Complaints Management Policy
In terms of Leppard Underwriting’s (“Leppard”) Treating Customers Fairly (TCF) policy as well as the Financial Sector Conduct Authority (FSCA) Policyholder Protection Rules (PPR), Leppard is committed to rendering financial services honestly, fairly, with due skill, care and diligence, and in the interests of its clients, and the general integrity of the financial services industry. One of the instruments to achieve this aim is a Complaints Management Policy, in order to address any perceived poor service by Leppard. This Complaints Management Policy therefore seeks to achieve compliance with the aims of Leppard’s own vision, the PPR and TCF principles.
OBJECTIVE OF POLICY
The purpose of this Policy is to:
- Formalize the procedure for the lodging of complaints by clients of Leppard who are dissatisfied with the financial service rendered by Leppard and to ensure that the procedure is accessible to all clients;
- Enable Leppard to effectively manage and resolve complaints relating to the financial service rendered by it to its clients;
- Enable Leppard to identify and analyse trends and areas of concern in the rendering of its financial service and thereby to ensure that appropriate interventions are put in place at the earliest possible opportunity;
- To ensure that processes are in place to familiarise staff with the appropriate way of dealing with complaints; and
- To ensure that senior management endorse and support the fair, objective and transparent management of complaints and the procedures set out in this document..
DEFINITIONS (as per the PPR)
“complainant” means a person who submits a complaint and includes a –
- (a) policyholder or the policyholder’s successor in title;
- (b) beneficiary or the beneficiary’s successor in title;
- (c) person that pays a premium in respect of a policy;
- (d) member of a group scheme; or
- (e) potential policyholder or potential member of a group scheme whose dissatisfaction relates to the relevant application, approach, solicitation or advertising or marketing material, who has a direct interest in the agreement, policy or service to which the complaint relates, or a person acting on behalf of a person referred to in (a) to (f);
“complaint” means an expression of dissatisfaction by a person to an insurer or, to the knowledge of the insurer, to the insurer’s service provider relating to a policy or service provided or offered by that insurer which indicates or alleges, regardless of whether such an expression of dissatisfaction is submitted together with or in relation to a policyholder query, that -
- (a) the insurer or its service provider has contravened or failed to comply with an agreement, a law, a rule, or a code of conduct which is binding on the insurer or to which it subscribes;
- (b) the insurer or its service provider’s maladministration or wilful or negligent action or failure to act, has caused the person harm, prejudice, distress or substantial inconvenience; or
- (c) the insurer or its service provider has treated the person unfairly;
“compensation payment” means a payment, whether in monetary form or in the form of a benefit or service, by or on behalf of an insurer to a complainant to compensate the complainant for a proven or estimated financial loss incurred as a result of the insurer’s contravention, non-compliance, action, failure to act, or unfair treatment forming the basis of the complaint, where the insurer accepts liability for having caused the loss concerned, but excludes any –
- (a) goodwill payment;
- (b) payment contractually due to the complainant in terms of a policy; or
- (c) refund of an amount paid by or on behalf of the complainant to the insurer where such payment was not contractually due; and includes any interest on late payment of any amount referred to in (b) or (c);
“goodwill payment” means a payment, whether in monetary form or in the form of a benefit or service, by or on behalf of an insurer to a complainant as an expression of goodwill aimed at resolving a complaint, where the insurer does not accept liability for any financial loss to the complainant as a result of the matter complained about;
“policyholder query” means a request to the insurer or the insurer’s service provider by or on behalf of a policyholder, for information regarding the insurer’s policies, services or related processes, or to carry out a transaction or action in relation to any such policy or service;
“rejected” in relation to a complaint means that a complaint has not been upheld and the insurer regards the complaint as finalised after advising the complainant that it does not intend to take any further action to resolve the complaint and includes complaints regarded by the insurer as unjustified or invalid, or where the complainant does not accept or respond to the insurer’s proposals to resolve the complaint;
“reportable complaint” means any complaint other than a complaint that has been –
- (a) upheld immediately by the person who initially received the complaint;
- (b) upheld within the insurer’s ordinary processes for handling policyholder queries in relation to the type of policy or service complained about, provided that such process does not take more than five business days from the date the complaint is received; or
- (c) submitted to or brought to the attention of the insurer in such a manner that the insurer does not have a reasonable opportunity to record such details of the complaint as may be prescribed in relation to reportable complaints; and
“upheld” means that a complaint has been finalised wholly or partially in favour of the complainant and that –
- (a) the complainant has explicitly accepted that the matter is fully resolved; or
- (b) it is reasonable for the insurer to assume that the complainant has so accepted; and
- (c) all undertakings made by the insurer to resolve the complaint have been met or the complainant has explicitly indicated its satisfaction with any arrangements to ensure such undertakings will be met by the insurer within a time acceptable to the complainant.
