HBCF Complaint and Dispute Handling Procedures

HBCF Complaint and

Dispute Handling

Procedures

Version 7.0

This document has been prepared by icare HBCF:

Insurance and Care NSW (icare) provides services in the administration of the Home Building

Compensation Fund for the NSW Self Insurance Corporation.

Printed copies of this document are uncontrolled.

ABN 97 369 689 650

Post GPO Box 4052

Sydney NSW 2001

Phone (02) 9216 3224

Email [email protected]

Web www.icare.nsw.gov.au

mailto:[email protected]

http://www.icare.nsw.gov.au/

[email protected]

02 9216 3224

icare.nsw.gov.au

icareTM | Insurance & Care NSW HBCF Complaint and Dispute Handling Procedures Page 2 of 31

Document control

Version Revision Description Date Author

1.0 20 Dec 2010 HWIF Risk Manager

1.1 4.1 Notice of Periodic Reviews 1 Nov 2011 HWIF Risk Manager

1.2 Changed all references to Consumer

Trader, Tenancy Tribunal (CTTT) to NSW

Civil and Administrative Tribunal (NCAT).

Also changes in line with amendments to

the ‘Claims Manual’ and ‘Claims

Information for Homeowners’ documents

1 Jul 2014 HWIF Risk Manager

2.0 Change all references to the Home

Warranty Insurance Fund (HWIF) to the

Home Building Compensation Fund

(HBCF). Other changes effecting because

of commencement of the Home Building

Amendment Act 2014

15 Jan 2015 HBCF Industry

Liaison Officer

3.0 Re-designed as per the icare style guide

icare Legal Review

19 June 17 HBCF Contract

Performance

Manager

3.1 Content refresh by HBCF team/Deloitte 9 Sep 2017 HBCF Contract

Performance

Manager

4.0 Content edited to reflect appointment of

new Claims and Eligibility Risk Managers

20 Sep 2018 HBCF Risk Manager

5.0 Revision for 2019 SIRA submission Content

edited to reflect:

having one Eligibility Risk Manager

restructured underwriting appeals process

removing duplication of content between

this document and the Eligibility Manual /

Underwriting Procedures Manual

8 Aug 2019 HBCF Risk Manager

HBCF Underwriting

Manager

6.0 Revision for 2020 SIRA submission 1 January 2021 HBCF claims

manager

HBCF Underwriting

Manager

mailto:[email protected]?subject=HBCF%20Enquiry

https://www.icare.nsw.gov.au/


Version Revision Description Date Author

7.0 Updates based on Customer Advocate

recommendations to rewrite content in

plain English.

Changed service standards for the claim

manager’s response from two to five days

for:

▪ Receipt of claim if prescribed claims

information is complete

▪ Receipt of claim if prescribed claims

information is incomplete requirements

Note: SIRA has already approved the

change from two to five days.

June 2021 icare HBCF

Technical Writer


Table of contents 1 Introduction .................................................................................................................................. 6 2 Objectives and scope .................................................................................................................. 6

2.1 Objectives ......................................................................................................................... 6 2.2 Scope ................................................................................................................................. 6 2.3 Supporting references ......................................................................................................7

2.3.1 Public documents ......................................................................................................................... 7

2.3.2 Scheme agent documents........................................................................................................ 7

2.3.3 NSW Fair Trading documents................................................................................................. 7

2.3.4 Law and justice policy ............................................................................................................... 7

2.3.5 State Insurance Regulatory Authority (SIRA) documents ............................................ 7

2.4 Definitions ..........................................................................................................................7

2.4.1 Complaint ....................................................................................................................................... 7

2.4.2 Dispute ............................................................................................................................................ 7

3 Process .......................................................................................................................................... 8 3.1 Service level – complaint & dispute handling process ............................................... 8 3.2 Underwriting – complaint & dispute handling process ............................................... 8 3.3 Overview of the service standards for the eligibility risk manager .......................... 8 3.4 Claims – complaint & dispute handling process .......................................................... 11 3.5 Overview of the service standards for the claims manager ...................................... 11

4 Complaints ................................................................................................................................... 14 4.1 Referral of disputes to icare HBCF ............................................................................... 15 4.2 Complaints registers ....................................................................................................... 15 4.3 Overview of the claim complaint and dispute handling process ............................. 15

4.3.1 Claim decisions by the claims manager .............................................................................. 15

4.3.2 Complaints by claimants ......................................................................................................... 16

4.3.3 Claims manager internal dispute resolution (IDR) system .......................................... 16

4.3.4 Referral of disputes to icare HBCF claims committee .................................................. 16

4.4 Overview of the underwriting complaint and dispute handling process ................ 17

4.4.1 Underwriting decisions by the eligibility risk manager .................................................. 17

4.4.2 Complaints by builders or brokers ....................................................................................... 17

4.4.3 Eligibility risk manager underwriting committee ............................................................ 17

4.4.4 Premium determinations by icare HBCF ........................................................................... 18

4.4.5 Referrals of complaints and disputes to icare HBCF ..................................................... 18

5 Roles & constitution of underwriting, internal dispute resolution (IDR) & claims committees ............................................................................................................................................. 19

5.1 Eligibility risk manager underwriting committee ....................................................... 19

5.1.1 Constitution .................................................................................................................................... 19

5.1.2 Complaints ..................................................................................................................................... 19

5.1.3 Other matters ............................................................................................................................... 19

5.2 icare HBCF underwriting committee ........................................................................... 20

5.2.1 Constitution .................................................................................................................................. 20

5.2.2 Complaints and disputes ........................................................................................................ 20

5.2.3 Other matters ............................................................................................................................. 22

5.3 Claims manager internal dispute resolution (IDR) .................................................... 22

5.3.1 Constitution .................................................................................................................................. 22


5.3.2 Complaints ................................................................................................................................... 22

5.3.3 Other matters ............................................................................................................................. 22

5.4 icare HBCF claims committee ...................................................................................... 23

5.4.1 Constitution ................................................................................................................................. 23

5.4.2 Disputes........................................................................................................................................ 23

5.4.3 Other matters ............................................................................................................................. 23

6 icare HBCF underwriting committee – management and record keeping ........................ 24 6.1 Quorum ............................................................................................................................ 24 6.2 Presiding member .......................................................................................................... 24 6.3 Voting .............................................................................................................................. 24 6.4 Minutes ............................................................................................................................. 24 6.5 Transaction of business outside meetings or by telephone or other means......... 24 6.6 Managing conflicts of interest ...................................................................................... 24 6.7 Confidentiality ................................................................................................................ 25 6.8 First meeting ................................................................................................................... 25

7 Summary and service standards .............................................................................................. 25 7.1 Service level complaints – scheme agents ................................................................. 25 7.2 Service level complaints – icare HBCF ........................................................................ 25 7.3 Eligibility risk manager underwriting committee – operation & service standards 26 7.4 icare HBCF underwriting committee – operation & service standards .................. 27 7.5 Claims manager internal dispute resolution (IDR) – operation & service standards 28 7.6 icare HBCF claims committee – Operation and Service Standards ........................ 29

8 State Insurance Regulatory Authority (SIRA) ........................................................................ 30 8.1 Requests for regulator compliance review (claims) ................................................. 30 8.2 Other complaints about icare HBCF (claims) ............................................................ 30 8.3 Requests for regulator compliance review ................................................................ 30 8.4 Other complaints about icare HBCF (eligibility) ....................................................... 30


1 Introduction

Insurance and Care NSW (icare) provides services in the administration of the Home Building

Compensation Fund for the NSW Self Insurance Corporation (icare HBCF). icare HBCF uses an

outsourced service model, with contractual arrangements with scheme agents. Gallagher Bassett

Services Pty Ltd is the claims manager and manages claims on behalf of the icare HBCF. Corporate

Scorecard is the eligibility risk manager and assesses builder eligibility on behalf of the icare HBCF.

icare HBCF is a licensed provider of insurance under Part 6 of the Home Building Act 1989, also

known as home building compensation (HBC) insurance. The State Insurance Regulatory Authority

(SIRA) regulates the market for this insurance, including the licensing of providers and oversight of

the operation of the home building compensation scheme.

