If you’re making a claim under the Health & Disability Commissioner Act 1994, you must first:
have your complaint investigated by the Health and Disability Commissioner and a breach of the Code must have been found and
the Commissioner decided not to refer the matter to the Director of Proceedings or
the Director declined or failed to take proceedings.
If the Health and Disability Commissioner has investigated your complaint and found the Code has been breached, and has decided not to refer the matter to the Director of Proceedings or the Director has declined or failed to take proceedings and you still want to make a claim to the Tribunal, fill in this form and return it to us:
If you're making a claim, you're known as the plaintiff.
Your Statement of claim must include:
your full name, physical address, occupation, postal address, telephone number and email address. Please add your physical address (if different from your address for service) to your Statement of Claim
the full name, physical address, telephone number, email address and occupation of the person (or organisation) you are making a claim against (the defendant)
the sections of the relevant Act(s) that you claim have been breached by the defendant(s)
a brief statement to describe what has happened, and why you think the person or organisation has breached the Act your claim relates to. This should make clear:
what your claim is about
who was involved
what happened, when and where - or what should have happened and didn't
what action, aside from the claim in the Tribunal, has been taken so far
what the defendant has said or done, or not said or done, about your complaint
what harm or damage you have suffered
explain what you seek from the Tribunal if your claim is successful
If your complaint was investigated by the Health and Disability Commissioner, attach a copy of the Commissioner's final opinion to your Statement of Claim
If your complaint was investigated by the Privacy Commissioner, attach a copy of the certificate of investigation to your Statement of Claim.
If your complaint was investigated by the Human Rights Commission, attach proof that you have been to the Commission with your complaint to your Statement of Claim.
You must sign and date your Statement of Claim.
You don’t need to have a lawyer or a representative to bring a claim to the Tribunal. However, it's highly recommended that you are represented by someone with experience in dealing with the type of claim you want to make.
If your representative is not a lawyer - both of you will need to fill in this form: