Level 2 complaints - vulnerable customers and high risk complaints (CLK)(MED) 104-02040020
Expand allThis page describes supplementary information for Complaints Officers in Centrelink and Medicare managing Level 2 complaints that are high risk or from vulnerable customers.
Investigate high risk complaints and complaints from vulnerable customers
The information provided in this procedure is supplementary to the complaints management processes in Level 2 complaints (CLK)(MED). Use the drop-down menu below for extra instructions for managing high risk complaints or complaints from vulnerable customers before returning to Level 2 complaints (CLK)(MED).
All staff
A vulnerable customer
Investigating complaints
This table describes the process Complaints Officers use to investigate complaints from vulnerable customers.
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Vulnerable customersA vulnerable customer is someone who, due to their personal circumstances, is especially susceptible to disadvantage. Complaints are prioritised based on the customer's circumstances. A high priority issue is when the customer is at risk or vulnerable or the impact on the customer is significant. If the complaint does not meet an escalation reason, the complaint is managed at the first point of contact. High priority complaints are managed with urgency or as immediately as possible. Make the relevant service offer to a complainant if they are identified as vulnerable. Use indicators of potential vulnerability to assess if it is appropriate to consult with or refer the customer to specialised business areas, including Social work services. See Level 1 - Manage complaints and feedback.
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Incarcerated customersIncarceration can make it difficult for customers to contact Services Australia. These customers will sometimes use nominees or representatives to provide feedback. When managing complaints from incarcerated customers, contact the appropriate service officer in Face to Face Incarcerated Customer Servicing team for assistance and guidance to contact the customer and respond to the issue. Refer to the Incarcerated customer directory on the Resources page for additional information.
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Customer is at risk or in crisisAdditional support is available to assist in the management of complaints from customers at risk or in crisis. See Level 1 - Manage complaints and feedback.
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Additional referrals for vulnerable customersWhile managing the complaint consider any other possible offers of support that can be provided to the customer. Resources has a link to the Payment and Service Finder. Centrelink staff
Medicare staff
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Systemic issues or complaint trends identifiedIf a systemic issue impacting on a vulnerable customer is identified during the management of a complaint, the Complaints Officer advises the Complaints Officer's Manager and reports the systemic issue to the Systemic Issues Resolution Group (SIRG) representative. See Table 2 on the Process page of Level 2 complaints. |
Allegation of potential breach of APS Code of Conduct - staff fraud and misconduct
Investigating and responding to complaints
This table provides supplementary information for Complaints Officers when investigating and responding to complaints received about a potential breach of the APS Code of Conduct due to staff fraud or misconduct.
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Potential breach of APS Code of Conduct and allegations of staff fraud or misconductComplaints about staff that include statements about a staff member's behaviour not being in accordance with the APS Code of Conduct or include allegations of fraud, unauthorised access or disclosure of information may include:
Level 1 staff immediately escalate these complaints to the Level 2 team for management per escalation reason 4 - Potential serious breach of APS Code of Conduct or allegations of fraud, unauthorised access or disclosure of information. See Complaints and feedback index. Complaints about whistle-blowers are managed in accordance with principles contained in Australian Standards AS 8004-2003. Resources has a link to the agency's Code of Conduct manual is included on the page. | |
Identify complaint issueAssess the feedback details to identify the person or business area responsible for the assessment of the issues. If the complaint is an allegation of:
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Allegations of APS Code of Conduct breachIf the complaint contains allegations of an APS Code of Conduct breach:
Level 2 Managers:
The Conduct Standards team require verbatim details of the complaint to assess whether action will be taken. | |
Allegations of Fraud/Unauthorised access/disclosure of informationIf the complaint contains allegations of staff fraud, unauthorised access or disclosure of information:
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Record the complaintRecord the complaint in the Customer Feedback Tool, including responses from other business areas assisting with the complaint. To protect the staff member's privacy, do not record the details of the allegations on the customer's record. | |
Conduct Standards or Internal Fraud team assessmentThe preliminary assessment by the Conduct Standards or Internal Fraud teams:
If the Complaints Officer is advised no action will be taken by Conduct Standards or Internal Fraud:
If the Complaint Officer is advised by the Conduct Standards or Internal Fraud team advises that action will be taken:
The staff member's Manager updates the service request, see Complaints and feedback index. | |
Provide customer responseThe response to the customer is dependent on the information received from the responsible business team. If the Complaint Officer is advised by the Conduct Standards or Internal Fraud team advises that action will be taken:
If the Complaints Officer is advised no action will be taken by Conduct Standards or Internal Fraud:
Return to Level 2 complaints (CLK)(MED) to continue managing the complaint. |
Culturally and Linguistically Diverse (CALD) customers
Investigating complaints
This table describes the process Complaints Officers use to investigate complaints from Culturally and Linguistically Diverse (CALD) customers.
