forwarding staff complaint to staff member’s team leader
Internal Review declined – Mainstream services available	Internal review declined due to supports being available through mainstream services
Where participant case is at ART	Response to complainant and template for requesting action/information on complaint received where ART Case Management branch/manager is listed in the alert
Where complaint is referred to National Delivery	Update to complainant where matter is referred to National Delivery for action (use this with follow-up

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Interaction Topic	Context
	process where resolution will take more than 21days)
Complaints for the NDIS Quality and Safeguards Commission	Response to complainant referring them to lodge provider complaint with the NDIS Quality and Safeguards Commission
Restream request	Response to restreaming request
Maintain privacy	Response to maintain privacy by not disclosing information
7.1 Email to the NDIS Fraud Team	Email to the NDIS Fraud team with manual RFA providing detail of fraud allegations reported and request for Case ID number.
Complaint regarding fraud/allegation	Response to complainant providing information on how fraud/allegations are handled within the NDIA
Managing multiple complaints about same issue from same complainant	Response to the complainant where multiple complaints from the same complainant about the same issue with the same outcome has been provided at least twice previously.

Response includes:

Advising previous complaint resolution and request for new information
No longer responding to a complainant about particular complaint as has been addressed numerous times previously | | Managing restrictions on unreasonable behaviour

(Assistant Director and Director to endorse) | Response to complainant where they have displayed or are continuing to display unreasonable behaviour when communicating with Complaints staff.

Response includes: |

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Interaction Topic	Context
	* Notifying complainant that restrictions may be applied on unreasonable behaviour (Assistant Director to endorse)

Notifying complainant that restrictions will be applied due to unreasonable behaviour (Director to endorse) | | Temporary measures only | These templates are to be used when directed by the Leadership team at the time when there are high volume of open complaints. Response includes:
Where complaint action has already been undertaken
Where complaint is about Provider staff and/or services |

Table caption: Table of templates for recording contact attempts with complainants

7.2 Send an SMS via Outlook

In Microsoft Outlook: Select New Email.
In From: Select Complaints.Internal@ndis.gov.au email address.
In To: Enter the person’s mobile number followed by @directsms.com.au (e.g., 04******** @directsms.com.au).
In Subject: Enter the following text for Phone Call Contact:

Important Message: A representative from the NDIA will call you at am/pm on dd/mm/yyyy regarding Complaint ID 81XXXXXXXXX from a private number. [SEC=UNOFFICIAL]

Important Message: A representative from the NDIA has sent you an email regarding Complaint ID 81XXXXXXXX on dd/mm/yyyy. Please check your email inbox. [SEC=UNOFFICIAL].

Note: Leave the body of the email blank.

Press Send
Select Unofficial. This is important otherwise the message won’t be sent
Press Send.

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7.3 Email Contact Attempt 1 or 2

Good <Morning/Afternoon> ,

My name is and I am a Complaints Officer with the National Disability Insurance Agency (NDIA)

Thank you for raising your complaint relating to . I have started to investigate the concerns you have raised.

Attempt 1 template

I have considered your complaint and the information in our system and want to seek further information that will allow me to progress your complaint.

Please respond to this email or provide the best contact and time suitable over the next two days so I can contact you to discuss your complaint.

Thank you again for raising your concerns.

Kind regards,

Attempt 2 template

On <dd/mm/yyyy>, I sent you an email asking for the best time to contact you to discuss your concerns and to get additional information that will enable me to progress your complaint. As I am yet to receive a response to my earlier contact, I am following up with you.

Please respond to this email or provide the best contact and time suitable over next two days so I can contact you to discuss your complaint.

Alternately, please let me know if the matter has now been resolved so I can close this complaint.

Thank you again for raising your concerns.

Kind regards,

7.4 Email/Phone - Unable to contact – unable to progress complaint

Good <Morning/Afternoon> ,

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My name is and I am a Complaints Officer with the National Disability Insurance Agency (NDIA). Thank you for raising your complaint relating to .

I have attempted to <call you by phone/email you> to discuss your concerns on the following occasions without success:

<Call/email> Attempt 1: dd/mm/yyyy at hh:mm <am/pm> <Call/email> Attempt 2: dd/mm/yyyy at hh:mm <am/pm> <Call/email> Attempt 3: dd/mm/yyyy at hh:mm <am/pm>

If Phone contact attempted and voicemail left: I have left a voicemail on the dates listed above advising that I would send you an email.

If email contact attempted: On the dates listed above, I sent you an email requesting a time to contact you to discuss your complaint.

As I have not received a response to these contacts, your complaint will now be closed.

I hope your matter has now been resolved however should you still require further assistance, please contact us on 1800 800 110 or email us at feedback@ndis.gov.au to open a new complaint.

Thank you again for raising your concerns.

Kind regards,

7.5 Email/phone – Unable to contact - complaint progressed

Good <morning/afternoon> ,

My name is and I am a Complaints Officer with the National Disability Insurance Agency (NDIA). Thank you for raising your complaint relating to .

On <dd/mm/yyyy>, I tried to contact you via <email/phone> to discuss your complaint. I believe I have all the necessary information available to progress your complaint .

From the information provided, I believe your concerns are:

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If there are any additional details you would like to share, please respond to this email.

