THE CONDUCT COMPLAINTS
61 On 18 September 2019, Mr Rauchle said in his email to the AFCA:
There are several concerns and/or cause for complaint arising from the process of assessing my claim.
These include but are not limited to:
The process by which the initial decision was commenced.
The adequacy of the initial decision.
The adequacy of the review decision.
Compliance with the principles of natural justice and procedural fairness.
Whether QSuper has reasonably complied with its claims philosophy and/or other applicable codes of practice and like …
62 The email continued to provide a description. The first comment is:
I note that a cases [sic] should be assessed thoroughly, fairly and objectively. The purpose of a statement of reasons is to make explicit the reasoning by which (all) material has been assessed and weighed to reach conclusions and the ultimate decision. This has not occurred.
63 This is a comment (rather than a complaint) regarding the process by which the decision was reached, rather than that the decision was flawed in the way contemplated by this Court in Bond.
64 The email continues to say that the complaint will, in the first instance, focus on one specific matter.
65 The paragraphs following relate to:
(a) the doctors' reports and a view that the review decision "failed to address the matters raised with respect to fatigue" and also that QSuper "declined to seek clarification of the medical opinions when requested";
(b) a contention regarding the finding of total and permanent disability; and
(c) disagreement as to the capacity to work as a machinery operator.
66 These paragraphs appear to deal with complaints 2 (adequacy of the initial decision) and 3 (adequacy of the review decision) and all concern merits and the process by which the decision was undertaken.
67 The email concludes saying that Mr Rauchle has "narrowed this complaint (in the first instance) because of my past experience with QSuper, where multiple points have been selectively evaded". This raises a question as to what complaints were made. The narrowing seems to relate to merits issues regarding the decision concerning the total and permanent disability.
68 The next communication regarding the complaint is an email from Mr Rauchle to Ash Horn dated 23 March 2020 at 10.59 pm.
69 The first paragraph refers to the initial complaint, which is said to have identified "a primary issue of the ultimate decision and a complaint that this was incorrect in that … it did not adequately consider the matter of fatigue and that fatigue … is sufficient to overturn QSuper's decision".
70 This description concerns the merits of the decision.
71 The email continues to refer again to the five "secondary matters of complaint" (it is assumed as described in the email of 18 September 2019) and continues saying that Mr Rauchle would "add that QSuper has attempted to deny this complaint to AFCA". This addition clearly does not relate to issues which precede the decision.
72 Mr Rauchle then turns to what appears to be a more detailed description of the first complaint - "[t]he process by which the initial decision was commenced". This was said to be that "[t]he claim was not initiated at my application". Mr Rauchle asserts that QSuper "failed to communicate at several levels, including the afore" and "did not communicate the specifics of the benefit nor the specifics of alternative findings". The email continues that, even when Mr Rauchle's employer decided to suspend their decision to terminate his employment, QSuper nonetheless proceeded. There was a transfer of the defined benefit amount to an accumulation account even though Mr Rauchle continued to be employed. He says that this objection was raised with QSuper, but was denied. Mr Rauchle recalled having been advised of no option to formally object. The commentary concludes: "The decision was incorrect at the time and not handled correctly". This passage relates to the payment into an accumulation account, which appears to have been a different issue. The discussion also may have related to a lack of procedural fairness in the way in which matters were not communicated to Mr Rauchle. It could potentially therefore deal with a complaint within section 5(b).
73 The next paragraph turns "to the last matter" which, it is suggested, should be assessed in light of all of the former matters. Specifically, the assertion is that questions were posed by QSuper during the review process, answers were provided, but the decision by QSuper was made "regardless" of the answers provided. It is asserted that this would appear to be specifically contrary to one aspect of the claims philosophy.
74 This appears to be a complaint about the outcome of the decision with QSuper not having had adequate regard to certain answers provided. It goes to the merits.
75 The next paragraph turns to the remaining matters raised which are said to be "broadly defined". Reference is made to an attached document where "some of the specifics of these broadly defined matters of complaint" (italics in original) are identified.
76 Mr Rauchle confirms "[t]o your previous question, these are my complaints".
77 The email continues by referring to an understanding that the AFCA process cannot "subsequently consider 'additional' matters" (italics in original). The parties agree that this probably was a suggestion that the matter could not be dealt with in a piecemeal way. However, Mr Rauchle reiterated his concerns that, by raising multiple matters, "the volume of matters may divert from a focus on a clear resolution of the primary matter". He reiterated his preference that the primary matter be resolved in the first instance, even if this is not, of itself, a resolution of the complaint as a whole. Again, this passage raises a question as to what complaint was actually referred to the AFCA for determination at that time.