PRINCIPLES OF THIS POLICY
The following principles will apply to any and all Complaints dealt with in terms of this Policy:
- All complaints are to be channeled via Jan Dijkman.
- All complaints will be thoroughly investigated and given due consideration. All complaints are to be dealt with in a fair, transparent and objective manner with due consideration for TCF principles and the complainant will during the complaints process be treated with dignity and respect.
- All staff handling complaints in terms of this Policy should have an appropriate mix of experience, knowledge and skill in complaints handling as well as in the principles of TCF and other regulatory provisions and should be authorised to make impartial recommendations regarding the handling of complaints.
- Only relevant information shall be considered when dealing with a complaint. Relevant information is only that information relating directly to the rendering of the financial service and which is founded on fact and can be empirically verified.
- All complaints will be dealt with promptly and with due consideration for the circumstances of the complainant and the Leppard staff member involved.
- The complainant will regularly be kept up to date with the progress of the complaints handling process and will receive written notification of the outcome of the complaints handling process which will supply clear and adequate reasons for any decision taken by Leppard.
- If the complaint is upheld any action undertaken by Leppard must be carried out without delay and/or within agreed timeframes.
- The complainant will be informed of his right to pursue his complaint with any relevant industry body or Ombudsman and will receive the appropriate assistance in pursuing his complaint.
- All complaints will be treated confidentially if required by the complainant or if the nature of the complaint justifies confidential treatment.
- Leppard will continuously track complaint trends and will take appropriate action to eliminate any identified shortcomings in its service to prevent a recurrence of any complaint.
INTERNAL COMPLAINTS HANDLING PROCESS
How to lodge a Complaint
- All complaints must be submitted in writing to Jan Dijkman. If it is impossible for the client to submit the complaint in writing, full details of the complaint must be verbally relayed to Jan Dijkman who will reduce the complaint to writing.
- The complaint may be submitted in any format by providing the relevant details.
- The complaint must provide details of the financial service of which the complainant is complaining and must contain sufficient detail to enable Leppard to identify the staff member involved, the reference number of the policy / claim file and the date that the financial service was rendered. All supporting documentation must accompany the complaint.
- The complaint must identify and explain the reason for the complainant’s dissatisfaction and how the complainant wants the complaint resolved.
Where to submit a Complaint
On Leppard’s website:www.leppard.co.za
By e-mail: firstname.lastname@example.org
By post: P O Box 2730, Houghton, 2041 (for attention of Jan Dijkman)
By hand: Leppard and Associates (Pty) Ltd (for attention of Jan Dijkman) 13 Baker Street, Rosebank, Johannesburg
Internal Complaints Handling Procedure
After receipt of the complaint, Jan Dijkman must immediately record the complaint in the Complaints Register.
- Jan Dijkman will within 3 working days of receiving the complaint acknowledge receipt of the complaint. The acknowledgement of receipt will inform the complainant that the matter is receiving the due consideration of Leppard and that a response with regard to whether or not the complaint will be pursued further, will be forthcoming within 21 days from receipt of the complaint. Further feedback will be provided at least every 2 months until the complaint is resolved, although Leppard undertakes to try and resolve all complaints within 6 weeks. The complainant will also be advised of his right to refer his complaint to the relevant industry body or Ombudsman. The complainant must be provided with the contact details of a staff member that will be able to assist with any queries that the complainant may have relating to progress of the complaint.
