INSURANCE COMPLAINTS

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IT is considered good practice for an insurance company’s complaints management policy to include processes for lodging complaints submitted by an authorised representative like a family member or a lawyer and confirmation that this is free of charge.

Policy holders also need to be assured of fair treatment of complainants once submitted.

The proper treatment of a complainant’s information and personal data, according to the applicable legal framework should be upheld.

It is also important to prevent, identify and manage possible situations of conflicts of interest in complaints management.

The prompt, equal, fair and efficient management of complaints, the adequate training of staff participating in complaints handling within the company, internal reporting, follow-up and monitoring of compliance with the complaints management policy need to be upheld.

 

Specific model

Irrespective of the specific model that particular insurance companies have adopted for complaints handling, it is considered best practice for insurance undertakings to appoint one or more senior manager(s) with overall regulatory responsibility for the complaints management function and to ensure the necessary internal flows of information and reporting lines for complaints management is followed.

Effective and efficient treatment

Insurers should control the effective and efficient treatment of complaints, without prejudice to applicable regulatory controls. It is considered good practice for an insurers’ register of complaints to contain all the necessary information on the complaints, including the subject of the complaint and all the data on particular complainants.

Other requirements include the date of receiving and answering complaints. The result/outcome of the complaints handling procedure and class of the insurance referred to.

Archiving of documents

Documentation relating to the complaint must be kept and archived in a secure manner for a reasonable period of time based on the nature of the complaint and the insurance undertaking involved.

Insurers are expected to provide information to complainants regarding their complaint, where reasonably requested by complainants.

he relevant supervisory authorities and policy holders should be informed of any changes in the identity and contact details of members of senior management involved in the complaints management function.

Insurers should have in place the following processes to comply with the proper internal follow up of complaints; The collection of management information on the causes of complaints and the products and services complaints relate to.

A process to identify the root causes of complaints and to prioritize dealing with the root causes of complaints.

A process to consider whether the root causes identified may affect other processes or products.

A process for deciding whether root causes discovered should be corrected and how this should be done and regular reporting to senior personnel where information on recurring or systemic problems may be needed for them to play their part in identifying, measuring, managing and controlling risks of regulatory concern and keeping records of analysis and decisions taken by senior personnel in response to management of information on root causes of complaints.

The name of the product should not be misleading in terms of the nature of the benefit that the product can deliver. When designing a product, the specified entity should identify the target market for the product, the nature and extent of the risks inherent in the product and the level, nature, extent and limitations of any guarantee attached to the product.

The target market should only comprise the types of consumers for which the product is likely to be suitable.

In this regard, it is important that insurers monitor on a periodic basis that the product remains suitable for the target market. An insurance company should ensure that the information it provides to an agent/intermediary about its products is clear, accurate and not misleading.

This product information should be sufficient to enable those who sell the product to understand it so as to be able to determine whether it is suitable for a consumer.

Adhere to applicable general good requirements,

An insurer should respect and adhere to applicable general good requirements, including complaints handling processes as required by law.

An insurer should check whether the product is continuing to meet the general needs of the target market for which it was designed in line with its own policies and procedures.

Where the insurer establishes that the product no longer meets the general needs of the target market, the insurer should review, monitor and test its internal control systems on a periodic basis to provide reasonable assurance that the potential for errors is minimised.

An insurer should have written procedures in place for the effective handling of material errors in compliance with error handling rules.

 Such procedures may include, inter alia; the identification of all affected parties, appropriate analysis of patterns of errors, proper control of the correction process and escalation of errors to compliance/risk units and senior management.

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An Insurer should establish appropriate and reasonable standards to determine the materiality of errors in compliance with available regulatory legislation, or in line with the company’s best practice in the absence of internal rules/regulations, taking into account policyholders’ reasonable expectations.

Furthermore, an insurer should ensure that material errors are corrected in a timely and fair manner, in compliance with error handling rules/legislation. Corrections may be instituted as permitted by local rules/legislation or in line with the insurer’s normal practices in the absence of local rules. Procedures should not result in policyholder detriment or ill treatment.

An insurer should not benefit from an error at the expense of a policyholder/customer. If for any reason the insurer can not refund a policyholder, a donation to a charity may be an appropriate course of action.

An insurer should disclose along with their annual compliance statement the occurrence of material errors that may be relevant to the company’s compliance with the Corporate Governance Code, and in line with the robustness of the company’s internal control systems.

In instances where a material error has had a negative impact on a policyholder’s transaction, the policyholder should be specifically notified of the error. This notification should include the steps that are being taken to correct the error.

In addition, an insurer should maintain a log of all identified errors, and actions taken to rectify the errors should be appropriately documented. This log may include details such as; details of the error, how it was discovered, the period over which the error occurred, the number of customers affected, the monetary amounts involved, the status of the error, the number of customers refunded, the total amount refunded and the date of notification.

An insurer/insurance company should take all reasonable steps to seek to resolve any complaints, including verbal complaints, with policyholders. When an insurer receives a verbal complaint and the complaint cannot be resolved at that time, the customer should be given the opportunity to have the complaint treated as a written complaint.

An insurer should maintain an up-to-date record of all complaints subject to the complaints procedure. Where a customer/policyholder elects to have all correspondence from the insurance company directed to an intermediary the insurance company should obtain a written declaration submitted from the consumer.

Subject to its obligations under relevant data protection legislation, and where necessary to fulfill existing requirements, the following information should be maintained by or on behalf of an insurance company, and should be accessible by the company when required; a copy of all documents required for consumer/policyholder identification and profile, the consumer’s contact details, details of and means of establishing the products and services provided to the consumer.

All correspondence with the policyholder and details of any other information provided to them in relation to the product or service. All documents or applications completed or signed by the consumer.

Copies of all original documents submitted by the consumer in support of an application for the provision of a service or product and all other relevant information concerning the consumer where required by existing legal and regulatory requirements.

The insurance company should consider performing regular spot checks and/or surveys of new policyholders across all agents/brokers/intermediaries and markets to ensure that they are satisfied with both the services and products provided.

Note: In this column I offer general insurance information. Do not completely rely on this column in making insurance decisions. For specific guidelines email; insuculture@gmail.com

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