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CALD customersFor information about recording complaints, compliments and suggestions from customers with a CALD status, see Step 4 in Table 5 of Level 1 – Manage complaint and feedback. Systemic Issues or complaint trends identified If a systemic issue impacting on CALD customers is identified or advice is required during the management of a complaint, notify Multicultural Services. Resources has a link to the Multicultural Services homepage. |
Indigenous customers
Investigating complaints
This table describes the process Complaints Officers use to investigate complaints from indigenous customers.
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Indigenous customersFor information about recording complaints, compliments and suggestions from customers with an Indigenous status, see Complaints and feedback index - ABSTUDY. Systemic Issues or complaint trends identified If a systemic issue impacting Indigenous customers is identified or advice is required during the management of a complaint, notify the Indigenous and Remote Servicing Branch. For contact details, see Indigenous and Remote Servicing Branch. |
Managed Service Plan (MSP) customers
Investigating complaints
This table describes the process Complaints Officers use to investigate complaints from customers with a Managed Service Plan (MSP).
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MSP customer contacts Services AustraliaWhen a customer with a Managed Service Plan (MSP) contacts the agency, the staff member taking the call:
Note: select the URL link from an MSP Warning message in CF, PD or CDMS to view MSP details in CIMS. See Customer aggression - Managed Service Plan (MSP) for more information. I f the customer is making a complaint or providing feedback, go to Step 2 | |
Complaint received from customer with an MSPManaged Service Plans (MSP) specify the way a customer can communicate with the agency. They do not restrict how the agency contacts the customer. The agency has a range of service delivery needs where direct contact with the customer is necessary. Responding to customer complaints and feedback is one of these. If a customer with an MSP is making a complaint about their One Main Contact (OMC), Level 1 staff warm transfer the customer to Level 2 in accordance with the agency's Customer Complaint and Feedback Policy. This does not preclude the Complaints Officer from liaising with the OMC. The Complaints Officer must consult with the customer's OMC if customer contact is required in relation to any complaint from a customer with an MSP. This collaborative approach:
If the customer has a Workplace Order in place:
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Personalised Services customers
Investigating complaints
This table describes the process Complaints Officers use to investigate a complaint from a Personalised Services customer.
Expand tableTransgender, intersex and non-binary
Investigating and responding to complaints
This table provides supplementary information for Complaints Officers when investigating and responding to transgender, intersex or non-binary complaints.
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Transgender, intersex and non-binary complaintsThe Australian Government Guidelines on the Recognition of Sex and Gender apply to all Australian Government departments and agencies that maintain personal records (including employee records) and collect gender information. The guidelines outline a consistent standard of evidence when gender is being verified or changed. The guidelines also define the gender classifications of male (m), female (f) and non-binary (x). A person of non-binary gender does not exclusively identify as either male or female. Level 2 Complaints Officers:
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Centrelink
Escalated Appeals Complaints
Investigating and responding to complaints
This table provides supplementary information for Complaints Officers when investigating and responding to complaints received via an escalated appeals complaint.
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Escalated Appeals Branch complaintsEscalated complaints and feedback received by the Level 2 team about appeals, reviews or Authorised Review Officers are referred and allocated to the Appeals Branch via the Customer Feedback Tool. The Appeals Branch are responsible for the start to finish management of this feedback. Level 2 staff identify and notify Appeals and Reviews Coordination (in the Appeals Branch) of any other identified information of importance or priority during the referral process. Appeals and Reviews Coordination is responsible for managing the feedback referred to the Appeals Branch. Appeals and Reviews Coordination may contact the Level 2 team for advice and assistance during the management of customer feedback. To record the complaint, see Complaint and feedback index. Return to Level 2 complaints (CLK)(MED) to continue managing the complaint. |
Restricted Access customers
Investigating complaints
This table describes the process Complaints Officers use to investigate complaints from Restricted Access customers.