HBC insurance is an integral component of the government’s consumer protection strategy for

homeowners having building work undertaken in New South Wales. It provides a safety net for

homeowners when their builder is unable to meet their obligations under the building contract due

to insolvency, death, or disappearance. The safety net is also provided where the builder’s licence is

suspended because they fail to comply with an NSW Civil and Administrative Tribunal (NCAT) or

Court order to pay compensation to the homeowner.

2 Objectives and scope

2.1 Objectives

This document provides detailed guidelines for handling complaints and disputes about:

• claim decisions

• service level standards

• eligibility applications

• eligibility reviews

• certificate of insurance applications

• premium determination.

The document defines how scheme agents handle complaints about their claim decisions and how

scheme agents and icare HBCF establish, constitute and operate claims and underwriting

committees to handle escalated disputes.

Underwriting and claims committees are an important component of icare HBCF’s complaints

handling process. This process ensures that icare HBCF and their designated agents manage

complaints and escalated disputes appropriately.

2.2 Scope

Where a builder or homeowner is unhappy with an underwriting or claims decision, the level of

service provided by a scheme agent, or their service providers or brokers, it is important that a

consistent set of guidelines and procedures are established and followed to manage complaints and

any escalated disputes.

Where appropriate, the scheme agent may refer some matters as disputes to icare HBCF and icare

HBCF’s underwriting or claims committees will review those disputes to reach an outcome.

The primary scope of this document will cover:

• The handling of complaints about claims decisions

• The handling of complaints and disputes about service level standards.

• The role of the scheme agents, icare HBCF’s underwriting team, and icare HBCF’s

underwriting and claims committees in handling complaints and escalated disputes.

• Determining when matters should be referred to icare HBCF’s underwriting team.

• Determining when matters should be referred to icare HBCF’s underwriting or claims

committees.


• The membership and constitution of icare HBCF’s underwriting and claims committees.

• Meeting management, record keeping and governance.

• Accessing complaint and/or dispute resolution processes provided by SIRA.

2.3 Supporting references

2.3.1 Public documents

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

• HBCF Eligibility Manual

• HBCF Claims Information for Homeowners

• HBCF Homeowner Fact Sheet

• HBCF Claims Fact Sheet

2.3.2 Scheme agent documents

• HBCF Underwriting Procedures Manual

• HBCF Claims Manual

• HBCF Eligibility Manual

2.3.3 NSW Fair Trading documents

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

• NSW Guide to Standards and Tolerances 2017

• Consumer Building Guide

2.3.4 Law and justice policy

Published by the NSW Department of Communities and Justice and available on its website at

www.justice.nsw.gov.au.

• NSW Government’s Model Litigant Policy

2.3.5 State Insurance Regulatory Authority (SIRA) documents

• Home building compensation (claims handling) insurance guidelines

• Home building compensation (eligibility) insurance guidelines

• Home building compensation (premium) insurance guidelines

• Home building compensation (prudential) insurance guidelines

• HBC standard licence conditions for insurers

• NSW Self Insurance Corporation conditions – Home building compensation regulation.

Published by SIRA and available on its website at www.sira.nsw.gov.au.

2.4 Definitions

2.4.1 Complaint

Any expression of dissatisfaction with a product or service offered or provided by icare HBCF or its

scheme agents including the scheme agent’s service providers.

2.4.2 Dispute

A complaint that icare HBCF or a scheme agent has considered and/or responded to but the

complainant is not satisfied with the outcome.


http://www.fairtrading.nsw.gov.au/

http://www.justice.nsw.gov.au/

http://www.justice.nsw.gov.au/

http://www.sira.nsw.gov.au/


3 Process

3.1 Service level – complaint & dispute handling process

Figure 1: Service Level complaint and dispute handling process

3.2 Underwriting – complaint & dispute handling process

Figure 2: Underwriting complaints and dispute handling process

3.3 Overview of the service standards for the eligibility risk manager

The eligibility risk manager’s focus is on customer service, responding technically correctly and in a

timely manner to all customer and other stakeholder enquiries – technical and procedural.


The quantitative service standards apply, as detailed below.

Table 1: Eligibility assessment and review service standards

Eligibility assessment and review Eligibility risk manager requirement for

completion

Issue notice to the builder commencing an

eligibility review process and requesting provision

of information and documentation by specified due

date (periodic eligibility reviews - PER- only).

Notice issued at least 40 business days

before the due date

Acknowledge receipt of eligibility application or

review documents

Within two business days of receipt of the

documents

The application/review documents have been

received but are deficient and further information

is required from the builder to progress the

application/ review.

Within seven business days of receipt of

the documents

Complete eligibility assessment/review and

communicate Eligibility profile, terms, and

conditions to the builder (via the distributor).

Within 10 business days of receipt of

complete information

Finalise an eligibility assessment Within 40 business days of communicating

eligibility profile, terms, and conditions to

the builder (via the distributor) unless:

▪ the builder provides evidence they are

taking steps to meet one or more

conditions of eligibility but will not satisfy

the condition(s) within this timeframe

▪ the builder has lodged a complaint

and/or dispute about the eligibility

profile, terms and conditions in

accordance with the Complaint and

Dispute Handling Procedures

Table 2: Project applications service standard

Project Applications Service Standards Eligibility risk manager requirement for

Assess whether additional information is required

and/or builder profile change and if required

request information or initiate review.

Within two business days of receipt of the

application for a certificate

Underwrite application for certificate of insurance

and advise the builder through their distributor of

decision including any proposed conditions on the

approval, for example security, Building Contract

Review Program (BCRP).

Within five business days of receipt of

complete information or completion of

review (whichever later)

Issue decision via CIMS to distributor Within two business days of receipt of

builder accepting underwriting conditions


Table 3: Response to enquiries service standards

Enquiries Service Standards Eligibility risk manager requirement for

completion

Responding to queries from icare HBCF, SIRA or

NSW Fair Trading (for example, the eligibility risk

manager may regularly receive enquiries from icare

HBCF, SIRA or Fair Trading. Some may be of an

eligibility-specific nature while others may be

related to scheme policy)

Within two business days for general

requests

Within four business hours for urgent

queries (such as where there is ministerial

involvement)


Note: The eligibility risk manager must communicate immediately with the builder’s

distributor where it believes it cannot meet the service standards before the due date for

delivery. The eligibility risk manager is to advise of the reasons for the delay and the

expected actual delivery date. Communication of a delay does not alter the builder or

distributor’s rights regarding a complaint or the process or obligations otherwise detailed in

this document.

3.4 Claims – complaint & dispute handling process

Figure 3: icare HBCF Claims - Complaints and Disputes Handling Process

3.5 Overview of the service standards for the claims manager

icare HBCF expects the claims manager to meet the following standards:

Table 4: Claims manager service standards

Action Service standard Claims manager

requirement for

completion

Response to the

claimant’s initial

enquiry

The claims manager will send the claimant a claim

form

Within two business

days

Receipt of

notification

The claims manager will acknowledge receipt of a

notification and advise that the prescribed claims

information is required before claim can be

assessed

Within two business

days

The claims manager will register the notification on

the system

Within two business

days



requirement for

completion

Receipt of claim

if prescribed

claims

information is

incomplete

The claims manager will notify the claimant in

writing that all information has not been received

and advise exactly what further information is

required to process the claim

Within five business

days

The claims manager will register the incomplete

claim as a notification on the system


days

The claims manager will raise an initial case reserve

on the system


days of registration

Follow up of

prescribed

claims

information

If the claims manager has not received all the

prescribed claim information from the claimant

within five business days of receiving some

prescribed claim information, the claims manager

will inform the claimant in writing of the additional

information that is required to process the claim

Within 24 hours after

the expiration of five

business days from the

initial request

Receipt of claim

if prescribed

claims

information is

complete

The claims manager will acknowledge receipt of a

claim and advise of the next steps to be taken to

assess the claim.