I will contact you when I have further updates on your complaint.

Thank you again for raising your concerns.

Kind regards

7.6 Email/phone – Complaint Progressed after contact (use this if complainant wants an email confirmation of the discussion)

Good <morning/afternoon> ,

Thank you for raising your complaint with the National Disability Insurance Agency (NDIA) relating to complaint number .

As discussed, the actions I will take to resolve your complaint are:

<list actions already undertaken/will be undertaken to resolve complaint>

I will contact you once I have further updates.

Thank you again for raising your concerns.

Kind regards

7.7 Reassigning Complaint to another Complaints Officer (Internal only)

(Copy and paste this email to all Complaint IDs when reassigning to another COs)

Hi ,

I have been assigned a complaint and noticed that you had closed the previous one within 2 weeks of when the new one was received.

Please see further details below:

Participant Name: NDIS Number: Previous Complaint number: (complaint closed by other staff member) New Complaint:

I have reassigned this complaint for you to progress it. Please review and action accordingly.

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Kind regards,

7.8 Payment Enquiry

Initial response to Complainant

Good <Morning/Afternoon> ,

Thank you for contacting us in relation to your payment issue/s.

I have escalated this matter to our Payments Escalation team to ensure that urgent attention is given to this request. The reference number for this payment matter is .

Please note, once I confirm our Payments team have taken carriage of this matter, I will contact you again to provide an update.

Thank you for bringing this to our attention.

Kind regards,

Final response to Complainant

Good <Morning/Afternoon> ,

Thank you again for contacting us in relation to your payment issue/s.

I have now confirmed that the Payments Escalation team have <taken carriage/resolved> your payment matter (reference number ) and have contacted you with on <dd/mm/yyyy>.

As this matter <has now been resolved/is pending resolution with the Payments Escalation Team>, I will now be closing your complaint.

If payment enquiry is still in progress when closing complaint (ensure follow up interaction is created): I will continue to monitor this record to ensure your payment request is resolved and will reach out to you if further escalation is required.

Once again, thank you for bringing this to our attention.

Kind regards,

Response to Provider for a Self-Managed participant

Good <Morning/Afternoon> ,

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Thank you for contacting us in relation to your complaint regarding outstanding invoices for .

I would like to gather more information to ensure I am providing the appropriate resolution and response to your concerns. Could you please respond to this email and provide the best contact and time suitable over the next two days so I can contact you to discuss further?

If the participant is self-managed, the relationship is between the participant and the provider, and any outstanding payment issues will need to be addressed with the participant.

The NDIA will be unable to assist you with outstanding invoices in these instances.

If the matter cannot be resolved between the participant and provider, this matter will need to be dealt with just as you would with any other client with outstanding invoices.

If the information above has resolved your enquiry, please let us know and we will close your complaint. Otherwise, we look forward to hearing back from you to discuss further.

Kind regards,

Response to Provider for a Plan-Managed participant

Good <Morning/Afternoon> ,

Thank you for contacting us in relation to the outstanding invoices for .

If a participant is plan-managed, the relationship is between the plan manager and the provider. This means all outstanding payment issues will need to be addressed with the participants plan manager.

When a plan manager is engaged, they are responsible for monitoring the plan budget, claiming and facilitating provider payments. The Plan Manager should also liaise with the National Disability Insurance Agency (NDIA) Payment Team on behalf of providers if they have issues claiming through the portal, or where there is reduced funding due to a plan review.

Any outstanding invoices should be referred to the participant’s nominated plan manager stating the outstanding claims and request that they follow up directly with the NDIA.

If the information above has resolved your enquiry, please let us know and we will close your complaint. Otherwise, we look forward to hearing back from you to discuss further.

Kind regards,

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7.9 Respond to complainant - Feedback referred to Review Team

Good <Morning/Afternoon> ,

My name is and I am a Complaints Officer with the National Disability Insurance Agency (NDIA).

Thank you for raising your complaint relating to . I have started to investigate the concerns you have raised.

[For S.48 Plan Reassessment use: if your circumstances have changed and your plan no longer meets your needs, you can request a plan review. Click here to find out further information about requesting a plan review based on Change of circumstances.

Your <Local Area Coordinator/Support Coordinator> can also assist you in making a review request]. Alternatively, we can discuss and lodge the request on your behalf.]

[For Internal review within 3 months of plan approval use: If you believe the decision, we have made is wrong, you can ask us to review our decision. Click here to find out further information about requesting internal review of a decision.

Your <Local Area Coordinator/Support Coordinator> can also assist you in making a review request]. Alternatively, we can discuss and lodge the request on your behalf.]

[Where review is already raised: I can see from your record that you have already requested a review of the decision.

The review team will review the plan in its entirety and deliver an outcome in line with the requirements of reasonable and necessary supports under the NDIS Act (2013).

We understand that review requests can be time sensitive for participants. Please be assured that our review assessment process takes this into account, and we endeavour to make a decision in a reasonable timeframe. Refer to the Participant Service Guarantee for information about review timeframes.]

[If complainant is unhappy with Review team staff member: Furthermore, I have escalated the feedback to staff member’s team leader in reference to your disappointment in engaging with NDIA staff.]

