UNITY OPERATIONS DIRECTOR: (AS AT..2007)

Transcription

1 POLICY: COMPLAINTS AND DISPUTE RESOLUTION POLICY POLICY OWNER: UNITY OPERATIONS DIRECTOR:. (AS AT..2007) APPROVED BY: UNITY EXECUTIVE COMMITTEE DATE: INTRODUCTION 1

2 UNITY fosters a culture of rendering financial services honestly, fairly, with due skill, care and diligence, and in the interests of clients and the integrity of the financial services industry. A fundamental tenet of this philosophy is a consistent drive to maintain excellent client relations. UNITY has therefore established internal protocols to facilitate client complaints and disputes, being managed in an appropriate, expedient and equitable manner. This policy sets out the complaint dispute resolution protocols, available to clients, for the purposes of addressing and resolving complaints and/or disputes with UNITY. 2. APPLICATION 2.1 This policy shall apply to all employees of UNITY, insofar as their role and activities are related to addressing and managing client complaints and disputes. 2.2 This policy shall apply to suppliers and/or partners of UNITY, who may represent UNITY in any matter, related to rendering a service to a client, which service may give rise to a client complaint or dispute. 2.3 This policy shall be a source of reference for clients, who require information relating to UNITY s internal complaint and dispute resolution protocols and information related to alternative dispute resolutions mechanisms available to the client. 3 PURPOSE 3.1 To ensure that client complaints and disputes are managed in a consistent, expedient and equitable manner. 3.2 To promote due and proper process, transparency and fairness, in addressing and managing client complaints and disputes. 3.3 To inform and provide guidance to UNITY employees and representatives, of the standard operating procedures to adopt when addressing complaints and managing disputes between a client and UNITY. 3.4 To inform and provide guidance to clients, of UNITY s standard operating procedures that a client must adopt when addressing a complaint or initiating a dispute with UNITY. 3.5 To ensure legal compliance, good corporate governance and client satisfaction. 4 POLICY STATEMENT 2

3 4.1 UNITY is committed to addressing and managing all questions, concerns, complaints and disputes in a timely, efficient and courteous manner. 4.2 UNITY is steadfast in ensuring that all complaints and disputes are managed in a consistent and equitable manner. UNITY takes all reasonable steps to investigate each matter and make an objective determination, based on the available facts. 4.3 UNITY ensures that its employees and representatives, appointed to address complaints and manage disputes, are adequately trained and skilled to competently discharge their duties. UNITY ensures that it deploys adequate resources and manpower to facilitate the effective delivery of this service. 4.4 UNITY ensures that its complaint handling and dispute resolution protocols are accessible, transparent and visible to its clients. UNITY regularly notifies clients of these protocols, thereby promoting client awareness. 4.5 UNITY maintains appropriate systems and technology, to ensure that all complaints and disputes are recorder and maintained, for prescribed periods (which is currently five (5) years). 4.6 UNITY regularly revises its complaint handling and dispute resolution protocols to ensure that they are appropriate and relevant. 4.7 UNITY is committed to co-operating with all relevant stakeholders (within the institutional framework) in order to facilitate expedient and equitable dispute resolution. 5 PROCEDURES 5.1 UNITY s Internal Complaint and Dispute Resolution Protocols Complaints must be submitted in writing (on the Complaint Form, attached hereto as Annexure A) and must contain all relevant information pertaining to the complaint/dispute, including copies of all relevant documentation (to be attached to the Complaint Form) The Complaint Form and supporting documentation must be submitted to: Unity Insurance Company Limited Client Services Department . Fax: 011 3