78 Mr Rauchle concludes by raising the "disjunction" he observed between statements of reasons for administrative decisions and judicial statements of reasons. He suggests that the purpose of an administrative statement of reasons is "to justify the decision made in the face of potential judicial scrutiny". Mr Rauchle suggests that the administrative statement of reasons should rise to the same standard and should not be an ambit denial. He concludes that such a denial indicates a bias in the decision-making process. That observation seems to relate to process - his disagreement with the decision. There is an unspecified suggestion of bias which may potentially raise an issue of conduct.
79 The next document is that which was referred to by Mr Rauchle as identifying "more specifically some of the specifics of these broadly defined matters of complaint" (italics in original).
80 Mr Rauchle notes that QSuper is a government corporation and may not be specifically bound by "the following". Mr Rauchle says that the following "is what the Queensland government identifies as best practice" (italics in original). Mr Rauchle provided two links, one to the Queensland Ombudsman and one to the Australian Law Reform Commission. The paragraphs relate to "Good decision-making" and "Procedural fairness: the duty and its content" respectively.
81 He says that "I have, in addition to the matter of the actual decision, identified four broad complaints in relationship to the process of making the decision. I have annotated the following with comments in red to indicate more specifically the basis for these broadly defined matters of complaint". By that description, it would be expected that the complaints relate to the process of making the decision.
82 Mr Rauchle identified in red the passages which contained his complaint.
83 In "5. Follow procedures", Mr Rauchle said "I had asked … for these procedures used by QSuper. I received only a response in general". Nothing further is identified. It relates to the procedures followed by QSuper. As such, it is not conduct which would lead to the conclusion that the decision was flawed in the way contemplated by the Court in Bond. However, it may suggest a denial of procedural fairness and that Mr Rauchle was not informed of the procedures which were to be followed in the determination.
84 Under "6. Gather all relevant information", Mr Rauchle has inserted: "I identified 'issues', particularly with the report of Dr. [Ljubisavljevic] and requested clarification (ie it was not the 'best' information available). The request was refused with words to the effect: 'I am not required to and I won't'". The issue relates to the weight given to Dr Ljubisavljevic's report. It would be a matter of process within the decision-making.
85 The next comment appears under the heading "7. Provide procedural fairness".
86 The comments made are as follows:
Documentation being relied upon was not generally disclosed until after the decision, and then, not in full.
[This appears to be a complaint regarding procedural fairness and natural justice.]
…
I was not invited to participate in the initial decision.
[This appears to raise a conduct issue involving the lack of procedural fairness.]
In my experience, identification of the "key issues" has taken the form of an initial assessment. By this, the participation can then be meaningful. This did not happen.
[This seems to relate to the way in which the process took place. It relates to the process of decision-making.]
…
The submission for the review was largely ignored
[It passage suggests a disagreement with the merits on the basis that the decision-maker did not pay particular attention to the submission.]
…
The principles of natural justice require that both parties should be afforded similar rights. QSuper has had the advantage of directing questions in the course of obtaining the medical reports. I was denied [the] opportunity to do so, particularly in the case of material identified in my review submission in [respect] to the report by Dr. [Ljubisavljevic].
[The complaint raises the principles of procedural fairness. The specific matter involves the report of Dr Ljubisavljevic about which Mr Rauchle had previously said that his submissions were ignored. It seems to be suggested that Mr Rauchle was treated differently from QSuper.]
(italics in original; my comments in square brackets beneath each of Mr Rauchle's comment)
87 The next comments appear under the heading "8. Determine the facts" as follows:
The sufficiency of Dr. [Ljubisavljevic's] report has already been raised.
…
A significant statement by Dr Douglas to [the] effect that "I would never return to employment" was ignored (in both the initial and review decision) as were other matters touched upon in my submission.
…
Transparency of process requires an explanation of how and why information was weighed. This was not done.
In the initial decision, it appears that medical opinion early in the course of my treatment was given equal weight to that contemporaneous with the decision. The early prognosis of a return to work was not fulfilled but it appears to have been given substantial weight regardless. Other matters were simply ignored if they did not support the decision.