If the information above has resolved your enquiry, please let us know and we will close your complaint. Otherwise, we look forward to hearing back from you to discuss further.

Kind regards,

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7.10 Response for Staff Complaint

Staff Complaint – initial response to the complainant

Good <Morning/Afternoon> ,

My name is and I am a Complaints Officer with the National Disability Insurance Agency (NDIA).

Thank you for raising your complaint relating to . I have started to investigate the concerns you have raised.

As I was disappointed to hear of this experience, I would like to gather more information on what has occurred as I acknowledge that it was upsetting and apologise for the stress it caused you. The conduct you described does not meet the high standards of communication to which the NDIA aspires.

Could you please respond to this email and provide the best contact and time suitable over the next two days so I can contact you to discuss further?

I look forward to hearing back from you shortly.

Kind regards,

Staff Complaint – final response to the complainant

Good <Morning/Afternoon> ,

Thank you again for contacting us in relation to .

We appreciate the time you have taken to provide your feedback. The NDIA takes all feedback seriously, and we are committed to continually improving the NDIS to ensure it delivers on its promise for people with disability.

I have escalated your concerns to the appropriate line manager for their consideration and attention to ensure any appropriate action is undertaken.

If complainant wants outcome of the complaint, add: [With regard to your request for information in relation to the outcome of this escalation, under section 62 of the National Disability Insurance Scheme Act 2013, disclosure of the information that you are seeking would amount to the disclosure of protected information about the staff in question; as such the NDIA is unable to provide you with any further information on this matter.]

The NDIA welcomes feedback to identify what is working and what can be improved. We have a strong commitment to learning from the experiences of people. As such, the feedback you

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provided will assist the NDIA to continually improve how staff communicate with participants and their families.

Please feel free to contact us again if you have any questions, further issues or concerns and we will be happy to help.

Kind regards,

Forwarding Staff complaint to relevant business area (INTERNAL ONLY – Do not copy/paste text of this email in CRM)

Note: All staff complaints are sent to the relevant line manager for the staff member (from redacted: s47E(d) - certain operations of agencies inbox), with the exception of:

Partner staff ‒ Send Partner staff complaints to redacted: s47E(d) - certain operations of agencies redacted
NCC staff ‒ Send NCC staff complaints to redacted: s47E(d) - certain operations of agencies

Subject: For Action: Staff complaint - Complaint ID [8100XXXXX] RFA [8100XXXXXX] [NDIS Number] [Participant Name]

Good <Morning/Afternoon> ,

My name is XXX and I am a Senior/Complaints Officer within the Complaints and Participant Incidents Team.

We have received some feedback from a complainant in relation to one of your staff members (enter staff members name & login ID). Please see further details below:

Participant Name: NDIS Number: Complainant (if different to participant): Complaint:

Please be advised that we do not require a response. The complainant has been advised that due to privacy, we are unable to provide any further information on actions taken against the staff member.

Please review and action accordingly. Should you require any further information, please do not hesitate to reach out to me.

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This matter will now be closed with the Complaints Team.

Kind regards,

7.11 Response to complainant – Internal Review Declined – Mainstream services available

Good <Morning/Afternoon> ,

My name is and I am a Complaints Officer with the National Disability Insurance Agency (NDIA).

Thank you for raising your complaint relating to . I can see that a letter dated <DD/MM/YYYY> was sent to you with the declined outcome and your review rights. I have attached the letter for your convenience.

The reason why this was declined is because is not funded through NDIS funding. We believe it may be covered by mainstream supports.

The National Disability Insurance Scheme (NDIS) provides funding for long-term, individualised care and support that are reasonable and necessary to meet the needs of people with permanent disability where their disability significantly affects their communication, mobility, self-care or self-management. The NDIS operates alongside other mainstream service systems, such as health and education, to improve the lives of people with disability in line with the National Disability Strategy.

As you may or may not be aware, the NDIS is not designed to replace or mitigate existing mainstream service systems responsible for providing supports to people with disability. This means where a support is most appropriately funded by another system, the NDIS will not fund that support. Where the NDIS does not fund a support previously received by a participant, the NDIA will seek to identify appropriate alternative supports or refer the participant to other service delivery systems to ensure they are able to achieve the same outcomes as before.

The NDIS will continue to provide community linking and individualised support for people with permanent and significant disability, their families and carers. The NDIA will continue to build relationships with mainstream service providers and the local community to improve their understanding about how they can assist people with disability. The NDIA is aware considerable work is still necessary to address issues participants may be experiencing at the interface of the

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NDIS and other services. However, this national approach will ensure where an interface issue has been addressed, application and understanding is consistent across all jurisdictions.

Further information is available in the Applied Principles and tables of support that determines responsibilities of NDIS and other mainstream services.

I understand that this is not the outcome that you were hoping for, and as the decision letter has advised, you can submit an external review request through the Administrative Appeals Tribunal (AAT).

If the information above has resolved your enquiry, please let us know and we will close your complaint. Otherwise, we look forward to hearing back from you to discuss further.

Kind regards,

7.12 Response to complainant – Where case is at ART

Where contact is ART Case Management Branch

Good <Morning/Afternoon> ,

My name is and I am a Complaints Officer with the National Disability Insurance Agency (NDIA).

