Part 1: Introduction

Accident Compensation Corporation: How it deals with complaints.

1.1
The theme of our Office's work programme for 2013/14 was Service delivery. As part of this theme, we looked at two aspects of the work of the Accident Compensation Corporation (ACC) and the Ministry of Social Development. We chose case management because that is how many people experience service delivery from those public entities. We chose complaints management because it is a useful barometer of an organisation's commitment to customer service. We expect to publish reports during 2014 on these two aspects of service delivery in these two public entities.

1.2
This report sets out the findings of our performance audit about complaints management within ACC.

1.3
In this Part, we discuss:

Why complaints are important

1.4
The number of complaints that New Zealanders made to the Office of the Ombudsman1 in 2012/13 was 79% more than in 2010/11. In other countries, the number of complaints is also increasing. Researchers at Britain's National Endowment for Science Technology and the Arts say that this may not always be a sign of declining service quality but "reflects in part rising expectations and new technologies making it easier to complain".2 This suggests an emerging gap between what users of services expect and what they experience.

1.5
Complaints are a valuable source of information for public entities to learn how people experience the public entities' services. Complaints can provide valuable insight into poor service, systemic errors, or problems with specific processes. Also, public entities have an opportunity to understand the motives, feelings, and expectations of the people using their services.

1.6
Public entities get the best value from information about complaints when they use the information to learn lessons and improve services. According to the United Kingdom's Public Administration Select Committee:

A failure to recognise the importance of complaints leads to insufficient redress for the individual, limits the impact that complaints have in improving services, and alienates the public.3

1.7
The Office of the Ombudsman in New Zealand states that "effective complaint handling is fundamental to the provision of a quality service".4

Effective complaint handling is fundamental to the provision of a quality service.
Office of the Ombudsman

What is a complaint?

1.8
We have used the International Organization for Standardization's (ISO) definition of a complaint:

… [any] expression of dissatisfaction made to an organisation, related to its products [or services], or the complaints-handling process itself, where a response is explicitly or implicitly expected … 5

1.9
The ISO definition is broad and some public entities might prefer a definition that is more appropriate to their business context. Any alternative definition should recognise that although all complaints can include negative feedback, some complaints might not require a formal resolution or follow-up. In those instances, the important matter is that entities set a clear definition and that all staff are aware of it and adhere to it consistently.

The role of the Accident Compensation Corporation

1.10
New Zealand's accident compensation scheme has been running since 1974. It provides no-fault compensation for all New Zealand residents and visitors who have suffered an accidental injury.

1.11
ACC is the Crown entity that manages the accident compensation scheme under the Accident Compensation Act 2001. In 2012/13, ACC received about 1.7 million new claims from about 1.3 million people. Nearly 1900 staff (from a total of about 3000) managed those claims. ACC's total net annual income for 2012/13 was about $4.7 billion and it had operating expenses of $415 million.

1.12
ACC is one of New Zealand's biggest customer service organisations. Figure 1 shows how it compares with some other organisations with many customers.

Figure 1
Number of people using the services of ACC and some comparable large customer-service organisations

Figure 1 Number of people using the services of ACC and some comparable large customer-service organisations.

Sources: The Ministry of Social Development figure is from page 6 of the Ministry's Statement of Intent 2014-2018. ACC provided the number of people who had a claim accepted in 2012/13. The other figures are indicative only, and are drawn from the organisations' annual reports or websites.

1.13
Handling complaints can be challenging when the public entity is the sole provider of the services. ACC is the sole provider of accident compensation coverage. Complainants remain users of ACC services after their complaint and have an ongoing relationship with ACC.

Complaints and decisions

The Code of ACC Claimants' Rights

1.14
The Injury Prevention, Rehabilitation, and Compensation (Code of ACC Claimants' Rights) Notice 2002 (the Code) is a statutory regulation that provides people with a way to raise concerns about how ACC treats them. Under the Code, if ACC breaches a person's rights, the person can lodge a complaint.

1.15
The Code was introduced in 2003 as a requirement of the Accident Compensation Act 2001. The Code's intent is to guarantee that people receive the highest possible standards of service and fairness. The Code's spirit is to encourage positive relationships between ACC and people submitting claims for compensation after an accident.

1.16
The Code gives rights to claimants and imposes obligations on ACC. It states that claimants and ACC need to work together, especially in rehabilitation. Figure 2 summarises the Code's eight rights and obligations.

Figure 2
Summary of the Code of ACC Claimants' Rights

RightYou have the right to …
1 be treated with dignity and respect.
2 be treated fairly, and to have your views considered.
3 have your culture, values, and beliefs respected.
4 a support person or persons.
5 effective communication.
6 be fully informed.
7 have your privacy respected.
8 complain.

1.17
The Appendix provides further details about the Code's rights and obligations.

1.18
A person can complain about ACC's service if they:

  • think ACC has breached the Code; and/or
  • have any issue that is not covered by the Code or one that does not relate to a specific claimant. These are known as non-Code complaints and do not have review rights.

1.19
If a complainant has exhausted the ACC complaints process and remains unhappy after an investigation by ACC's complaints investigation unit, the complainant can ask for an independent review. The review process covers alleged Code breaches, but excludes non-Code complaints. ACC's data shows that independent reviews of Code complaints form a very small part (about 0.6%) of all reviews lodged.

1.20
ACC's complaints investigation unit is called the Office of the Complaints Investigator (OCI). OCI is responsible for investigating complaints from people who think that ACC has not met its obligations under the Code (see paragraph 2.29).

