Complaint form – National Injury Insurance Scheme Queensland

You can use the below online Complaint form to provide a complaint to the NIISQ Agency.

Questions marked with * must be completed.
Provide details of your complaint.*
What outcome are you expecting?*
Have you lodged a complaint about this issue previously?*
- Yes
- No
When did you previously complain?*
Date Format: DD slash MM slash YYYY
What happened?*
If we need more information, can we contact you?
- Yes, you can contact me.
- No, I don’t want to provide more information
We may not be able to resolve this matter if further information required and we are unable to contact you.
Name
Given name Family name
Preferred method of contact*
- Email
- Contact number
- Postal address
Email*
Contact number*
Postal address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
The National Injury Insurance Agency, Queensland (NIISQ Agency) is collecting your personal information in order to perform our functions under the National Injury Insurance Scheme (Queensland) Act 2016 (NIISQ Act). We collect, use, disclose and store your personal information in accordance with the Information Privacy Act 2009, the NIISQ Act and the National Injury Insurance Scheme (Queensland) Regulation 2016. Your personal information will not be released unless the disclosure is permitted or required by law. Further information on how NIISQ Agency handles your personal information can be found in our privacy policy or by contacting our Privacy Officer on 1300 607 566 or NIISQ-Privacy@niis.qld.gov.au.
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Email
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