Thank you for raising your complaint relating to . I have started to investigate the concerns you have raised.

I can confirm that there is an open Administrative Review Tribunal (ART) appeal, and a Case Manager from our ART Case Management Branch is appointed on this case to progress the matter.

I have sent an email to our ART Case Management Branch and included your complaint. I have requested that your Case Manager contacts you to discuss the concerns raised as I am unable to discuss matters before the ART.

If there are other matters You would like us to address that are not related to the ART appeal, could you please respond to this email and provide the best contact and time suitable over the next two days so I can contact you to discuss further.

If the information above has resolved your enquiry, please let us know and we will close your complaint. Otherwise, we look forward to hearing back from you to discuss further.

Kind regards,

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Email to ART Case Management Branch requesting information on complaint received (to be sent from `redacted: s47E(d) - certain operations of agencies` – INTERNAL ONLY)

Hi Team

The Complaints Management Team (CMT) and Participant Critical Incidents (PCI) have received a complaint lodged by the Participant on [insert complaint date], seeking to know the progress on the original complaint/case.

I can see there is an alert on the system that your team has received an application for the above participant, which is in front of Administrative Review Tribunal (ART) at the moment.

Whilst a matter is before ART, correspondence about the matter should only occur between the applicant or their representative and the NDIA representative. As such, no specific information has been provided regarding this matter.

I have attached a copy of the original complaint (if available) and my response to the complainant for your reference.

Can <participant’s name> ART Case Manager contact the participant and provide further information.

7.13 Response to complainant – Referred to National Delivery (use this with the follow-up process where resolution will take more than 21days)

Good <Morning/Afternoon> ,

Thank you for contacting us in relation to the delay in getting your <support item/s> request processed.

, I have escalated this matter to our National Delivery team to ensure that urgent attention is made to action this request.

I will contact you again when I have more updates, however if you would like to provide additional information or you would like me to contact you to further discuss this, please provide the best contact and suitable time for me to contact you in the next two business days.

Once again, thank you for bringing this to our attention and I hope the matter is resolved shortly.

Kind regards,

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7.14 Response to complainant – Complaints for the NDIS Quality and Safeguards Commission

Good <Morning/Afternoon> ,

My name is and I am a Complaints Officer with the National Disability Insurance Agency (NDIA).

Thank you for raising your complaint relating to . I have started to investigate the concerns you have raised.

The NDIA is not the right area for complaints against providers including support coordinators and plan managers.

Complaints about providers should be referred to the NDIS Quality and Safeguards Commission. It is an independent agency established to regulate NDIS providers, improves the quality and safety of NDIS supports and services, and resolves issues between providers and NDIS participants.

You can lodge a complaint with NDIS Quality and Safeguards Commission Team over the phone or online. Please see the links below

How to make a complaint about a provider with the NDIS Quality and Safeguards Commission
Phone no – 1800 035 544
Please click here for Complaint Contact form to lodge a complaint

If the information above has resolved your enquiry, please let us know and we will close your complaint. Otherwise, we look forward to hearing back from you to discuss further.

Kind regards,

7.15 Restream Request

Good <Morning/Afternoon> ,

Thank you for contacting us to request changing your My NDIS Contact from a Local Area Coordinator (LAC) to a NDIA Planner.

There is a criteria which participants are assessed against to determine whether they are supported by an LAC or NDIA Planner. Participants cannot be changed to a NDIA Planner at their request – they must meet the criteria to warrant being transferred to a NDIA Planner. This

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criteria is largely based on the Participant’s circumstances rather than the complexity of their disability.

I would like to gather more information regarding the reasons for your request and would like the opportunity to discuss your concerns.

Could you please respond to this email and provide the best contact and time suitable over the next two days so I can contact you to discuss further?

I look forward to hearing from you shortly.

Kind regards,

7.16 Maintain privacy

Good <Morning/Afternoon> ,

Thank you for your email regarding .

The Agency is bound by the Privacy Act 1988 and the National Disability Insurance Scheme Act 2013. Under these Acts, consent must be granted by the participant or by participant’s legal guardian or representative before I can share with you any specific information held by the National Disability Insurance Agency (NDIA) concerning the participant.

As there is no consent on file, the Agency is not authorised to discuss whether the person is or is not known to the Agency or disclose any personal information.

Kind regards,

7.17 Email to the NDIS Fraud Team

Subject: For Action: Complaint ID [8100XXXXX] RFA Fraud Risk; Due by: [Response Due Date] [NDIS Number] [Participant Name]

Note: Fraud Reporting – redacted: xxxxxxxxxxxxxx@xxxx.xxx.xx Do not request Fraud team to respond with actions undertaken/next steps but to provide a Case ID number. Scheme Integrity Branch (Fraud) will provide the response by the Due Date listed in the subject line.

Good <Morning/Afternoon>,

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Please see RFA providing detail on the report and actions requested.

If you require further information, please do not hesitate to contact me.

Thank you for your assistance.

Kind regards,

7.18 Complaint regarding fraud allegation

Good <Morning/Afternoon> ,

Thank you for your email regarding .

The National Disability Insurance Agency (NDIA) appreciates the time you have taken to provide us with your complaint.

I acknowledge your concern and disappointment experienced on this occasion and apologise for the inconvenience that this may have caused you.