The claims manager will inform the claimant that

the claim will be deemed as accepted or declined

within 90 days, unless the claimant agrees to an

extension of time for the claims manager to

determine the claim.


days

The claims manager will register the claim on the

system


days

The claims manager will raise an initial case reserve

on the system


days of registration

Determination

of builder’s

status

If at any time the claims manager forms the view

that the policy has not been triggered, the claims

manager will inform the claimant in writing and

provide details of the source of that view


days

The claims manager will inform the claimant

whether it accepts that the status of the builder has

been established so that the policy is triggered or

alternatively whether further information is required

Within 30 business

days of receipt of

claim



requirement for

completion

Appointment of

service provider

The claims manager will appoint any necessary

technical consultant


days of registration of

the claim

After appointing any service provider, the claims

manager will notify the claimant and provide the

contact details for the provider


days

Determination

of claim

The claims manager will either accept or deny the

claim

Within 90 days after

receipt of all

prescribed claims

information

Supply of

consultants

reports to

claimants

The claims manager will provide the claimant with

copies of reports from service providers that are

relied upon to reject a claim or reduce the liability

in respect of a claim.

There is no requirement to disclose information

where:

▪ it is confidential information provided by third

parties

▪ the information cannot be disclosed under law

▪ the information is subject to legal professional

privilege.

Within 10 business

days of receiving a

written request

Review of case

reserves

The claims manager will review case reserves whilst

investigations are continuing, and evidence is being

obtained to enable a determination of indemnity

and liability to be made

Every four weeks or

within five business

days of receipt of new

information

Review of claim The claims manager will review the claim Every four weeks or

within five business

days of receipt of new

information

Communication

with claimant

The claims manager will return all telephone calls

with the claimant or their representative

Within one business

day

The claims manager will keep the claimant informed

about the progress of the claim in writing

Every month



requirement for

completion

The claims manager communicates to the claimant

at least three days before the expiry of a service

standard when it believes that it cannot meet its

claim service standards and will indicate its likely

response time and the way in which the claim will

be handled

At least three days

prior to expiration of

service standard

Claim dispute or

complaint

The claims manager is to consider the claimant’s

escalated complaints disputes through their internal

IDR

Within 15 business

days of lodgement of

the dispute

icare HBCF claims committee must consider any

escalated complaints

Within 10 business

days of receiving a

request to review a

complaint

Payments The claims manager will action the payment of

accounts and settlements

Within 10 business

days or within the

timeframes specified

by NCAT or a Court

Actioning icare

HBCF

instructions

The claims manager is to action any instructions

issued by icare HBCF

Within two business

days of the instruction

being issued

Responding to

queries from

icare HBCF,

SIRA or NSW

Fair Trading

The claims manager may regularly receive enquiries

from icare HBCF, SIRA or NSW Fair Trading. Some

may be of a claims specific nature while others may

be related to scheme policy

Within two business

days of general

requests

Within four business

hours for urgent

queries (such as where

there is Ministerial

involvement)

Finalisation The claims manager will finalise a claim:

▪ once the claim has been fully investigated

▪ when they have determined the liability and

amount (if any)

▪ when they have paid the claimant and relevant

service providers.

Within 14 days of last

action on claim

4 Complaints

A homeowner can make a complaint about a claim decision by asking the claims manager to refer

the decision to the claims manager’s internal dispute resolution (IDR) process. Homeowners must

make this request within 30 days of receiving their written claim decision.

A homeowner, builder, or a distributor on behalf of the builder can complain about the level of

service provided by icare HBCF or on behalf of icare HBCF by a scheme agent, provided they do

this within reasonable timeframes.

To start with, the scheme agent should handle complaints about service standards (other than a


complaint about icare HBCF itself) in accordance with their internal complaint and dispute handling

procedures.

The scheme agent’s response to the complainant should also provide information about how to

access and use icare HBCF’s dispute handling process.

4.1 Referral of disputes to icare HBCF

If a complainant is not satisfied with the outcome of the scheme agent’s review of the original

complaint they may ask the scheme agent to refer the matter to icare HBCF for review.

The scheme agent will submit a written referral to icare HBCF, asking them to undertake a review.

When the scheme agent submits the referral for review, they will also submit all case information.

This includes supporting documentation submitted by the complainant and the scheme agent’s

underwriting committee eligibility decision if the original complaint has been reviewed and

responded to.

icare HBCF will consider the complainant’s and scheme agent’s submissions and then determine the

dispute and notify the complainant of the decision. The decision is final and binding and the scheme

agent will implement the decision as soon as practicable.

4.2 Complaints registers

Each scheme agent must establish a register of complaints or disputes and record the nature of

each complaint or dispute and how and when it was resolved. This register should include all details

of how each complaint or dispute was managed in accordance with the process listed in section

Service level complaints – scheme agents on page 25.

Each scheme agent must make information from their complaints and disputes registers available to

icare HBCF when requested.

Note: Complaints and enquiries are

treated differently. A complaint will only arise for the purposes of reporting to icare HBCF

where the person making the complaint requests it to be registered or to be referred to the

scheme agent’s internal dispute handling process. A scheme agent that receives a

complaint must ask the complainant whether that person wishes the complaint to be

registered or referred to the internal dispute settlement process.

4.3 Overview of the claim complaint and dispute handling process

4.3.1 Claim decisions by the claims manager

The claims manager will provide documented reasons for its decisions on indemnity and liability to

the claimant. The claims manager will document in writing to the claimant its decision to do one of

the following:

• Accept the claim and on what conditions

• Reject the claim, in whole or part

• Reduce its liability in respect of a claim.

The claims manager will promptly advise the claimant of the decision and the reasons for the

decision. The claims manager will also advise the claimant of the availability of its internal dispute

handling procedure and the rights of the claimant to appeal the decision through the NSW Civil and

Administrative Tribunal (NCAT) or the District Court where the amount involved exceeds the

$500,000, jurisdictional limit of the Tribunal.

The claims manager should ensure that it advises its decision in such a manner that the claimant is

able to exhaust all internal review processes before needing to appeal to NCAT or the court to

avoid cost and unnecessary stress.

The claimant is to be advised to refer any dispute in relation to a decision by a claims manager on a

claim to the claims manager internal dispute handling system, not later than 30 days after written

notice of the decision on the claim was given to the claimant, to ensure that this avenue is not

available indefinitely.

The claims manager will also advise the claimant that:


• Any appeal to the NSW Civil and Administrative Tribunal (NCAT) or District Court must be

lodged within 45 days of final written notification by the claims manager that the claim has

been ultimately rejected following the exhaustion of the claim review processes

• It will not seek to impose any time constraints upon the claimant until the internal review

processes and any review sought through icare HBCF have been exhausted. This means that

the 45-day time limit to appeal (to NACT or a Court) does not start until all icare review

processes have been completed.

• The claimant can by-pass the dispute handling procedures and has the right to appeal the

decision immediately to NCAT or a court (it is important a claimant is aware of, and able to

exercise, their rights and obligations under the Home Building Act 1989).

4.3.2 Complaints by claimants

The claims manager has its own internal complaint and dispute handling procedures that are

approved by icare HBCF and comply with relevant SIRA Guidelines.

icare HBCF’s Claims Manual requires the claims manager to establish an internal disputes resolution

process to deal with a range of matters including all complaints by claimants about claims

decisions.

The claimant is to have the opportunity, within 30 days after written notice of the decision on the

claim, to make a submission to the claims manager responding to the reasons for the initial claim

decision.

4.3.3 Claims manager internal dispute resolution (IDR) system

Unless there are special circumstances, a claimant should refer any dispute about a claim decision

to the claims manager’s internal dispute resolution system, not later than 30 days after the claimant

received written notice of the decision.