…
The initial decision was generally deficient. The review decision, while better, was deficient in explaining how the evidence had been weighed and the evidentiary basis for reaching a conclusion.
88 These all appear to relate to the merits of the decision, including issues such as weighting and not having regard to evidence. They are all process of reasoning issues relating to merits.
89 The next comments appear under the heading "10. Give meaningful and accurate reasons for your decision" as follows:
The statement of reasons fails to reconcile the evidence, the weighing of the evidence, the criteria for decision and the submission against each other in a way that is meaningful and reasonable. It omits to address significant matters that would lead to a contrary decision.
[Again, these comments relate to criticisms as to the merits, including reconciling evidence, weighing of evidence, consideration of the submissions and reliance on some matters over others.]
…
Following the review decision, the time allowed for appeal was not advised. QSuper subsequently relied upon the time expired to disallow this complaint.
[This is not relevant to the decision under review.]
(my comments in square brackets beneath each of Mr Rauchle's comment)
90 The next document is an email from Mr Rauchle to Ash Horn on 6 May 2020 attaching Conclusions.
91 Headings 1 to 8 of the Conclusions clearly relate to the merits and the way in which the evidence should be approached. Those relate clearly to the process of the decision-making.
92 Under the headings "9. Concerns with opinion of Dr. Ljubisavljevic", "Initial decision of 2010" and "The review decision with effect of 2010", reference is made to bias and to principles of natural justice. These are made against the background of the guide to decision-making, which was a document of another agency, not QSuper. The focus of that document was, of course, decision-making. The criticisms again relate to not addressing all matters raised in Mr Rauchle's submission, not seeking clarification of matters identified by Mr Rauchle and placing weight on the report of Dr Ljubisavljevic. The criticisms include not seeking clarification, failure of analysis and weighing of evidence, cherry picking evidence to suit conclusions, a misquoting of a witness in one area, and ambiguity of a report. These are all matters of the process leading to the decision. In the section "The review decision with effect from 2010", it is said "while a submission was invited by QSuper, it did not give notification of the key issues and thereby failed to comply with procedural fairness" This potentially raises issues of procedural fairness.
93 The next document on the file is the AFCA Recommendation. The process followed by the AFCA involved the circulation to the parties for comment of the Recommendation (to the decision-maker) prepared by an officer of the AFCA. A Determination taking account of all of the comments is later prepared.
94 Relevant aspects of the Recommendation are:
1 Overview
…
1.2 Issues and key findings
Is [Mr Rauchle] TPD or PPD?
The weight of information shows in 2008 and 2010 [Mr Rauchle] had capacity for alternative work despite suffering from depression and fatigue.
[Mr Rauchle] permanently could not return to his substantive role and retired on grounds of ill health in 2010.
Given the above, [the AFCA was] satisfied [Mr Rauchle] is PPD and not TPD.
Did the trustee incorrectly transfer [Mr Rauchle's] account?
…
[The Recommendation dealt with whether] the trustee correctly transferred [Mr Rauchle's] account to an accumulation account in July 2008.
Was the trustee's decision fair and reasonable?
[The Recommendation concludes that] the trustee's decision that [Mr Rauchle] is PPD and not TPD is fair and reasonable.
…
…
2.2 Did the trustee incorrectly transfer [Mr Rauchle's] account to an accumulation account?
[The decision regarding the accumulation account flowed from the consequence of Mr Rauchle being PPD - which leads to the impact on the accumulation account which had been discussed in some of the communications.]
2.3 Was the trustee's decision fair and reasonable?
The trustee informed [Mr Rauchle] of its decision that he is not TPD
[Mr Rauchle] says the trustee and its board did not inform him of the reasons he was PPD and not TPD. [Mr Rauchle] also says the trustee was not transparent.
The decline letter dated 3 July 2008 enclosed a statement of reasons which sets out the trust deed definition of PPD and temporary disablement. It also outlines the evidence that was reviewed, including a summary of the evidence relied upon. The letter indicates the trustee opined [Mr Rauchle] was not TPD in line with its trust deed definition, however was PPD which meant his IP benefits would cease.
I am of the view the trustee could have explained how the medical evidence did not support [Mr Rauchle] met the TPD definition. However, I am satisfied this letter informed [Mr Rauchle] of the trustee's decision and the evidence which was relied upon.