4 5.1.3 Upon receipt of the Complaint Form, UNITY shall promptly notify ( Notice of Confirmation ) the client, in writing, of the following particulars: The full name and contact details of the UNITY representative that will be responsible for addressing the complaint and/or managing the dispute; The date by which the client can expect a response from UNITY ; and Any additional information, related to the complaint/dispute, that UNITY may require UNITY shall ensure that: The representative dealing with the complaint/dispute, follows the established protocols, to ensure consistency and objectivity; There are appropriate management controls and supervision to guarantee that the complaint/dispute receives proper consideration; Where the complaint/dispute is considered to be serious and non-routine, the representative shall escalate such complaint/dispute to a senior representative of UNITY, with the appropriate experience, expertise and level of authority to resolve the complaint/dispute; The client is informed ( Notice of Outcome ), in writing, of the outcome of the complaint/dispute, within the prescribed timeframe (which is currently six (6) weeks from the date of receipt of the complaint/dispute); and Where the outcome is not favorable to the client, the Notice of Outcome shall include a comprehensive disclosure of the reasons supporting UNITY s decision. In addition, Notice of Outcome shall advise the client of their right to refer their complaint to the FAIS and/or STI Ombud, within six (6) months of the date of the Notice of Outcome. The contact details of the respective Ombuds shall accompany the Notice of Outcome Where the complaint/dispute is resolved in favor of the client, UNITY shall ensure that the client receives appropriate redress as soon as is reasonably possible UNITY shall initiate appropriate internal follow-up procedures to ensure the avoidance of occurrences that may give rise to similar complaints/disputes, in the future. 5.2 Alternative Dispute Resolution via the Ombud for Financial Service Providers ( FAIS Ombud ) and the Short-Term Insurance Ombud ( STI Ombud ) In those instances where a client is not satisfied with the outcome of a complaint/dispute disposed of, in terms of UNITY s Internal Complaint and Dispute Resolution Policy, the client may refer their complaint to either the FAIS Ombud or the STI Ombud, whos respective contact details are set out herein STI Ombud 4

5 Introduction The purpose of the Short Term Insurance Ombudsman is to resolve disputes between members and insured consumers in an independent, impartial, cost-effective, efficient, informal and fair way. The Ombudsman provides, free of charge, informal and speedy dispute resolution process to Policyholders whose claims have been rejected or partly admitted. The Ombudsman resolves disputes using the criteria of the law, proper Insurance practice (which includes fair dealing and equity). Jurisdiction The Ombudsman shall consider a complaint referred to him, if he is satisfied that: the complaint is not the subject of existing litigation; the complaint does not involve a monetary claim in excess of R800,000, subject to the Insurer agreeing, in writing, to this limitation be exceeded; the complaint is made by a Policyholder or duly authorised representative of the Policyholder to whom or from whom the Insurance services in question were provided; the complaint is being pursued reasonably by the complainant and not in a frivolous, vexatious, offensive, threatening or abusive manner, as the Ombudsman may decide in his or her sole discretion; the complaint has not become prescribed in terms of the Prescription Act 68 of 1969 or any enforceable time-bar provisions contained in the Policy. Referring a Complaint The Ombud will only consider a complaint referred to its office, pursuant to the complainant having addressed the matter with the relevant Insurer and having exhausted the internal dispute resolution mechanisms, provided by the Insurer. The complaint must be submitted, in writing, on the prescribed form, which can be obtained from the Ombud s office or the website. Considering a Complaint When all the material facts are agreed or the facts have been established to the Ombudsman s satisfaction on a balance of probabilities, the Ombudsman shall make a ruling. Rulings shall be based on the law and proper Insurance practice (which includes without limiting the generality of the foregoing, fair dealing and equity. Any ruling made by the Ombudsman shall be binding on the Insurer concerned. 5