The claims manager will maintain its own IDR area (or equivalent) for consideration and

determination of disputes and complaints that require escalation because the claimant is

dissatisfied with the claims manager’s claim decision.

Complaints about a claim (whether lodged personally, by telephone or in writing) should be

directed to the claims manager for referral to its IDR area for consideration and determination.

The claims manager’s IDR area will investigate the complaint and consider all supporting

documentation and information provided by, or on behalf of, the claimant. The claims manager will

notify the claimant of the outcome of the IDR’s consideration of the complaint and provide written

reasons for its decision. The claims manager will attach a copy of that notification to the claim file.

The response to the claimant will also provide information about icare HBCF’s dispute handling

process and how to access it. The response will also advise the claimant that if they wish to refer

the dispute to icare HBCF, they must request this referral within 30 days after receiving the written

notice of the review outcome.

If the claimant is dissatisfied with the claims manager’s response to a complaint they may escalate

the complaint and request that it be treated as a dispute for referral by the claims manager for

further investigation by icare HBCF.

The claims manager will inform the claimant that they can bypass the process of referring the

dispute to icare HBCF and immediately appeal the decision to the NSW Civil and Administrative

Tribunal (NCAT) or District Court.

4.3.4 Referral of disputes to icare HBCF claims committee

Where a claimant is not satisfied with the outcome of the claims manager’s review of the original

claim decision, the claimant may ask the claims manager to refer the matter to the icare HBCF

claims committee for review. For an assessment and review to be undertaken, the claims manager

must submit a written referral (to the icare HBCF claims committee) that is accompanied by the

claim manager’s recommendation or submission and all case information, including supporting

documentation submitted by, or on behalf of, the claimant

The icare HBCF claims committee will consider the submission by the claims manager and by, or on

behalf of, the claimant and will then determine the dispute and notify the claims manager of the

decision. The decision is final and binding. The claims manager will implement the decision as soon


as practicable. The claims manager will also notify the claimant of the decision and include contact

details for icare HBCF if the claimant requires information about the decision.

The claims manager will advise the claimant that all internal dispute handling mechanisms have now

been exhausted and that any appeal to the NSW Civil and Administrative Tribunal (NCAT) (or the

District Court where the amount involved exceeds the $500,000, jurisdictional limit of the Tribunal)

must be lodged within 45 days of the claimant receiving written notification of the review outcome

from the icare HBCF claims committee.

The claims manager is also to provide information regarding dispute mechanisms external to icare

HBCF, offered by SIRA and available on its website at www.sira.nsw.gov.au.

4.4 Overview of the underwriting complaint and dispute handling

process

4.4.1 Underwriting decisions by the eligibility risk manager

The eligibility risk manager is not limited to applying standard factors to their underwriting

assessments and may consider other matters, including relevant non-financial matters. They are to

exercise prudent business practices in their determinations.

When the eligibility risk manager makes an underwriting decision, they must notify the builder (or a

distributor on behalf the builder). The decision may be about:

• a certificate of insurance

• eligibility reviews

• eligibility applications.

This includes decisions to cancel, suspend or change an existing eligibility. The notification must be

in writing and include written reasons for the decision.

The decision notification must include information about complaint and dispute handling

procedures for:

• the eligibility risk manager

• icare HBCF

• SIRA.

Where the eligibility risk manager proposes to cancel or modify an existing eligibility, the Agent will

only do so in accordance with their appropriate delegated authority. They will give the builder at

least the minimum required notice period of the decision (notice periods are defined in the

Underwriting Procedures Manual).

4.4.2 Complaints by builders or brokers

The eligibility risk manager has its own internal complaint and dispute handling procedures.

icare HBCF requires the eligibility risk manager to establish an underwriting committee to deal with

a range of underwriting matters including all complaints by builders about underwriting decisions.

The builder, or a distributor on behalf of the builder, is to have the opportunity, within reasonable

timeframes, to make a submission to the eligibility risk manager responding to the reasons for the

initial underwriting decision.

4.4.3 Eligibility risk manager underwriting committee

Complaints by, or on behalf of, a builder regarding the eligibility risk manager’s underwriting

decisions should in the first instance be directed to the eligibility risk manager for referral to its

underwriting committee for consideration and determination.

The underwriting committee is to be constituted so that its collective members have the necessary

skills, knowledge and experience to be able to consider and make informed determinations in

relation to all builder eligibilities.

The underwriting committee will investigate the complaint.

Where the eligibility risk manager’s committee reviews a dispute raised by a builder, the committee

is to consider the matter on its merits based on all the relevant information available and provided



by, or on behalf of, the builder. This includes any further information submitted to the committee by

the builder, following notification of the original decision. The Committee is also to seek further

information or clarification of information provided from the builder where considered appropriate.

The eligibility risk manager’s committee should determine whether to support, overturn or modify

the original eligibility decision.

The eligibility risk manager will notify the builder, or their distributor, of the outcome of the

underwriting committee’s consideration of the complaint and provide reasons for its decision. A

copy of that notification is to be uploaded into the builder’s assessment file in the Builders Eligibility

Assessment Tool (BEAT).

The response to the builder or distributor will also provide information about the icare HBCF and

SIRA dispute handling processes and how to access them.

If the builder is dissatisfied with the eligibility risk manager’s response to a complaint, in some

instances, they may be able to escalate the complaint through their distributor. The builder should

ask their distributor to refer the issue to the eligibility risk manager as a dispute for further

investigation by icare HBCF.

4.4.4 Premium determinations by icare HBCF

Complaints by, or on behalf of a builder, regarding any aspect of a premium determination (that is,

quantum, risk-based weighting, etc.) should be directed to icare HBCF for internal review and

decision.

icare HBCF is to acknowledge receipt of complaints within three business days. icare HBCF will

investigate complaints and provide a written response within 15 business days of receipt of the

complaint. The response will advise the builder of the outcome and explain the reasons for the

decision.

4.4.5 Referrals of complaints and disputes to icare HBCF

The builder or distributor may ask the eligibility risk manager to refer the matter to icare HBCF for

determination, when a builder:

• disputes the outcome of the eligibility risk manager’s review of the original underwriting

decision; or

• makes a complaint about an underwriting decision made by icare HBCF.

The eligibility risk manager will submit all referrals in writing to icare HBCF’s underwriting manager.

For icare HBCF to undertake an assessment and review, the eligibility risk manager should also

provide a recommendation, the eligibility risk manager’s underwriting committee outcome, and a

summary of issues (including a submission of case information and including supporting

documentation submitted by the builder or distributor and reviewed by the ERM).

Complaints and disputes arising from an underwriting decision in relation to a matter that is within

the scope of the Underwriting Procedures Manual or any instructions, guidelines or written

directions given by icare HBCF are not generally to be referred to icare HBCF unless directed or

otherwise agreed by icare HBCF.

A builder or their appointed distributor can ask the eligibility risk manager to refer the following

types of decisions to icare HBCF’s underwriting committee for review:

• Decline a builder’s application for eligibility

• Cancel a builder’s eligibility

• Suspend a builder’s eligibility

• refuse to provide cover for a specific project based on a subjective assessment

Where a quorum of the icare HBCF underwriting committee cannot be convened in person in a

reasonable time, icare HBCF may in its discretion have the underwriting committee make a decision

‘out of session’ by providing recommendations based on papers circulated outside meetings.

While the above matters may be routinely referred to icare HBCF’s underwriting committee, icare

HBCF may in its absolute discretion determine an underwriting matter without first having received

a recommendation from icare HBCF’s underwriting committee.


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

• Where an urgent response is required

• Where the complaint or dispute arises from an underwriting decision in relation to a matter

that is entirely within the scope of the Underwriting Procedures Manual or any instructions,

guidelines or written directions given by icare HBCF

• Where icare HBCF’s underwriting committee is unable to agree on a recommendation

• Where icare HBCF is concerned, on reasonable grounds, that the committee or a member of

the committee may be prejudiced in relation to a matter.

icare HBCF (or icare HBCF’s underwriting committee as applicable) will consider the submissions by

the eligibility risk manager and by, or on behalf of, the builder.