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Restricted Access customersThe Restricted Access is available for customers seeking additional protection of personal information held by Services Australia. It is a computer based security system which denies access to the customer's computer record for the majority of staff. Only a limited number of staff in the customer's home service centre and the agency's Canberra site can access the record. The purpose of Restricted Access is to protect the customer's location details. Restricted Access is available to customers who have genuine fears for their safety, or where there is a risk that a staff member could endanger the customer by accessing the customer's computer record. Restricted Access should only be used in exceptional circumstances. Internally escalated complaints Immediately transfer the call if the customer is not calling to provide feedback, use the procedures for Restricted Access customers. As the feedback will be treated anonymously, certain restrictions apply. Level 2 Complaints Officers:
Complaints received from external source Complaints received from external sources, for example Ministerial and Ombudsman referrals, require Complaints Officers to:
Return to Level 2 complaints (CLK)(MED) to continue managing the complaint. |
Disability Support Pension claiming process or Assessment Services
Investigating and responding to complaints
This table provides supplementary information for Complaints Officers when investigating and responding to complaints received via Disability Support Pension claiming process or Assessment Services.
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Disability Support Pension claiming process or Assessment ServicesOn 1 January 2015 the Department of Human Services (previous name of Services Australia) introduced changes to the claim and assessment process for Disability Support Pension (DSP). DSP claimants are no longer required to provide a Medical Report (SA012), instead they must provide existing medical evidence, such as clinical notes, test results and specialist reports to support their claim. See Eligibility for Disability Support Pension (DSP). Claimants may also be required to attend a Disability Medical Assessment (DMA) with a Government-contracted doctor (GCD) as part of their claim process. See Disability Medical Assessment (DMA) referrals. To manage the complaint:
To record the complaint, see Complaints and feedback index. Return to Level 2 complaints (CLK)(MED) to continue managing the complaint. |
Farm Household Allowance customers
Investigating and responding to complaints
This table provides supplementary information for Complaints Officers when investigating and responding to complaints received from Farm Household Allowance customers.
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Farm Household Allowance CustomersFarm Household Allowance (FHA) complaints and feedback received at the first point of contact are escalated via warm transfer to Level 2 staff. Customers in receipt of FHA can be classified as highly vulnerable. Level 2 Complaints Officers:
The Rural and Complex Team Smart Centre ICT referral officer (SCIRO):
The FHA team provides the Complaints Officer with a response. Return to Level 2 complaints (CLK)(MED) to continue managing the complaint. |
Medicare
Health fraud, compliance and inappropriate practice
Investigating and responding to complaints
This table provides supplementary information for Complaints Officers when investigating and responding to complaints received about health fraud, compliance and inappropriate practice.
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Health fraud, compliance and inappropriate practiceComplaints about health fraud, compliance and inappropriate practice include complaints about:
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INVEST message and CMBO flagThe Debt, Appeals and Health Compliance Division (DAHCD) undertakes a diverse range of compliance activities to protect the integrity of its service delivery and government outlays. For members of the public these activities include an INVEST message placed on the customer's Medicare Card or a CMBO flag placed on the customer's PIN. Complaints officers need to complete the Medicare Payment Integrity report form available on the Customer complaints and feedback management page under 'I want to' Complete a Medicare Payment Integrity Report and send to the team responsible. Resources has a link to the Customer complaints and feedback management page. Follow the information and advice in Suspected Medicare fraud and Business Integrity (BI) flags for details on how to assist a claimant when either an INVEST message or a CMBO flag has been placed. Do not disclose to the claimant any details of the Compliance activity. To record the complaint, see Complaints and feedback index. Return to Level 2 complaints (CLK)(MED) to continue managing the complaint. | |
Complaints from Health Professionals about the audit processWhen a Health Professional lodges a complaint regarding an audit decision or recovery amount, the staff member should confirm with the Health Professional if they have received written notification from Debt, Appeals and Health Compliance Division (DAHCD) advising details of the offer of a Review of Decision. In most instances, the Health Professional will be given the option to request a Review of Decision if they disagree with the audit findings. This will be conducted by an independent officer who will review the relevant services identified in the audit and notify the Health Professional in writing of the outcome. The health professional will be notified by phone and letter before the audit begins and will be provided with the name and contact phone number of the Compliance Officer assigned to the audit case. Return to Level 2 complaints (CLK)(MED) to continue managing the complaint. | |
Alleged inappropriate practice by a Health ProfessionalCustomers can report alleged fraud abuse or inappropriate practice by a health professional such as:
The Complaints Officer:
The customer has the right to remain anonymous when reporting instances of alleged fraudulent behaviour and in this instance the complaints officer should also forward the report to the Fraud Tip-off Team. Return to Level 2 complaints (CLK)(MED) to continue managing the complaint. |