- After consideration of the type/nature of the complaint, Jan Dijkman will:
- - request the file and after due consideration of the facts/circumstances of the complaint, based on relevant information will, where appropriate, interview the relevant staff member(s) involved in the circumstances giving rise to the complaint; and
- - after due consideration and consultation, will prepare a draft response for approval by the Directors which will be sent to the complainant within 21 days of receipt of the complaint. Such response will set out whether or not Leppard will be pursuing the complaint, or any other action decided by the Directors.
- Any complaint via any social media platform must be referred to Jan Dijkman who will either advise on an appropriate response or will provide an official acknowledgment of the complaint that requests the complainant to submit the complaint via the formal complaints process in order that it may be given due consideration in terms of the formal complaints process.
Timeframe for resolution of the Complaint
- Leppard will do its utmost to resolve the complaint as soon as possible but within at least 6 weeks from date of receipt.
- Should it become apparent that the complaint cannot be resolved within 6 weeks; Jan Dijkman will contact the complainant and inform him of the progress in the matter and/or request an extension within which to respond to the complaint.
- Should a response to the complaint not be finalised within the 6 week period, or within the agreed extended period, or should the complainant not agree to the extension, the complainant must be informed of his right to refer the matter to the relevant Ombudsman or other appropriate industry body.
Notification to Client of Complaint outcome/resolution
- Once a decision has been made with regards to outcome of the complaint, the decision must be reduced to writing and must be sent to the complainant.
- The response must explain the decision/finding regarding the complaint and must record the reasons for the decision and the complainant must be informed of his right to refer the complaint to the relevant industry body or Ombudsman (whose contact details must be provided in the response).
Finalisation of the Complaint
- If the complaint has been resolved in favour of the complainant, the appropriate redress must be implemented without delay.
- If the complaint cannot be resolved, or cannot be resolved within the time allowed for resolution of the complaint, or has not been resolved to the satisfaction of the complainant, the complainant must be informed of his right to refer the matter to the relevant industry body or Ombudsman within 6 months from date of the outcome of the internal complaints resolution process.
- Once the complainant has been informed of the outcome of the complaint, Jan Dijkman will record the details of the decision in the Internal Complaints Register and will retain a copy of the response in electronic format.
- Jan Dijkman will ensure that the complainant has received the response and will where appropriate obtain an acknowledgement of receipt.
- Should Jan Dijkman not receive confirmation that the complainant is satisfied with the outcome of the complaint, the complaint will be kept open for a period of 6 months from date of the response.
Details of the Ombudsman
- If the complaint is against the insurer (Lombard Insurance Company Ltd) it must be lodged with the Ombud for Short-Term Insurance. The procedure for lodging a complaint may be found on the website of the Ombud for Short-Term Insurance (www.osti.co.za) or may be obtained from the Ombud: tel: (011) 726 8900; fax: (011) 726 5501, Sharecall: 860 726 890 or email email@example.com; physical address Sunnyside Office Park, 5th Floor, Building D, 32 Princess of Wales Terrace, Parktown.
- If the complaint is against the intermediary (Leppard or your broker) it must be lodged with the FAIS Ombud. A complaints registration form may be downloaded from the FAIS Ombud’s website (www.faisombud.co.za) or obtained from the FAIS Ombud: tel: (012) 470 9080; fax: (012) 348 3447 or email firstname.lastname@example.org; physical address Sussex Office Park, Ground Floor, Block B, 473 Lynnwood Road, Cnr Lynnwood and Sussex Avenue, Pretoria, 0081.
Reporting on Internal Complaints
- Jan Dijkman will on a quarterly basis provide a report to Leppard’s Management Committee on the contents of the Internal Complaints Register along with any commentary on complaint trends and/or recommendations on preventing future similar complaints. The report will include all complaints but will distinguish between reportable and non-reportable complaints. Such reports shall include a summary of the following information –
- - Number of complaints received;
- - Number of complaints upheld in favour of complainant including details of the nature of such complaints and consequences of the outcome thereof;
- - Number of complaints rejected including details of the nature of such complaints and consequences of the outcome thereof;
- - Number and nature of complaints referred to the Ombud and the outcome thereof;
- - Number and amounts of compensation payments made;
- - Number and amounts of goodwill payments made; and
- - Total number of complaints outstanding.