Please be advised that your feedback is appreciated and has been passed on to the fraud team for further investigation. The NDIA takes all reports seriously. Every allegation is assessed by a specialist officer and the most appropriate action undertaken.

Your Case ID provided by the Fraud team is .

Please note: the Agency will only contact you if we require further information regarding your concern/allegation.

We know you may want to know about the progress and result of the information you have given us, however we are unable to follow up with you and release individual details about our activities. It is our policy, based on privacy and confidentiality principles, not to provide any information or updates on current matters.

Please view NDIA’s fraud strategy statement for further information on our approach to addressing fraud.

With the information provided above, I will now be closing your complaint. Please feel free to contact us again if you have any questions, further issues or concerns and we will be happy to help.

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Kind regards,

7.19 Managing multiple complaints about same issue from same complainant

Use these templates where there have been multiple complaints from the same complainant regarding this issue and the same outcome has been provided at least twice previously.

Important: An interaction is to be created immediately after contact to make sure the correct date is reflected in the participant record.

Advising previous complaint resolution and request for new information

Good <Morning/Afternoon> ,

Thank you for raising your complaint with the National Disability Insurance Agency (NDIA) relating to complaint number .

My name is and I am the Complaints Officer that will help you with the complaint. I have started to look into the concerns/matters you raised.

I have reviewed your complaint and understand that your concerns are about . From our records, I can confirm that you have raised a complaint regarding the same issue on the following occasions:

[Insert Date] [Insert Complaint Number] handled by: [insert complaints officer] regarding [insert details].
[Insert Date] [Insert Complaint Number] handled by: [insert complaints officer] regarding [insert details].

I can confirm that the information provided to you on both occasions remains correct.

If you have any further/new information to support your request, please respond to this email at feedback@ndis.gov.au with the new information attached.

If we do not receive further information to support your request within 5 working days your complaint will be closed.

If you are not happy with the outcome of your complaint, please reach out to the Commonwealth Ombudsman via https://www.ombudsman.gov.au/.

Kind regards,

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No longer responding to a complainant about particular complaint as has been addressed numerous times previously (Assistant Director to endorse)

Good <Morning/Afternoon> ,

Thank you for raising your complaint with the National Disability Insurance Agency (NDIA) relating to complaint number .

My name is and I am the Complaints Officer that will help you with the complaint.

I have reviewed your complaint and understand that your concerns are about . From our records, I can confirm that you have raised a complaint regarding the same issue on the following occasions:

[Insert Date] [Insert Complaint Number] handled by: [insert complaints officer] regarding [insert details].
[Insert Date] [Insert Complaint Number] handled by: [insert complaints officer] regarding [insert details].

I can confirm that the information provided to you on both occasions remains correct.

I appreciate that you do not agree with the outcome of your complaint about . The NDIA has previously provided a response to your concerns and outlined your review rights.

I would like to advise that the NDIA will no longer acknowledge or respond to issues that have previously been addressed on two separate occasions. This means you will not receive a response to further correspondence about . Your complaint will be now closed.

It is not the intention of the NDIA to dismiss your concerns, we simply wish to focus our efforts where they will have greater impact and benefit for participants.

The NDIA is committed to working with you to ensure receives the reasonable and necessary supports to pursue [his/her] goals and aspirations. Should you have new queries that have not been addressed by the NDIA, I encourage you to contact our Complaints Team at: redacted: xxxxxxxx@xxxx.xxx.xx

If you are not happy with the outcome of your complaint, please reach out to the Commonwealth Ombudsman via https://www.ombudsman.gov.au/.

Kind regards,

7.20 Managing restrictions on unreasonable behaviour

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(Warning letter) - Notifying complainant that restrictions may be applied on unreasonable behaviour (Assistant Director to endorse)

Good <Morning/Afternoon> ,

Thank you for raising your complaint with the National Disability Insurance Agency (NDIA) relating to complaint number regarding .

You recently had <state the form of contact – e.g., telephone, written> contact with staff within the NDIA Complaints team on <dd/mm/yyyy> for the above complaint.

[During that telephone call/In your email,] I understand that you .

We consider this type of behaviour to be inappropriate and it must stop. If you continue to behave in this way or in any other way that my staff consider to be unreasonable, we will impose restrictions on your contact with the Complaints team. This may involve restricting your contact to [apply the relevant option(s)]:

‘Writing only’ – this means that we will only accept communications from you in writing, via email or letter
‘Telephone contact only’ – this means that you will only be able to contact us by telephone on a specified time and day of the week.
‘Specific staff contact only’ – this means that your contact will be limited to scheduled meetings with a specified member of our staff.
Or any other restriction that we consider to be appropriate in the circumstances.

Restrictions will be applied over a period of time ranging from 3-12 months and can be reviewed earlier if requested.

The NDIA ensures that all complaints are dealt with professionally, fairly and impartially. Our staff will treat all parties to a complaint with courtesy and respect, and we expect the same courtesy and respect in return.

If you have any questions about this letter, contact <insert TL name and/or myself> via feedback@ndis.gov.au

Kind regards,

Notifying complainant that restrictions will be applied due to unreasonable behaviour (Director to endorse)

Good <Morning/Afternoon> ,

Thank you for raising your complaint with the National Disability Insurance Agency (NDIA) relating to complaint number regarding .

