52 My Battle to Make the Health Insurers Obey the Law Part 9, Section 2 – the Disappearing Ombudsman: 14 October 2024

Sarah De Sade finally rang me at 9:13 am on Thursday 28 January 2022.  She said she had not replied to any of my letters since December 2021 because she had been on holidays.  She said she had not asked anyone else to look after her files while she was on leave.

Sarah said that the complaints about the refusal of the health insurers to pay for medical treatments provided by Lift Cancer Care Services were well known to the Ombudsman.  This had been a matter of dispute for about three or four years.  Senior officers at the Ombudsman had been having discussions with the Health Department for a long time and the Ombudsman had not yet made up its mind about what to do about the many complaints it had received concerning Lift.  I would have to be patient while the Ombudsman decided what action it intended to take.  When I said to Sarah that I believed the Health Department had been actively refusing to enforce the legislation, she assured me that the Ombudsman was a separate agency from the Health Department and would make its own decision.

When I pressed her, Sarah said she had not herself examined the legislation.  She then said something which I thought was strange, claiming the Ombudsman did not have any statutory power to enforce the health legislation and its opinion on the law had no legal force.  I answered that if the Ombudsman thought the law was being broken, this would have power even if the Ombudsman could directly enforce its interpretation of the law.

I was disturbed by what Sarah said.  She did not feel any urgency to deal with my complaints and had no interest in the law.  Any decisions about my complaints would be taken by officers more senior officers than her and she would do as directed.

The “investigator” appointed by the Ombudsman to deal with my complaints would not do any investigating and all decisions would be made by more senior officers who had no knowledge of of my complaints.

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Although I know Sarah De Sade sent me an email on Wednesday 2 February, that email disappeared after I had read it.  I was having computer issues then and I initially read the email in my webmail account, rather than on my home computer.  Perhaps my computer malfunctions were the reason for the disappearance of this email, but no other emails disappeared at that time.  I wondered whether Ms De Sade had “recalled” it after sending it to me, because parts of the email were embarrassing to Ms De Sade personally and to the Ombudsman itself.

At my request, Ms De Sade resent the missing email on Friday 18 February. At about the time the resent email arrived, the original email reappeared in my inbox.  The appearance, disappearance and reappearance of this email was strange.  The 2 February 2021 email said this.

 

Dear John Thank you for contacting the Commonwealth Ombudsman about the complaint you made to HCF in relation to Margaret and Lift Cancer Care. As I mentioned last week during our telephone conversation our Office was in discussions about the best way to move forward with Lift and HCF.  It is my understanding our Director of Dispute Resolutions will be writing to Lift.  So that I can better understand the offer that HCF have made to you I have requested a formal response from the insurer in relation to the complaint you have raised. HCF may take two to three weeks to provide a detailed response to this Office. After I receive the response, I will carefully consider the information. I will provide you with regular updates when they become available. I respectfully ask that you do not contact HCF about this specific complaint while I am investigating. Please feel free to contact the insurer about separate matters. I will be in contact once I have received the requested report from the insurer or if we require further information from you. If you would like a progress update at any stage, please feel free to contact me via return email or on 1300 362 072 (option 4) and provide your complaint reference number.

 

 

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This seemingly innocuous sentence in the De Sade email would have been very embarrassing to the Ombudsman if it later became public.

 

… our Office was in discussions about the best way to move forward with Lift and HCF.  It is my understanding our Director of Dispute Resolutions will be writing to Lift

 

On 29 March 2021, Senior Assistant Ombudsman Emma Cotterill wrote a letter “cease and desist” letter to the Chief Executive of Lift Cancer Care Services telling her Lift should not to tell its patients of their legal right to complain to the Ombudsman.  This Ombudsman letter said in effect that if the health insurers refused to honour claims for services provided by Lift, Lift should absorb the resulting bad debts.  In effect, the opinion of the Ombudsman was that Lift patients ought not to be asked to pay for their treatments when the health insurers broke the law.  I discuss this letter in more detail in a later blog.

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Another seemingly innocuous statement in the De Sade email was also very embarrassing to the Ombudsman.  It was an admission that for two complete months, the Ombudsman had quite literally done nothing about my complaint.

So that I can better understand the offer that HCF have made to you I have requested a formal response from the insurer in relation to the complaint you have raised.

 

I had very definitely rejected the HCF offer of an “ex gratia” payment to make me go away, and I had provided the Ombudsman with a copy of my letter rejecting the HCF offer.  This was the only reason why the Ombudsman had finally decided to respond to my complaint.  Clearly, in the two months since I had made my complaint, the Ombudsman had not bothered to require HCF to give written reasons for refusing to pay our claims.  That Margaret had terminal cancer and time was extremely short, did not matter to the Ombudsman.