87 The Ombudsman Denies It Acted Corruptly (3): 7 November 2024
Unpicking The Ombudsman Email of 5 April 2022 (4)
The Ombudsman Tells Me It Is Untouchable
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“It
is not the role of this Office to make determinations for hospitals and
insurers with regard to the correct interpretation of specific rules.
Our role is to help people resolve complaints about their private health
insurance as quickly as possible. This Office makes sure an insurer’s
decisions are consistent with legislation, policy terms and conditions and
their own internal procedures and rules. We are independent and impartial.” |
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Translation ↓ |
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Sentences like these sentences are intended to
make your head spin in confusion. I
will translate into plain English. |
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Translation ↓ |
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We refuse
to tell health insurers and health providers what the law requires them to
do. |
****
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Our role is to help people resolve
complaints about their private health insurance as quickly as possible. |
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↓ |
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Our role is to do as
little as possible. |
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This
Office makes sure an insurer’s decisions are consistent with legislation,
policy terms and conditions and their own internal procedures
and rules. |
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↓ |
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Even though we refuse to tell health insurers and health
providers what the law requires them to do (see first box statement), we have
told HCF that its actions are legally fine in our opinion. |
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We are independent and impartial. |
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↓ |
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We
don’t care what you think. Under the Ombudsman
Act, we can do anything we want and there is nothing you can do about
it. Bugger off! |
The Ombudsman Emphasises the “Go Away” Money
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Outcome In this case, although the dispute between HCF and LCC remains
unresolved to date
… |
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↓ |
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We refuse to carry out the job given to us by Parliament. Bugger off! |
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HCF has agreed to reimburse you $8,623.00 to cover claims for services incurred at Lift Cancer Care
between January 2021 and February 2022. |
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↓ |
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We have
persuaded HCF to give you a lot of money.
Be grateful and bugger off! |
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I am of the view this a reasonable outcome … |
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↓ |
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It took
a lot of work on my part to get HCF to pay this large amount of money. I refuse to do anything else for you. Be grateful and bugger off! |
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… and that HCF have acted in accordance
with the expectations of the Office to resolve your individual complaint. |
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↓ |
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We do
not normally need to ask health insurers to pay as much money as this and it
took a lot of work to get HCF to pay this.
Be grateful and bugger off! |
Like the Ombudsman, HCF is Untouchable
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Going forward we would not expect HCF to continue
paying claims from LCC until the dispute is resolved at a higher level. |
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↓ |
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Like Pontius Pilate, we wash our hands of this whole
affair. HCF can do what it likes to
you and the other cancer patients who attend Lift. Be grateful for the money we have got you
and bugger off! |
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“I recognise that this is not the
outcome you were hoping for. Unfortunately the Office is unable to
intervene further with the broader issues being experienced by [Lift].” |
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↓ |
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Like Pontius Pilate, we wash our hands of this whole
affair. HCF can do what it likes to
you and the other cancer patients who attend Lift. Be grateful for the money we have got you
and bugger off! |
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I will request
that HCF contact you directly with regard to your financial reimbursement of
$8,623.00. |
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↓ |
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Grab the money and run.
Bugger off! |
Ombudsman Says Have a Good Life
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“As there is no further remedy this Office can provide you in
relation to your complaint, I will be finalising our file on this matter.
Your complaint will remain in our system as we report on issues
of concern to consumers and your complaint may be used in this regard. Please feel
free to contact me if you have any questions. Kind regards Sarah de Sade Complaints Officer Private Health Insurance I will request
that HCF contact you directly with regard to your financial reimbursement of
$8,623.00.” |
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↓ |
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We are getting out of
here now. Bugger off and leave us
alone! |
****
The 5 April 2022 Email – Possible Crimes
The only way in which any decision can be
made on whether a crime has been committed is to go through a proper process. The prosecution must lay a charge. The charge must be heard before a Court, and the
Court must make an official finding that the charge has been proved.
Before any finding can be made by a
court, there must be an official investigation where evidence is uncovered that
indicates a crime may have been committed.
I have no powers of investigation and I am unable to predict the result
of any prosecution before a Court.
Despite these handicaps, I am able to
identify relevant criminal offences that I believe may have been committed based
on the facts known to me.
In what follows, I do not claim that
specific crimes were committed by named individuals.
In my opinion, the 5 April 2022 email
from the Ombudsman indicates the possibility that a variety of crimes may have
been committed by the Ombudsman and by HCF - and possibly by the Australian
Health Department. These crimes are set
out in sections 135 to 142 of the Australian Criminal Code Act, 1995. Proper investigation would be needed before
specific individuals could be identified as having possibly committed specific
crimes.
In future blogs I will summarise the
relevant Criminal Code Act provisions which the email may have been violated.
It is possible that other crimes created
by different statutes may also have been violated, but I do not have the
resources to identify them.
Is it really the case that no one who reads this blog feels motivated to comment in any way about the utter contempt shown by the Ombudsman - an agency supposedly there to ensure lawful decision making - for the very people who complain to it about the unlawful conduct they have been subjected to? How astonishing. None of you are remotely surprised to hear about unlawful behaviour by an agency supposedly dedicated to making sure behaviour is lawful. That says a lot about he experiences ordinary people consistently have when they deal with government agencies.
ReplyDeleteWe all EXPECT to be mistreated by government!