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We communicated with you via email on <dated/mm/yyyy> about your unreasonable behaviour towards the NDIA Complaints staff for the above complaint.

I am writing to let you know that we need to make changes to how you can communicate with the NDIA Complaints team henceforth.

Why are these changes required?

< During your telephone calls/ In your emails> to the NDIA you displayed several inappropriate behaviours, which affected staff safety and wellbeing. As a result of this behaviour, we need to make changes to the way you can communicate with the NDIA Complaints staff. From now on, your communication with the NDIA Complaints team will be restricted to [Select one option:]

‘Writing only’ – this means that we will only accept communications from you in writing, via email or letter. No phone conversations will be accepted.
‘Telephone contact only’ – this means that you will only be able to contact us by telephone at a specified time/day of the week.
‘Single staff contact only’ – this means that your contact will be limited to a single Complaints staff member (a sole contact point) who will exclusively manage your complaint(s).

Depending on the type of restriction, we may limit <Telephone calls/ written communications> to 1 every month. These restrictions will be in place for up to [add timeframe in months] after which these will be reviewed and based on your conduct will be:

maintained – e.g. because the conduct has continued or is likely to continue, is disproportionate etc.;
removed – e.g., because the complainant has complied with the restrictions etc.; or
amended – e.g., because the complainant’s circumstances have changed and the current restriction is no longer appropriate

It is important that you engage with your Local Area Coordinator/Support Coordinator regularly to ensure that you are accessing all necessary supports included in your plan as well as linking with other mainstream services or providers.

If you have any questions about this letter, contact <insert Assistant Director’s name and/or myself> via redacted: xxxxxxxx@xxxx.xxx.xx

Kind regards,

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No further contact from the NDIA (Director to endorse this response)

Good <Morning/Afternoon> ,

Thank you for your email regarding .

The NDIA will no longer be able to acknowledge or respond to issues that have previously been addressed. Please note, this means you will not receive a response to further complaints about this. If you have further issues or concerns not relating to <insert participant issue e.g., your internal review decision>, please contact us and we will address those.

If you are dissatisfied with the outcome of your complaint you may seek assistance from the Commonwealth Ombudsman, https://www.ombudsman.gov.au/How-we-can-help/australian-government-agencies-and-services/national-disability-insurance-scheme or call on 1300 362 072.

Kind regards,

8. Temporary measure ONLY

Use the below only when instructed by the Assistant Director or Directors. This is a temporary measure only to be used when there is a high volume of open complaints

8.1 Where complaint is regarding the SDA Pricing Review 2023-24 and the new SDA rates effective 1 July 2023

Good morning/afternoon ,

Thank you for raising your complaint with the National Disability Insurance Agency (NDIA) regarding the 2023/2024 Price Guide for SDA.

My name is and I am a Complaints Officer with the NDIA.

I have considered your complaint and the information in our system regarding the SDA pricing review 2023-24. I can confirm that the NDIA commenced automatically updating new prices for SDA in eligible participant’s plans in mid-October 2023. SDA funding adjustments will be backdated to 1 July 2023.

While taking longer than expected, the work is progressing and the Agency is looking for ways to speed up this process. For some participant’s plans, the update will take longer than others,

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and we are not able to provide a specific date for when this process will be completed. We will provide further updates via our website as they become available.

Your complaint will now be closed. If you have further issues or concerns not relating to this matter, please email feedback@ndis.gov.au.

Again, thank you again for raising your concerns.

Kind regards,

8.2 Where complaint is about Provider staff and/or services

Good morning/afternoon ,

Thank you for raising your complaint with the National Disability Insurance Agency (NDIA) regarding .

My name is and I am a Complaints Officer with the NDIA.

The NDIA encourages participants to raise any concerns about the services they are receiving with the providers directly. If the matter cannot be resolved, participants are encouraged to raise the issue with the NDIS Quality and Safeguards Commission (NDIS Commission) which was established to help uphold the integrity of the NDIS by ensuring participants receive safe and quality services.

The NDIS Commission responds to concerns, complaints, and reportable incidents, including the abuse and neglect of NDIS participants.

The NDIS Commission is responsible for the registration and regulation of providers in all states and territories. More information about the NDIS Commission and its role can be found at www.ndiscommission.gov.au.

As a NDIS participant, you have choice and control when deciding which providers you engage with to support you. If you would like guidance on how to change providers or have any queries regarding your plan, we encourage you to contact your who can assist you.

If the above has resolved your complaint please let us know by , and we will close your complaint. Otherwise please respond to this email if any of the issues remain unresolved from this complaint so I can action it accordingly.

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Again, thank you again for raising your concerns.

Kind regards,

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9. Oversight Complaints Email Templates

The following pages are email templates for Oversight team to email external stakeholders.

All correspondence must be in Plain English and follow the NDIS Writing Style Guide. Refer to NDIA Standard Words for wordings for more templates

Note: Copy/paste email texts in Interactions and not attach it in Inbound Documents

Interaction Topic	Context
NDIS Quality and Safeguards Commission	Email templates for complaint received via warm transfer, acknowledgement and response to request for information
Commonwealth Ombudsman	Email templates for acknowledgement and response to requests for Section 7a and Section 8
NSW Ageing and Disability Commission	Email template to respond back to ADC regarding the issues raised

Table caption: Table of Oversight templates for recording contact attempts with complainants.