Decisions about cover and entitlements

1.21
A person who disagrees with an ACC decision about approving or not approving a claim (a cover decision) or what ACC can and cannot do to help (an entitlement decision) can ask for an independent review of that decision.

1.22
ACC deals with disagreements about cover and entitlement decisions through a review process. The complaints process does not deal with these matters.6 ACC's approach assumes that people can clearly explain what they are complaining about and that the problem can be easily identified as either a cover or entitlement matter or a service problem (a complaint).

1.23
ACC's separation of complaints and decisions has meant that, in the past, it had two separate and different systems. ACC's 2008 National Issues Management Strategy intended to resolve some of this separation between complaints and decisions to concentrate on resolving problems, irrespective of the source of the person's dissatisfaction. However, this has been only partially embedded. ACC now has a system that is intended to deal with both complaints and decisions but, in practice, does not do this consistently.

What our audit looked at

1.24
In this report, we focus on:

  • how easy it is to make a complaint;
  • how ACC records and handles complaints;
  • how ACC responds to complaints; and
  • whether ACC uses information from complaints to improve services.

1.25
In designing our audit, we drew on the ISO Standard on complaints handling in organisations,7 Office of the Ombudsman guidelines, and other relevant literature.

What we did not cover

1.26
Our audit did not include:

  • reviewing any individual complaint;
  • examining the processes for reviewing decisions about cover and entitlement;
  • the process for complaints made by other ACC stakeholders, such as levy payers8 and service providers;9 and
  • ACC's dispute resolution service, which mostly adjudicates on cases of legal entitlement to services.

1.27
We are grateful to those people who have shared with us their experiences of ACC's complaints system. We do not have the power to resolve individual complaints. We recognise that complainants might find this disappointing and frustrating. Independent organisations that can deal with individual complaints include:

  • the Office of the Privacy Commissioner for privacy complaints (www.privacy.org.nz);
  • the Office of the Ombudsman for complaints about treatment from a government agency (www.ombudsman.parliament.nz); and
  • the Health and Disability Commissioner for complaints about a health or disability service or conduct of a treatment provider (www.hdc.org.nz).

How we carried out our audit

We are grateful to those people who have shared with us their experiences of ACC’s complaints system.

1.28
We visited ACC's head office in Wellington and the Customer Support Service (CSS) in Hamilton to learn how ACC receives and processes complaints. To learn about how local office staff (frontline staff) deal with complaints, we visited five of ACC's 25 local offices – Auckland City, Counties Manukau, Dunedin, Hamilton, and Timaru.

1.29
We interviewed 56 ACC staff. They included:

  • staff from CSS and OCI (complaints staff);
  • local office managers; and
  • staff from other teams that interact with the complaints system, including the training, assurance, legal, cultural services, research, privacy, and government services teams.

1.30
We ran eight focus groups with frontline staff and read and analysed many documents with information about ACC's complaints work.

1.31
To see how local offices handle complaints, in March 2014 we surveyed 1057 frontline staff about dealing with dissatisfied people and complaints. The survey had a response rate of 59%. Our survey used a six-point scale. Unless otherwise stated, we used the bottom two (disagree and disagree very strongly) and top two (agree and agree very strongly) of the scale when presenting results from the survey.

1.32
To get a wider view of ACC's complaints system, we interviewed representatives of the Office of the Ombudsman, Workplace Injury Advisory Service, and the Linkage Trust. We also spoke to some networks that support ACC service users, including the Serious Injury Advisory Group and the Older People Advisory Group.

1.33
We reviewed a representative sample of complaint case files to check whether staff applied ACC processes and procedures consistently and appropriately. We reviewed 15 examples of complaints that were handled by CSS and 15 examples of complaints that were handled by OCI.

1.34
In May 2014, we used Colmar Brunton to survey 242 ACC complainants by telephone. Their work also included speaking in depth to 10 people who had complained to ACC and to 23 people who contacted our Office about their ACC experiences.

Structure of this report

1.35
In the following parts of this report, we discuss:

  • ACC's system for dealing with complaints (Part 2);
  • the accessibility of ACC's system for handling complaints (Part 3);
  • how ACC responds to complaints – whether ACC responds to complaints effectively and efficiently (Part 4);
  • how ACC measures and reports complaints (Part 5); and
  • how ACC manages and learns from complaints – and uses information from complaints to improve services (Part 6).

1: Under the Ombudsmen Act 1975, these are complaints about state sector administration and decision-making.

2: National Endowment for Science Technology and the Arts (2013), Grumbles, gripes and grievances. The role of complaints in transforming public services, page 7, available at www.nesta.org.uk.

3: Public Administration Select Committee (2014), More complaints please!, House of Commons, United Kingdom.

4: Office of the Ombudsman (2012), Effective complaint handling, page 3.

5: International Organization for Standardization, Quality management – customer satisfaction – guidelines for complaints handling in organisations, ISO 10002.

6: ACC told us that, although entitlement decisions cannot be investigated under the Code, ACC takes a holistic view of complaints and OCI can examine the robustness of a decision as part of its investigation.

7: International Organization for Standardization, Quality management – customer satisfaction – guidelines for complaints handling in organisations, ISO 10002.

8: Levies are paid by businesses, motor vehicle owners, and employees for injury cover that is funded by ACC. Disputes about levies (that is, how much a business should pay) are handled through ACC's business service centre.

9: Examples of services providers are doctors and medical centres that treat injured people who are covered by ACC. Disputes about the relationship between service providers and ACC should, in the first instance, be discussed with a service provider's relationship manager at ACC.

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