6 The Ombud s ruling is not binding on the insured/client of the Insurer. Notwithstanding the Ombud s decision/ruling on a matter, the client may institute proceedings in any competent court of law against the Insurer. A complainant may at any time terminate the Ombudsman s investigation of the complaint and resort to litigation. Contact Details Ombud for Short-Term Insurance ( STI Ombud ) Address: PO Box 32334, Braamfontein, 2017 Tel: Fax: (011) info@osti.co.za Website: FAIS Ombud Introduction The Office of the Ombud for Financial Services Providers ( FAIS Ombud ) was established by the Financial Advisory and Intermediary Services Act No 37 of 2002 ( FAIS Act ). The objective of the FAIS Ombud is to consider and dispose off complaints by clients against financial services providers in a procedurally fair, informal, economical and expeditious manner and by reference to what is equitable in all the circumstances. In the investigation and disposal of a complaint the FAIS Ombud acts independently, impartially and objectively. The complainant and any other party to the complaint are expected to give their fullest cooperation to the disposal of the complaint within a reasonable time. The services of the FAIS Ombud are not similar to those of a professional legal adviser and are confined to the mediation, conciliation or determination of complaints in terms of the FAIS Act and the Rules. Jurisdiction The FAIS Ombud deals with complaints submitted to the Office by a specific client against a financial services provider. The complaint will be considered if it is alleged that the provider or representative: has contravened or failed to comply with a provision of the FAIS Act and that as a result thereof the complainant has suffered or is likely to suffer financial prejudice or damage; has wilfully or negligently rendered a financial service to the complainant and has caused prejudice or damage to the complainant or which is likely to result in such prejudice or damage; or has treated the complainant unfairly. 6

7 Referring a Complaint Before submitting a complaint to the Office, the complainant must endeavour to resolve the complaint with the responding party. The responding party has six weeks in which to resolve the complaint with the complainant. After receipt of the final response of the responding party, the complainant has six months within which to submit a complaint to the FAIS Ombud. A complaint will not be investigated if, before the date of receipt of the complaint by the FAIS Ombud, or during an investigation by the FAIS Ombud, the complainant institutes proceedings in a court regarding the subject matter of the complaint. The complaint must not constitute a monetary claim in excess of R ,00 unless the responding party has agreed in writing to this limitation being exceeded. Considering a Complaint The FAIS Ombud must first explore any reasonable prospect of resolving a complaint by a conciliated settlement between the parties, endeavouring to mediate such a settlement or to make a recommendation as to how the complaint should be resolved. Where a matter has not been settled or the FAIS Ombud s recommendation not accepted by the parties, the FAIS Ombud will make a final determination which may include the dismissal of the complaint; or the upholding of the complaint wholly or partially, eg by awarding the complainant an amount as fair compensation for the financial prejudice or damage suffered. The FAIS Ombud s determination has the effect of a civil judgment of a court. A determination is appealable to an appeal tribunal but only with the leave of the FAIS Ombud who will take into consideration the complexity of the matter and whether there is a reasonable likelihood that the appeal tribunal may reach a different conclusion. There is a further right of leave to appeal to the Chair of the appeal tribunal, should the FAIS Ombud refuse leave to appeal. Summary Dismissal of Complaints A complaint may be dismissed summarily if on the facts provided by the complainant it appears to the FAIS Ombud that the complaint does not have any reasonable prospect of success; 7

8 the responding party has made an offer which is fair and reasonable and which is still open for acceptance by the complainant; the matter has previously been considered by the FAIS Ombud or has essentially been decided in court proceedings; the subject matter of the complaint is pending in court proceedings; or the complaint is being pursued in a frivolous, vexatious or abusive manner. Contact Details Office of the Ombud for Financial Service Providers ( FAIS Ombud ) Address: PO Box 74571, Lynnwood Ridge, 0040 Tel: Fax: (012) info@faisombud.co.za Website: 6 ROLES AND RESPONSIBILITIES The UNITY Operations Director shall be accountable to the Executive Committee for the effective implementation of this Policy. The Operations Director shall be responsible for the maintenance and revision, from time to time, of this Policy. The Operations Director shall delegate the enforcement and monitoring of this Policy to the Operations Manager. The Operations Manager shall design, implement and monitor appropriate protocols, including effective controls, to ensure that this Policy is operationalised and properly carried into force and effect. Every employee and representative, responsible for or required to address complaints and manage disputes between a client and UNITY, shall observe the principles of this Policy and comply with its protocols. 8