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9.1 NDIS Quality & Safeguards Commission email templates

NDIS Quality & Safeguards Commission warm transfer complaints acknowledgement email

Dear Mr/Ms (insert Last name of NDIS Commission staff member),

Thank you for referring the below matter to the National Disability Insurance Agency (NDIA) on behalf of Mr/Ms (insert name of complainant). The NDIA will take carriage of this complaint.

An NDIA Complaints Officer will contact the complainant and work towards a resolution with them.

Should you have any further information, or any queries, please contact the NDIA via redacted: s47E(d) - certain operations of agencies.

Kind regards, <Insert sender’s first name and staff ID>

NDIS Quality & Safeguards Commission Request for information acknowledgement email

Dear Mr/Ms (insert Last name of NDIS Commission staff member),

Thank you for your email request regarding Mr/Ms (insert name of participant).

A National Disability Insurance Agency (NDIA) Complaints Officer will be actioning this referral and providing a response to your request.

Should you have any further information, or any queries, please contact the NDIA via redacted: s47E(d) - certain operations of agencies.

Kind regards, <Insert sender’s first name and staff ID>

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NDIS Quality and Safeguards Commission provision of information acknowledgement email

Dear Mr/Ms (insert Last name of NDIS Commission staff member),

Thank you for emailing the National Disability Insurance Agency (NDIA). We have categorised this item as a provision of information. The NDIA will assess the information and take any necessary actions.

Should you have any further information, or any queries, please contact the NDIA via redacted: s47E(d) - certain operations of agencies.

Kind regards, <Insert sender’s first name and staff ID>

NDIS Quality and Safeguards Commission request for information dispatch email

Dear XXXX

Please find below a response to your request for information.

This information has been disclosed in this instance in accordance with s60(2)(e) of the NDIS Act as it is believed to be necessary to prevent or lessen a serious threat to an individual’s life, health or safety.

This information has been disclosed in this instance in accordance with s66(1)(b)(v) of the NDIS Act as a delegate of the CEO of the NDIA has determined that doing so is for the purposes of the Commissioner.

I hope my response assists you with your investigation. Should you have any further questions redacted: s47E(d) - certain operations of agencies please contact me via

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9.2 Commonwealth Ombudsman email templates

Ombudsman Section warm transfer complaints acknowledgement email

Dear Mr/Ms (insert Last name of OCO staff member),

Thank you for referring the below matter to the National Disability Insurance Agency (NDIA) on behalf of Mr/Ms (insert name of complainant). The NDIA will take carriage of this complaint.

An NDIA Complaints Officer will contact the complainant and work towards a resolution with them.

Should you have any further information, or any queries, please contact the NDIA via redacted: s47E(d) - certain operations of agencies.

Kind regards, <Insert sender’s first name and staff ID>

Ombudsman Section 7a or Section 8 acknowledgement email

Dear Mr/Ms (insert Last name of OCO staff member),

Thank you for your referral of investigation to the National Disability Insurance Agency (NDIA) regarding Mr/Ms (insert participant’s name) on behalf of Mr/Ms (insert complainants name) (if applicable).

(Insert the assigned CO’s name) will be conducting this investigation and providing a response to your questions.

Should you have any further information, or any queries, please contact the NDIA via redacted: s47E(d) - certain operations of agencies

Kind regards,

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Ombudsman Section 7a dispatch email

Dear Mr/Ms XX

Your ref: 2022- XXX Our Ref: XXXX

Please find the NDIA’s Response to your questions below.

Requested information:

[Insert OCO question in italics and NDIA response standard Arial 12pt font]

I hope this information assists with your preliminary inquiries. If we can assist further, please let redacted: s47E(d) - certain operations of agencies me know via

Ombudsman Section 8 dispatch email

Dear Ms/Mr xxxx,

Please find attached a response to your investigation regarding the complaint raised by xxxx on behalf of xxxx.

redacted: s47E(d) - certain operations of agencies If we can assist further, please contact me via

For Section 7a and Section 8 responses over multiple emails because of attachment size

Email subject prefix: Email xx of xx -

Inserted in body of email:

Please note that this response is being sent over xx emails due to the size of the attachments and in box capacity:

Email 1 (response and Attachment A to Attachment xx);

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Email 2 (Attachment xx to Attachment xx); and
Email 3 (Attachment xx to Attachment xx).

This is email xx of xx.

9.3 NSW Ageing and Disability Commission (ADC) email template

ADC Acknowledgement email

Dear Mr/Ms (insert Last name of NSW ADC staff member),

Thank you for your referral regarding Mr/Ms(insert participant’s name).

A National Disability Insurance Agency (NDIA) Complaints Officer will be actioning this referral and providing a response to your questions.

Should you have any further information, or any queries, please contact the NDIA via redacted: s47E(d) - certain operations of agencies

Kind regards,

ADC Dispatch email

Dear Mr/Ms (insert Last name of NSW ADC staff member),

Please find attached a response to your correspondence regarding Mr/Ms(insert participant’s name).

