Complaints Your first name*Your last name*Are you making this submission on behalf of someone else?*YesNoWhat is their full name?Contact phone numberPlease enter a phone number for the person who would like to hear back from us about this complaint.Contact email address* Please enter an email address for the person who would like to hear back from us about this complaint.Contact addressPlease enter an address for the person who would like to hear back from us about this complaint.Name of the person or organisation you would like to make a complaint about?*What is your complaint?*Does your complaint relate to a Compulsory Third Party (CTP) licensed insurer?YesNoDon't knowHave you requested an internal review of your complaint from the insurer's claims manager?YesNoPlease forward a copy of the internal review by the insurer to maic@maic.qld.gov.au, including the subject line "Complaint (your name)". We recommend you contact the insurer and request an internal review prior to submitting your complaint. What is your desired outcome?*Have you contacted the insurer to attempt to resolve the complaint directly?*YesNoDid you go through the insurer’s internal dispute resolution process?YesNoWhat was the outcome of the insurer’s internal dispute resolution process?When was the insurer’s internal dispute resolution process completed? Date Format: MM slash DD slash YYYY CAPTCHANameThis field is for validation purposes and should be left unchanged.