Where a complaint or dispute has been determined by icare HBCF, without reference to the icare

HBCF underwriting committee, the icare HBCF underwriting manager will:

• Determine the matter

• Communicate the decision to the builder, or their broker, and provide information regarding

dispute mechanisms external to icare HBCF, offered by SIRA and available on its website at

www. sira.nsw.gov.au.

• Notify the eligibility risk manager of the decision.

The eligibility risk manager is to implement the decision, which is final and binding, as soon as

practicable.

Where a complaint or dispute is referred to icare HBCF’s underwriting committee, and the

underwriting committee makes a recommendation on the complaint or dispute, icare’s General

Manager, General Lines Underwriting will:

• Determine the matter

• Communicate the decision to the builder, or their broker, and provide information regarding

dispute mechanisms external to icare HBCF, offered by SIRA and available on its website at

www. sira.nsw.gov.au



practicable.

5 Roles & constitution of underwriting, internal dispute

resolution (IDR) & claims committees

5.1 Eligibility risk manager underwriting committee

5.1.1 Constitution

The eligibility risk manager’s underwriting committee is to be constituted so that its collective

members have the necessary skills, knowledge and experience to be able to consider and make

informed determinations in relation to all builder eligibilities.

Additionally, its members must be available such that meetings of the underwriting committee can

be convened within 10 business days of receipt of a complaint, with complete information at hand

to decide no later than 5 business days after the committee has met and considered the complaint.

5.1.2 Complaints

Complaints by, or on behalf of, a builder regarding the eligibility risk manager’s decision in relation

to an application for, or a review of, eligibility including an application for a certificate of insurance

for a specific project, are to be submitted in the first instance to the eligibility risk manager’s own

underwriting committee for consideration and determination.

5.1.3 Other matters

The eligibility risk manager’s underwriting committee is also able to consider matters which fall

outside the scope of icare HBCF’s Underwriting Procedures Manual or any instructions, guidelines

http://www/

http://www/


or written directions given from time to time by icare HBCF as well as underwriting decisions

relating to high risk builders (that is, those that are or may be required to be—depending on the

view taken by the committee—subject to intensive monitoring) and any other matter or class of

matters that may be referred to it by icare HBCF from time to time.

The eligibility risk manager is, always, to be conscious of the potential broader implications that an

underwriting decision may have for icare HBCF, the NSW Government and broader government

policy, such as a decision that may affect or be inconsistent with icare HBCF’s legislative objectives.

Any such matters, even if they fall within the eligibility risk manager’s authority or functions, are to

be reported to icare HBCF as soon as practicable.

The eligibility risk manager’s underwriting committee must also continually assess the quality of its

underwriting decisions, based in part on any inordinate level of dispute emanating from an

individual underwriter’s decisions within the eligibility risk manager’s operations.

5.2 icare HBCF underwriting committee

5.2.1 Constitution

icare HBCF is required to have an underwriting committee. The membership of icare HBCF’s

underwriting committee is to comprise:

• icare HBCF’s Underwriting Manager [Chairperson]

• icare HBCF’s Risk Manager [Deputy Chairperson]

• icare HBCF’s Claims Manager

• a minimum of two building industry experts.

The building industry experts will be nominated by the Housing Industry Association (HIA) and

Master builders Association (MBA). The associations are to be requested by icare HBCF to

nominate two experienced builders (being a member and a deputy). The building industry experts

are appointed to the committee because of their building industry knowledge and expertise and are

not appointed as representatives of the Associations.

icare HBCF may invite one senior underwriter from the eligibility risk manager to attend an icare

HBCF underwriting committee in some circumstances (for example the matter being considered by

the icare HBCF underwriting committee is a dispute of an eligibility decision made by the eligibility

risk manager).

All icare HBCF underwriting committee members, and attendees at icare HBCF underwriting

committee meetings, will be required to enter into a confidentiality agreement acknowledging and

agreeing that:

• The information provided to members of icare HBCF underwriting committee is to be used

exclusively for enabling the underwriting committee to carry out its role and functions

effectively and efficiently.

• No amendments will be made to the information provided.

• Confidential information obtained as a member of icare HBCF’s underwriting committee will

not be disclosed without the express permission of icare HBCF.

• The confidentiality requirements extend beyond the term of icare HBCF underwriting

committee’s operations.

• The member accepts liability for any breach of the confidentiality agreement.

• The member will erase information from any storage system once their appointment to icare

HBCF’s underwriting committee has finished.

5.2.2 Complaints and disputes

The builder or distributor may request the matter to be referred to icare HBCF for determination,

when a builder:

• Disputes the outcome of the eligibility risk manager’s review of the original underwriting

decision

• Makes a complaint about an underwriting decision made by icare HBCF


The eligibility risk manager should also provide a recommendation, outcome made by the ERM’s

underwriting committee and a summary of issues (including a submission of case information and

including supporting documentation submitted by the builder or distributor), for an assessment and

review to be undertaken by icare HBCF.

Complaints and disputes arising from an underwriting decision in relation to a matter that is within

the scope of the Underwriting Procedures Manual or any instructions, guidelines or written

directions given by icare HBCF are not generally to be referred to icare HBCF unless directed or

otherwise agreed by icare HBCF.

A builder or distributor may ask for the following decisions to be referred to icare HBCF’s

underwriting committee for review:

• Decline a builder’s application for eligibility

• Cancel a builder’s eligibility

• Suspend a builder’s eligibility

• Refuse to provide cover for a specific project based on a subjective assessment





• Where an urgent response is required.

• Where it is not possible to obtain a quorum for a meeting of the icare HBCF underwriting

committee within a reasonable period of time.


that is within the scope of the Underwriting Procedures Manual or any instructions, guidelines

or written directions given by icare HBCF.

• Where icare HBCF’s underwriting committee is unable to agree on a recommendation.



icare HBCF’s underwriting committee will meet as required. Reviews of underwriting decisions may

be undertaken out-of-session by way of telephone and email with recommendations confirmed at

the next formal meeting of the committee.

icare HBCF’s underwriting committee shall make its recommendations considering prudent

insurance industry practice and after giving due consideration to the submissions and/or

recommendations of the eligibility risk manager involved as well as submissions by, or on behalf of,

the builder. Submissions on behalf of the builder may be submitted by the building entity or on its

behalf (for example by a director, partner, officer, broker, accountant, solicitor etc.).

Where a complaint or dispute has been determined by icare HBCF, without reference to the icare

HBCF underwriting committee, the icare HBCF Underwriting Manager will:

• Determine the matter.

• Communicate the decision to the builder, or their distributor, and provide information

regarding dispute mechanisms external to icare HBCF, offered by SIRA and available on its

website at www.sira.nsw.gov.au.



practicable.

Where a complaint or dispute is referred to icare HBCF’s underwriting committee, and the

underwriting committee makes a recommendation on the complaint or dispute, icare’s General

Manager, General Lines Underwriting will:

• Determine the matter.

• Communicate the decision to the builder, or their distributor, and provide information


regarding dispute mechanisms external to icare HBCF, offered by SIRA and available on its

website at www.sira.nsw.gov.au.



practicable.

5.2.3 Other matters

The eligibility risk manager must also refer to icare HBCF any underwriting matters, required to be

so referred under the Delegation of Underwriting Authorities (DUA), as soon as practicable for

decision. In such circumstances, the referral should be accompanied by the recommendation of the

eligibility risk manager together with a supporting submission incorporating relevant background

material.

Matters which fall outside the scope of icare HBCF’s Underwriting Procedures Manual or any

instructions, guidelines or written directions given from time to time by icare HBCF may also be

referred to icare HBCF.

Other matters or classes of matters may also be referred to the icare HBCF underwriting committee

by icare HBCF (or by the eligibility risk manager when instructed in writing to do so by icare HBCF)

from time to time for consideration.