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If we can assist further, please contact via redacted: s47E(d) - certain operations of agencies.

Kind regards,

Feedback

If you have any feedback about this Standard Operating Procedure, please email it to the CMEOI Continuous Improvement Team. In your email, remember to include the title of the product you are referring to and describe your suggestion or issue concisely.

Version control

Version	Amended by	Brief Description of Change	Status	Date
1.0	JS0106	Initial Version — approved by BC0038	APPROVED	2021-03-24
1.1	JS0106	Update to include repeat complainant templates	APPROVED JS0061
1.2	JS0106	Update instruction to Reassigning complaints to another complaints officer email.	APPROVED JS0061	2022-10-27
1.3	JS0106	Update to include SMS contact templates	APPROVED Y40	2022-12-14
1.4	JS0106	Update to add Fraud option to manual RFA template, email correspondence to Fraud team and to complainant. Update includes endorsement requirement where no longer responding to a complainant	APPROVED JS0061	2023-01-12
5.0	NGC832	Updated template content in sections 1.1.1-1.5 and 6.2-6.19.3	APPROVED CRK782	2023-03-08

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Table of Contents

1. Interactions

Interactions

1.1 SMS Alert Options

SMS prior to Contact Attempt by Phone

SMS post Contact Attempt by Email

1.2 Contact Attempt 1, 2 or 3 - Phone

Attempt 1 or Attempt 2 Template

Attempt 3 Template

1.3 Contact Attempt – Email

Attempt 1 template

Attempt 2 template

1.4 Contact Established

With Participant, Child Representative or Nominee

With Unauthorised Representative

1.5 Contact between Complaints Officers for complaint/s carriage

1.6 Verbal Consent Obtained

2. Follow-up Interactions

Create a Follow-up Interaction

If follow-up contact is required in less than 28 calendar days

3. Request for Action (RFA)

3.1 Create a RFA in CRM

3.2 Create an off-system (manual) RFA

Request for Action

3.3 RFA endorsement email to COMPLAINTS.INTERNAL inbox for Senior

3.4 CMT - RFA Escalation template

CMT — RFA Escalation Template

4. Request for explanation of a decision

5. Payment Enquiries

6. Recording complaints outcome in the Outcome sub-tile

6.1 Complainant uncontactable – unable to progress

6.2 Able to progress complaint

7. Email templates

7.2 Send an SMS via Outlook

7.3 Email Contact Attempt 1 or 2

Attempt 1 template

Attempt 2 template

7.4 Email/Phone - Unable to contact – unable to progress complaint

7.5 Email/phone – Unable to contact - complaint progressed

7.6 Email/phone – Complaint Progressed after contact (use this if complainant wants an email confirmation of the discussion)

7.7 Reassigning Complaint to another Complaints Officer (Internal only)

7.8 Payment Enquiry

Initial response to Complainant

Final response to Complainant

Response to Provider for a Self-Managed participant

Response to Provider for a Plan-Managed participant

7.9 Respond to complainant - Feedback referred to Review Team

7.10 Response for Staff Complaint

Staff Complaint – initial response to the complainant

Staff Complaint – final response to the complainant

Forwarding Staff complaint to relevant business area (INTERNAL ONLY – Do not copy/paste text of this email in CRM)

Participant Name: NDIS Number: Complainant (if different to participant): Complaint:

7.11 Response to complainant – Internal Review Declined – Mainstream services available

7.12 Response to complainant – Where case is at ART

Where contact is ART Case Management Branch

Email to ART Case Management Branch requesting information on complaint received (to be sent from redacted: s47E(d) - certain operations of agencies – INTERNAL ONLY)

7.13 Response to complainant – Referred to National Delivery (use this with the follow-up process where resolution will take more than 21days)

7.14 Response to complainant – Complaints for the NDIS Quality and Safeguards Commission

7.15 Restream Request

7.16 Maintain privacy

7.17 Email to the NDIS Fraud Team

7.18 Complaint regarding fraud allegation

7.19 Managing multiple complaints about same issue from same complainant

Advising previous complaint resolution and request for new information

No longer responding to a complainant about particular complaint as has been addressed numerous times previously (Assistant Director to endorse)

7.20 Managing restrictions on unreasonable behaviour

(Warning letter) - Notifying complainant that restrictions may be applied on unreasonable behaviour (Assistant Director to endorse)

Notifying complainant that restrictions will be applied due to unreasonable behaviour (Director to endorse)

No further contact from the NDIA (Director to endorse this response)

8. Temporary measure ONLY

8.1 Where complaint is regarding the SDA Pricing Review 2023-24 and the new SDA rates effective 1 July 2023

8.2 Where complaint is about Provider staff and/or services

9. Oversight Complaints Email Templates

9.1 NDIS Quality & Safeguards Commission email templates

NDIS Quality & Safeguards Commission warm transfer complaints acknowledgement email

NDIS Quality & Safeguards Commission Request for information acknowledgement email

NDIS Quality and Safeguards Commission provision of information acknowledgement email

NDIS Quality and Safeguards Commission request for information dispatch email

Email to ART Case Management Branch requesting information on complaint received (to be sent from `redacted: s47E(d) - certain operations of agencies` – INTERNAL ONLY)