If the mediation has not been successful or has been refused, we assign an investigator to your complaint.
The investigator will prepare a file for our adjudication team, following the steps in section 1 below.
It should be noted that all timeframes are guidelines. This office has the discretion to grant time extensions if required on the request of either the Complainant or the Provider.
1. Formal Investigation
Once a case has been approved for investigation, a timeframe in the region of 6-8 weeks usually applies before formal investigation of the complaint will commence. Each Party will be given every reasonable opportunity to make such submission or observation as required.
1.1 Summary of Complaint
In the course of investigation this office will issue a “Summary of Complaint” to the Provider. The “Summary of Complaint” sets out the complaint which is the subject of the formal investigation and requires the Provider to answer a series of questions, to submit evidence and make any submissions which the Provider sees as being desirable to put before the Ombudsman to investigate and adjudicate upon the complaint. A copy is sent to the Complainant. The original “Summary of Complaint” and copy “Summary of Complaint” is issued to the Provider and Complainant(s) respectively on the same day.
1.2 Exchange of documentation
- Upon receipt of the Provider’s response to the Summary of Complaint, a full copy of these responses and any evidence submitted will be copied to the Complainant who will be given 10 working days to submit any observations. Any observations from the Complainant will be copied to the Provider who will be given 5 working days to submit any further observations.
- The process of documentary exchange continues until each party has made the required submissions. We give everyone time to respond. This is one reason why some complaints can take some time to resolve.
The Provider's formal response may also contain medical evidence. The Bureau's normal practice will be to forward this medical evidence to the Complainant/the Complainants representative, however if preferred the Complainant may wish to nominate a medical professional, e.g. the Complainantís General Practitioner, Consultant etc. to whom the medical part of the file will be forwarded.
The nominated medical professional must give his/her consent to the Complainant to take part in this process, and any fees falling due to the nominated medical professional arising from his/her involvement, will be payable by the Complainant. This office is not liable for any such fees. The Complainant is asked to advise their preferred choice i.e. receive the medical evidence directly or nominate a medical practitioner on the Complaint Form. This applies to dental as well as medical evidence.
It should also be noted that if the Complainant submits medical evidence and it forms part of the Bureau's consideration of the complaint, that information will be forwarded by the Bureau to the Provider in the normal exchange of documentation.
The time taken to examine a complaint in hand and reach a preliminary finding depends on the complexity of the individual case as well as outside factors, such as the availability of relevant material. In general, we aim to complete the adjudication process within 6 -12 weeks after a full exchange of documentary evidence has taken place. However, for certain cases supplementary information will be necessary which may cause this period to be extended.
An oral hearing may be necessary where there is an issue of fact in dispute between you and the Provider which we can not resolve fairly without hearing you both. An oral hearing is not required in every case.
Expedition of Case
A case may only be expedited in very limited circumstances. Any request to have a case expedited must be submitted to the Director Of Adjudication and Legal Services who has sole discretion in this matter.
When the investigation is complete, we issue the finding to the Complainant and the Provider.
Findings can have only three possible outcomes:
- Your complaint is upheld.
- Your complaint is partly upheld.
- Your complaint is not upheld.