• Where an urgent response is required.

• Where it is not possible to obtain a quorum for a meeting of the icare HBCF underwriting

committee within a reasonable period of time.


that is within the scope of the Underwriting Procedures Manual or any instructions, guidelines

or written directions given by icare HBCF.

• Where icare HBCF’s underwriting committee is unable to agree on a recommendation.



The role of icare HBCF’s underwriting committee may also include reviewing icare HBCF’s

Underwriting Procedures Manual and Eligibility Manual and providing advice and recommendations

to icare HBCF on any proposed changes to those procedures, if required by icare HBCF.

5.3 Claims manager internal dispute resolution (IDR)

5.3.1 Constitution

The claims manager’s internal dispute resolution (IDR) area is to use employees with the necessary

skills, knowledge, and experience to be able to consider and make informed determinations in

relation to claims under contracts of insurance under icare HBCF (policies).

Under the Claims Manual and the service level standards a claims manager is required to consider a

claimant’s complaint through its IDR area within 15 business days of lodgement of the complaint.

5.3.2 Complaints

Complaints by, or on behalf of, a claimant regarding the claims manager’s decision in relation to a

claim are to be submitted in the first instance to the claims manager’s own IDR area for

consideration and determination.

5.3.3 Other matters

The claims manager is, always, to be cognisant of the potential broader implications that a claim

decision may have for icare HBCF, the government and broader government policy, such as a

decision that may affect or be inconsistent with icare HBCF’s legislative objectives. Any such

matters, even if they fall within the claims manager’s authority or functions, are to be reported to


icare HBCF as soon as practicable.

The claims manager must also continually assess the quality of its claim decisions, based in part on

any inordinate level of dispute emanating from an individual claims officer’s decisions within its

operations and arising from the recommendations and/or advice of service providers engaged by

the claims manager.

5.4 icare HBCF claims committee

5.4.1 Constitution

icare HBCF is required under SIRA’s Home building compensation (claims handling) insurance

guidelines to have documented complaint and dispute processes. As part of these processes icare

HBCF has established a icare HBCF claims committee.

The membership of the icare HBCF claims committee is to comprise of icare HBCF’s General

Manager, GL Claims (Chairperson) and the icare HBCF claims manager. The committee may access

independent technical and/ or legal advice as and when required.

5.4.2 Disputes

Where a claimant is not satisfied with the outcome of the claims manager’s review of the original

claim decision, the claimant may request that the matter be referred by the claims manager to the

icare HBCF claims committee for review. A referral to the icare HBCF claims committee is to be

formally submitted by the claim manager in writing to icare HBCF and be accompanied by a

recommendation or a submission of the claims manager and all case information, including

supporting documentation submitted by, or on behalf of, the claimant, for an assessment and

review to be undertaken.

The icare HBCF claims committee will meet as and when required. Reviews of claims decisions may

be undertaken out-of-session by way of telephone and email with recommendations confirmed at

the next formal meeting of the committee.

The icare HBCF claims committee shall make its recommendations considering prudent insurance

industry practice and after giving due consideration to the submissions and/or recommendations of

the claims manager involved as well as submissions by, or on behalf of, the claimant. Submissions

on behalf of the claimant may be submitted by the individual claimant or on the claimant’s behalf

(for example by a director, partner, officer, strata managing agent, owners corporation executive,

building consultant, solicitor etc.).

The icare HBCF claims committee will review the claims manager’s decision or recommendation to

ensure that the claims manager acted reasonably and in accordance with the policy and relevant

legislative provisions, icare HBCF’s Claims Manual and Claims Information for Homeowners, relevant

SIRA Guidelines, and the NSW Government’s Model Litigant Policy etc. The icare HBCF claims

committee will then determine the dispute and notify the claims manager of the decision.

The claims manager is to implement the decision, which is final and binding, as soon as practicable.

Where the decision of icare HBCF is different to that made previously by the claims manager, the

outcome of the dispute shall be amended by the claims manager to reflect the decision of icare

HBCF.

The claims manager is also to notify the claimant of the decision and include contact details for

icare HBCF should information be required about the decision.

The claimant should also be advised that all internal dispute handling mechanisms have now been

exhausted and that any appeal to the NSW Civil and Administrative Tribunal (NCAT) (or the District

Court where the amount involved exceeds NCAT’s $500,000 jurisdictional limit) must be lodged

within 45 days of written notification by the claims manager of the outcome of the review by the

icare HBCF claims committee.

The claims manager is also to provide information regarding dispute mechanisms external to icare

HBCF, offered by SIRA and available on its website at www.sira.nsw.gov.au.

5.4.3 Other matters

The claims manager must also refer to icare HBCF any claim matters, required to be so referred

under the Delegation of Claims Handling Authorities, as soon as practicable for decision. In such

circumstances, the referral should be accompanied by the recommendation of the claims manager



together with a supporting submission incorporating relevant background material.

Matters which fall outside the scope of icare HBCF’s Claims Manual or any instructions, guidelines or

written directions given from time to time by icare HBCF may also be referred to icare HBCF.

Other matters or classes of matters may also be referred to the committee by icare HBCF (or by the

claims manager when instructed in writing to do so by icare HBCF) from time to time for

consideration.

The role of the icare HBCF claims committee also includes reviewing icare HBCF’s Claims Manual

and Claims Information for Homeowners and providing advice and recommendations to icare HBCF

on any proposed changes to those documents.

6 icare HBCF underwriting committee – management and

record keeping

6.1 Quorum

The quorum for meetings of icare HBCF’s underwriting committee is a majority of its members for

the time being and must include a minimum of two building industry experts.

6.2 Presiding member

Meetings of icare HBCF’s underwriting committee are to be chaired by:

• The Chairperson of the committee

• In the absence of the Chairperson, the Deputy Chairperson.

The member chairing any meeting of the committee has a deliberative vote and, in the event of an

equality of votes, has a second or casting vote.

6.3 Voting

A recommendation supported by a majority of the votes cast at a meeting of icare HBCF’s

underwriting committee at which a quorum is present is the recommendation of icare HBCF’s

underwriting committee.

6.4 Minutes

icare HBCF’s underwriting committee must cause full and accurate minutes to be kept of the

proceedings and recommendations of each meeting of the committees.

6.5 Transaction of business outside meetings or by telephone or other

means

icare HBCF’s underwriting committee may, if it is of the view that it is appropriate to do so, transact

any of its business by the circulation of papers among all the members of the committee for the

time being. Papers may be circulated among members by email, facsimile or other transmission of

the information in the papers concerned.

A decision in writing approved by a majority of members is taken to be a recommendation of icare

HBCF’s underwriting committee and is to be recorded in the minutes of the meetings of the

committee.

icare HBCF’s underwriting committee may, if it is of the view that it is appropriate to do so, transact

any of its business at a meeting at which members (or some members) participate by telephone,

close-circuit television, or other means, but only if any member who speaks on a matter before the

meeting can be heard by the other members.

In the above cases the Chairperson, Deputy Chairperson and each member have the same voting

rights as they have at an ordinary meeting of the body.

6.6 Managing conflicts of interest

A member of icare HBCF’s underwriting committee who has a direct or indirect pecuniary interest

in a matter being considered or about to be considered at a meeting of the committee, and whose

interest appears to raise a conflict with the proper performance of the member’s duties in relation


to the consideration of the matter, must, as soon as possible after the relevant facts have come to

the member’s knowledge, disclose the nature of the interest at a meeting of the committees.

A disclosure by a member of icare HBCF’s underwriting committee at a meeting of the committee

that the member is a member, or in the employment, of a specified company or other body, or is a

partner, or in the employment, of a specified person, or has some other specified interest relating to

a specified company or other body or to a specified person, is a sufficient disclosure of the nature

of the interest.

In such cases the member is to abstain from any discussion and vote on a recommendation on the

matter. Particulars of any such disclosure are to be recorded in the minutes of the proceedings of

the meeting.