The decline letter dated 26 September 2014 provides a background on the events which led to the trustee's review, sets out the trust deed definition of PPD and TPD, outlines the evidence that has been reviewed, including a summary of the evidence relied upon, explains the material findings from the medical evidence and explains why [Mr Rauchle] is not TPD. Therefore, I am satisfied [Mr Rauchle] was informed of the trustee's reasons for its decision.
Given the above, I am satisfied the trustee informed [Mr Rauchle] of its decision that he is PPD and not TPD.
Procedural fairness was provided to [Mr Rauchle]
[Mr Rauchle] says when the trustee made the decision that he was PPD and not TPD in 2008, it did not request and seek his input prior to the decision being made.
The trustee informed [Mr Rauchle] on 3 July 2008 of its decision that he was PPD and not TPD. I note this letter indicated if [Mr Rauchle] does not agree with this decision he could seek a review from the board of trustees initially, and if he remains dissatisfied, he can raise the matter to the superannuation tribunal.
The available information does not show the trustee sought [Mr Rauchle's] input prior to making the decision he was PPD in 2008. However, it is important to note [Mr Rauchle's] IP benefits ceased as he received it for the maximum two-year benefit period and the trustee proceeded to determine whether he was TPD or PDD without a claim being submitted.
While the trustee did not seek [Mr Rauchle's] input prior to making the decision he was PPD and not TPD in 2008, it provided him the opportunity to appeal and provide his input after the decision was made.
Additionally, although the trustee could have sought [Mr Rauchle's] input prior to making its decision in 2008, I am of the view had it done so, it would have not changed the trustee's decision.
Given this, I am satisfied procedural fairness was provided to [Mr Rauchle'].
The trustee's decision is fair and reasonable
Based on the available information, I am satisfied the trustee's decision that [Mr Rauchle] is PPD and not TPD is fair and reasonable. This is because the weight of information supports [Mr Rauchle] was PPD and not TPD.
95 The Recommendation took into account the issue of procedural fairness in the context of its implication for the decision.
96 Importantly, the Recommendation concludes that although the trustee could have sought Mr Rauchle's input "prior to making its decision in 2008 … had it done so, it would not have changed the trustee's decision".
97 Therefore, a conclusion was reached as to satisfaction with the procedural fairness which was provided to Mr Rauchle.
98 This document recognises a complaint having been made by Mr Rauchle in relation to lack of procedural fairness.
99 The decision deals with that issue and it cannot be said that the issue was ignored or not dealt with.
Report of a telephone conversation between Ms Linda Nguyen and Mr Rauchle on 2 October 2020
100 The comments largely relate to the merits of the Recommendation.
101 There is a comment as to the AFCA's process, which is "[t]here was no standard, guideline, policy or procedure to be followed in making a recommendation. Consequently, I could not be provided with such information". I do not regard that as an issue of separate conduct. It was an observation as to why information could not be provided.
102 After the Recommendation was received by Mr Rauchle, there was a communication in which Mr Rauchle confirmed that he did not accept the Recommendation and, during a conversation, it was acknowledged by Ms Nguyen, on behalf of the AFCA, that "the decision had (more than likely) not addressed all of the matters of the complaint".
Submission to the AFCA Ombudsman
103 A submission was made to the AFCA Ombudsman. In that submission, Mr Rauchle said:
5.b QSuper has acted contrary to its claims philosophy, procedural fairness and the principles of natural justice in reaching a decision to deny TPD.
(italics in original)
104 This is also repeated in Conclusion c.
105 A comment in 5.b is "QSuper has acted contrary to its claims philosophy, procedural fairness and the principles of natural justice in reaching a decision to deny TPD" (italics in original).
106 The reference is to the decision itself. So much is clear from the following paragraphs (6-11), which deal with probative value of reports, contradictions in reports, the level of weight which should be attributed to a report and the need for further consideration of the definition of TPD. No conduct is identified outside the decision-making process.
107 Conclusions c asserts "QSuper has acted contrary to its claims philosophy, procedural fairness and the principles of natural justice in reaching a decision to deny TPD" (italics in original). The meaning of this complaint can be gleaned from the context in which it is put in the document. Paragraphs 6-11 provide this context. It is a complaint relating to the process of decision-making rather than conduct.
108 The Determination was delivered on 22 October 2021.