- Any complaint of a serious nature or any complaint which may have reputational implications for Lombard or Leppard will immediately be escalated to Lombard Senior Management and will be raised at Leppard’s Management Committee.
- The details of all complaints will be recorded in the Internal Complaints Register.
- The Register will record as a minimum the following information –
- - the identity of the complainant;
- - the nature of the financial service of which the complainant is complaining (i.e. underwriting or claims);
- - the staff member involved in rendering the initial financial service;
- - the reference number of the policy / claim;
- - the type of policy involved;
- - details of the specific issue being complained of;
- - classification according to PPR categorisation;
- - the date that the complaint was received;
- - who the complaint was allocated to;
- - the outcome of the complaint;
- - whether the complainant was satisfied with the outcome of the complaint;
- - the date that the complainant was informed of the outcome.
- Jan Dijkman is the custodian of the Internal Complaints Register.
- All complaints records will be retained for a minimum of 5 years from date of resolution of the complaint.
Monitoring of the Contents of the Internal Complaints Register
- The information contained in the Internal Complaints Register will be monitored by Jan Dijkman on an ongoing basis in order to identify any trends and areas of concern in the rendering of financial services by Leppard and to ensure that appropriate interventions are put in place at the earliest possible opportunity.
- Any trends or matters of concern will be raised at Leppard’s Management Committee meeting along with any recommendations to mitigate the trend in question where appropriate/possible.
- Complaints analysis should be used to –
- - Identify common/recurrent root causes of complaints;
- - Identify failings in control systems;
- - Detect and correct/mitigate poor staff or service provider performance, lack of skills or misconduct;
- - Track implementation of TCF outcomes.
Consequences of Non-Compliance
- Fair, effective and satisfactory resolution of complaints is the responsibility of every employee.
- Every employee is expected to read and familiarize themselves with the contents of this Policy and to adhere to the procedures as outlined in this Policy.
- Any wilful or negligent non-compliance with the Policy and the procedures instituted in terms thereof by any employee will constitute an offence as outlined in Leppard’s HR Policies and Practices document and could form the subject of disciplinary action by Leppard against any person found not to adhere to the Policy.
- Any such transgression must be reported to one of the Directors who will decide on what action should be taken
Staff Training & Awareness
Leppard undertakes to create awareness and understanding of the Policy by –
- - Distributing the Policy amongst its staff;
- - Including reference to the Policy in the HR Policies and Practices document;
- - Providing adequate training regarding the Policy to all staff;
- - Ensuring that the Policy is accessible to all staff at any time.
Client Awareness of and Accessibility to the Policy
Leppard undertakes to ensure awareness and accessibility to the Policy by –
- - Uploading the Policy onto Leppard’s website;
- - Making the Policy available to any client on request or at any time when Leppard becomes aware of an actual or potential complaint;
- - Making the Policy accessible to all staff members.
Review of the Policy
- This Policy will be reviewed in the event of any legislative changes necessitating such review or alternatively annually.
- The purpose of the annual review will be to –
- - monitor the effectiveness of the Policy and to adapt the Policy where it seems to have been ineffective;
- - monitor internal compliance with and awareness of the Policy;
- - refine the processes and procedures in the Policy where necessary;
- - ensure compliance with applicable legislation.
Last updated April 2018
CATEGORISATION OF COMPLAINTS
Complaints are allocated to the following categories (per the PPR):
- (a) complaints relating to the design of a policy or related service, including the premiums or other fees or charges related to that policy or service;
- (b) complaints relating to information provided to policyholders;
- (c) complaints relating to advice;
- (d) complaints relating to policy performance;
- (e) complaints relating to service to policyholders, including complaints relating to premium collection or lapsing of policies;
- (f) complaints relating to policy accessibility, changes or switches;
- (g) complaints relating to complaints handling;
- (h) complaints relating to insurance risk claims, including non-payment of claims; and
- (i) other complaints.