6.7 Confidentiality

All members of icare HBCF’s underwriting committee, and all attendees at icare HBCF underwriting

committee meetings, are required to enter into a Confidentiality Agreement acknowledging and

agreeing to the confidentiality and security of information received as a member of the

underwriting committee.

6.8 First meeting

The first meeting of icare HBCF’s underwriting committee is to be called in such manner as icare

HBCF determines.

7 Summary and service standards

7.1 Service level complaints – scheme agents

Complaints regarding service standards (whether lodged personally, by telephone or in writing)

should be handled by the scheme agent in accordance with the scheme agent’s internal complaint

and dispute handling procedures.

• Oral complaints will be acknowledged immediately and written complaints within three

business days advising the complainant of the complaint and dispute handling procedure.

• Complaints will be investigated, and a response provided in writing within 15 business days of

receipt of the complaint provided the scheme agent has all the necessary information and

has completed any investigation that may be required.

• In cases where further information, assessment or investigation is required, reasonable

alternative timeframes will be agreed.

• Complainants will be kept informed of the progress of the response to their complaint.

• The response to the complaint should also provide information about the dispute handling

process of icare HBCF and how to access the dispute handling process.

• If a complainant is not satisfied with the outcome of the scheme agent’s review of the

original complaint they may request that the matter to be referred by the scheme agent to

icare HBCF for review.

• Referral of a dispute to icare HBCF by a scheme agent is to occur within three business days

of the scheme agent being notified of the complainant’s request that the dispute be referred

to icare HBCF.

• A referral to icare HBCF is to be formally submitted by the scheme agent in writing to icare

HBCF and be accompanied by all case information (including supporting documentation

submitted by, or on behalf of, the complainant) for a review to be undertaken.

7.2 Service level complaints – icare HBCF

icare HBCF will contact the complainant within five business days of receiving a dispute to:

• acknowledge receipt and to provide a contact name for enquiries and a timeframe for

determining the matter.

icare HBCF must ensure that the matter is considered by an appropriate officer within 10 business

days of receipt by icare HBCF of the dispute.


icare HBCF will consider the submissions by the scheme agent and by, or on behalf of, the

complainant icare HBCF will then formally determine the dispute (via a sign-off by icare HBCF's

Underwriting Manager, or General Manager, General Lines Underwriting or Group Executive,

Prevention & Underwriting) and notify the scheme agent in writing of the decision within 3 business

days of the sign-off.

The scheme agent is to implement the decision, which is final and binding, as soon as practicable.

The scheme agent is also to notify the complainant in writing of the decision within three business

days of its receipt of the decision and include contact details for icare HBCF should information be

required about the decision. The scheme agent is also to provide information regarding dispute

mechanisms external to icare HBCF, offered by SIRA and available on its website at

www.sira.nsw.gov.au.

7.3 Eligibility risk manager underwriting committee – operation &

service standards

• The eligibility risk manager is to have its own underwriting committee.

• Members of the committee should be carefully selected based on sufficient skill, knowledge,

and experience.

• The established committee will consider complaints by, or on behalf of, a builder regarding a

decision by the eligibility risk manager in relation to an application for, or a review of,

eligibility (including an application for a Certificate of Insurance for a specific project).

• Such complaints are to be submitted, in the first instance, to the eligibility risk manager for

consideration and determination by its underwriting committee


business days advising the builder (or distributor on behalf of the builder) of the •

complaint and dispute handling procedure. All complaints regarding an eligibility decision

will be acknowledged in writing.

• The committee is to convene within 10 business days of receipt of a complaint.


alternative timeframes will be agreed, and the builder/distributor will be kept informed of the

progress of the response to their complaint.

• A determination is to be made and advised to the builder (or a distributor on behalf of the

builder) within five business days of the committee having considered the complaint.

• All decisions must be consistent with icare HBCF’s Underwriting Procedures Manual or any

instructions, guidelines or written directions given from time to time by icare HBCF.

• The response to the builder or distributor is to include written reasons for the decision and a

copy of the response is to be provided to icare HBCF.

• The response to the builder or distributor is to also include information about the dispute

handling process of icare HBCF including advice as the type of matters which may be

referred to icare HBCF and how to access the dispute handling process.

• If the builder is dissatisfied with the eligibility risk manager’s response to a complaint they

may, in some instances, be able to escalate the complaint and request via their distributor

that it be treated as a dispute for referral by the eligibility risk manager for further

investigation by icare HBCF.

• Referral of a dispute to icare HBCF by the eligibility risk manager is to occur within three

business days of the eligibility risk manager being notified of the builder’s or distributor’s

request that the dispute be referred to icare HBCF.

• A referral to icare HBCF’s underwriting committee is to be formally submitted by the

eligibility risk manager in writing to icare HBCF. The eligibility risk manager should also

provide a recommendation and a summary of issues (including a submission of case

information and including supporting documentation submitted by the builder or distributor),

for an assessment and review to be undertaken.

The eligibility risk manager’s underwriting committee is also able to consider:



• matters which fall outside the scope of icare HBCF’s Underwriting Procedures Manual or any

instructions, guidelines or written directions given from time to time by icare HBCF

• underwriting decisions relating to high risk builders (that is, those that are or may be

required to be subject to intensive monitoring (depending on the view taken by the

Committee)

• any other matter or class of matters that may be referred to it by icare HBCF from time to

time.

• The eligibility risk manager’s underwriting committee must also continually assess the quality

of its underwriting decisions, based in part on any inordinate level of dispute emanating from

an individual underwriter’s decisions within the eligibility risk manager’s operations.

7.4 icare HBCF underwriting committee – operation & service standards

icare HBCF is to have an underwriting committee in operation. The membership of icare HBCF’s

underwriting committee is to be constituted as follows:

• icare HBCF Underwriting Manager (Chairperson)

• icare HBCF Risk Manager (Deputy Chairperson)

• icare HBCF claims manager

• a minimum of two building industry experts (nominations from the Housing Industry

Association (HIA) and Master Builders Association (MBA).

• All members of icare HBCF’s underwriting committee, and all attendees at icare HBCF

underwriting committee meetings, are to enter into a Confidentiality Agreement

acknowledging and agreeing to the confidentiality and security of information received as a

member of the underwriting committee.

• icare HBCF’s underwriting committee may consider the following types of matters:

◦ underwriting decisions by the eligibility risk manager and confirmed or modified by the

eligibility risk manager’s underwriting committee that continue to be disputed by a builder

◦ complaints regarding underwriting decisions made by icare HBCF

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

◦ underwriting matters required to be referred to icare HBCF by the eligibility risk manager

under the Delegation of Underwriting Authorities

◦ other matters or classes of matters referred from time to time by icare HBCF (or by the

eligibility risk manager when instructed in writing to do so by icare HBCF)

◦ reviewing and recommending changes to the Eligibility Manual and Underwriting Procedures

Manual as requested by icare HBCF.

• icare HBCF will contact the builder, or their distributor, within three business days of

receiving a complaint or dispute to acknowledge receipt and provide an indicative timeframe

for determining the matter.

• icare HBCF (by the icare HBCF Underwriting Manager) will initially review Complaints or

Disputes referred to it to determine if they will be determined by icare HBCF or referred to

the icare HBCF underwriting committee for a recommendation (see section 5.2).

• Where icare HBCF determines a complaint or dispute, without referral to the icare HBCF

underwriting committee, the icare HBCF Underwriting Manager will:

◦ advise the eligibility risk manager in writing of icare HBCF’s decision within five business

days of the determination of the complaint or dispute

◦ notify the builder’s distributor in writing of the decision within five business days of icare

HBCF determining the complaint or dispute and include contact details for icare HBCF

should information be required about the decision.

◦ provide the builder’s distributor with information regarding dispute mechanisms external to

icare HBCF, offered by SIRA as detailed on its website at www.sira.nsw.gov.au

• icare HBCF’s underwriting committee will consider submissions referred to it by the icare

HBCF Underwriting Manager and make a recommendation to icare’s General Manager,

General Lines Underwriting. icare HBCF will then formally determine the dispute (by sign- off



by icare’s General Manager, General Lines Underwriting) and:

◦ advise the eligibility risk manager in writing of icare HBCF’s decision within five business

days of the determination of the complaint or dispute

◦ notify the builder’s broker in writing of the decision within five business days of icare HBCF

determining the complaint or dispute and include contact details for icare HBCF should

information be required about the decision.

◦ provide the builder’s broker with information regarding dispute mechanisms external to

icare HBCF, offered by SIRA as detailed on its website at www.sira.nsw.gov.au

• The eligibility risk manager is to implement icare HBCF decisions, which are final and binding,

as soon as practicable.

• Complaints or disputes referred to icare HBCF should generally:

◦ Be determined within 10 business days of receipt of the complaint or dispute from the

eligibility risk manager.

◦ Have icare HBCF’s determination of the complaint or dispute communicated to the eligibility

risk manager and builder’s distributor within 15 business days of receipt of the complaint or

dispute from the eligibility risk manager.

In cases where this is not possible (for example obtaining a quorum for a meeting with the icare

HBCF underwriting committee, further information or investigations being required) reasonable

alternative timeframes will be communicated and the builder’s distributor will be kept informed of

the progress of the response to the builder’s complaint or dispute.

• Decisions in relation to any aspect of a premium determination that is disputed by a builder

will:

◦ be notified to the builder’s distributor in writing by icare HBCF within five business days of

the determination by icare’s General Manager, General Lines Underwriting

◦ Be determined within 15 business days of receipt of the dispute.

7.5 Claims manager internal dispute resolution (IDR) – operation &

service standards

• The claims manager is to have its own IDR area.

• IDR staff should be carefully selected based on sufficient skill, knowledge, and experience to

be able to consider and make informed determinations in relation to claims under contracts

of insurance under icare HBCF (policies).


business days advising the claimant of the complaint and dispute handling procedure. All

complaints regarding a claim decision will be acknowledged in writing.


alternative timeframes will be agreed, and the claimant will be kept informed of the progress

of the response to their complaint.

• The claims manager is required to consider a claimant’s complaint through its IDR Area

within 15 business days of lodgement of the complaint.

• A determination is to be made and advised to the claimant within five business days of

having considered the complaint.

• All decisions must be consistent with icare HBCF’s Claims Manual or any instructions,

guidelines or written directions given from time to time by icare HBCF.

• The response to the claimant is to include written reasons for the decision.

The response to the claimant will also provide information about the dispute handling process of

icare HBCF and how to access the dispute handling process. The response should also advise that

any request for referral of a dispute to icare HBCF should occur within 30 days after written notice

of the outcome of the review by the claims manager’s IDR area is provided to the claimant and that

the claimant can bypass this process and immediately appeal the decision to the NSW Civil and

Administrative Tribunal (NCAT) or District Court.

• If the claimant is dissatisfied with the claims manager’s response to a complaint they may

escalate the complaint and request that it be treated as a dispute for referral by the claims


manager for further investigation by icare HBCF.

• Referral of a dispute to icare HBCF by the claims manager is to occur within three business

days of the claims manager being notified of the claimant’s request that the dispute be

referred to icare HBCF.

• The claims manager must formally submit written referrals to the icare HBCF claims

committee. These referrals must be accompanied by a recommendation or a submission of

the claims manager and all case information (including supporting documentation submitted

by, or on behalf of, the claimant) for an assessment and review to be undertaken.

• The claims manager must also continually assess the quality of its claim decisions, based in

part on any inordinate level of dispute emanating from an individual claims officer’s decisions

within its operations and arising from the recommendations and/or advice of service

providers engaged by the claims manager.

7.6 icare HBCF claims committee – Operation and Service Standards

• icare HBCF is to have a claims committee and the membership of the icare HBCF claims

committee is to be constituted as follows:

◦ General Manager, GL Claims (Chairperson)

◦ icare HBCF claims manager.

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

• The icare HBCF claims committee may consider the following types of matters:

◦ disputes over claims decisions by the claims manager and confirmed or modified by an IDR

decision that continue to be disputed by a claimant

◦ claim matters required to be referred to icare HBCF by the claims manager under the

Delegations of Claims Handling Authorities

◦ other matters or classes of matters referred from time to time by icare HBCF (or by the

claims manager when icare HBCF provides them with written instructions to do so)

◦ reviewing and recommending changes to the Claims Manual and Claims Information for

Homeowners when requested by icare HBCF.

• icare HBCF will contact the claimant within five business days of receiving a dispute to

acknowledge receipt and to provide a contact name for enquiries and a timeframe for

determining the matter.

• The icare HBCF claims committee is to meet as required but must meet within 10 business

days of icare HBCF receiving a dispute.

• The icare HBCF claims committee will consider the submissions by the claims manager and

by, or on behalf of, the claimant and make a decision.

• icare HBCF will then formally determine the dispute (by sign-off by icare HBCF’s General

Manager, General Lines Claims or Group Executive, Prevention & Underwriting) and send

written notification of the decision to the claims manager within three business days of the

Claims Committee having made its recommendation.

• The claims manager must implement the decision, which is final and binding, as soon as

practicable.

• The claims manager must provide the claimant with a written notification of the decision

within three business days of its receipt of the decision. This notification must include contact

details for icare HBCF so the claimant can get more information about the decision.

• icare HBCF should also advise the claimant that all internal dispute handling mechanisms

have now been exhausted. They must also advise that any appeal to the NSW Civil and

Administrative Tribunal (NCAT) (or the District Court where the amount involved exceeds

NCAT’s $500,000 jurisdictional limit) must be lodged within 45 days of receiving written

notification from the claims manager stating the outcome of the icare HBCF claims

committee review.

• icare HBCF should also provide the claimant with information about dispute mechanisms

(external to icare HBCF) offered by SIRA as detailed on its website at

https://www.sira.nsw.gov.au.

https://www.sira.nsw.gov.au./

https://www.sira.nsw.gov.au./


8 State Insurance Regulatory Authority (SIRA)

8.1 Requests for regulator compliance review (claims)

• A claimant may request that SIRA review icare HBCF’s handling of a claim if the claimant

believes that icare HBCF has not complied with the Home Building Act 1989, the Home

Building Regulation 2014, the Home building compensation (claims handling) insurance

guidelines or its documented approach to complaint and dispute management.

• SIRA will assess icare HBCF’s compliance with the relevant obligations. SIRA will decide

appropriate action or make recommendations to icare HBCF in respect of any substantiated

non-compliance. A regulator compliance review is not a mechanism of appeal to review the

merits of a particular claim and does not overturn claims decisions.

8.2 Other complaints about icare HBCF (claims)

• A claimant may lodge a written complaint about icare HBCF with SIRA if they are not

satisfied with the service provided by, or the conduct of icare HBCF’s handling of the claim. If

the claimant has evidence to support the complaint, they must provide it to SIRA with the

written complaint.

8.3 Requests for regulator compliance review

• A contractor may request that SIRA undertake a regulator compliance review to investigate

potential breaches of the Act, the Regulation, or the Guidelines by icare HBCF.

• A regulator compliance review is not a mechanism of appeal to review the merits of a

particular contractor’s eligibility and does not overturn eligibility decisions.

8.4 Other complaints about icare HBCF (eligibility)

• A contractor can also lodge a complaint about icare HBCF with SIRA.

• icare HBCF must provide SIRA’s contact details to a contractor so that they may seek a

further review if they are not satisfied with the approach or outcome of the icare HBCF’s

determination.

SIRA Contact Details

• Telephone: 13 10 50

• Email: [email protected]

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


Insurance and Care NSW (icare)

ABN: 97 369 689 650

[email protected]

(02) 9216 3224

www.icare.nsw.gov.au



Documents

HBCF Complaint and Dispute Handling Procedures