Purpose of this Complaints Policy 

In terms of the FAIS General Code of Conduct, The Liability Company must have a documented complaints management and resolution procedure that enables the consideration of complaints after suitable investigation and review of the information and circumstances and delivers on our commitment and legal obligation to treat clients fairly.  This policy should be read in conjunction with our TCF policy.  

A complaint is: An expression of dissatisfaction relating to a financial product sold or marketed or financial service of The Liability Company’ which alleges that we have:

  1. treated the client unfairly, or
  2. prejudiced the client through poor administration, deliberate or negligent acts or
  3. we have failed to comply with an agreement with the client or
  4. any applicable law, rule or code of conduct which we are bound by or subscribe to. 

We consider the following laws and codes to be applicable in this context: the FAIS Act, FAIS General Code of Conduct and Fit & Proper Regulations, the Insurance Act and the Policyholder Protection Rules as well as the SAUMA Code of Conduct. 

Note that the complaint can be lodged by someone representing the client or even by someone we have marketed to and includes an individual member of any scheme business we write. 

All complaints must be handled in accordance with this policy. However, some issues are of such a nature as to be able to be speedily resolved; thus, any complaint received and resolved to the clients’ satisfaction within five days will not be considered as necessary to report on and will be captured as a “query” in our complaints management system. 

Responsibilities: 

The Liability Company has appointed our Claims Manager as the primary person to investigate and resolve any complaints. The Claims Manager will refer the complaints to the Underwriting or Accounts Managers where applicable.  The Claims Manager has appropriate access to the necessary records and sufficient authority to investigate and make final decisions to resolve complaints. Additionally, the Claims Manager has the necessary experience, knowledge and skills in complaints handling, TCF, our products and services and the legislative framework. 

We do not remunerate our Claims Manager in relation to any outcome or number of complaints.  We will ensure that no cases of conflict of interest arise in the handling of complaints. Should any person handling a complaint determine that they are in a conflicted position, then an alternate person will take over the role in that investigation. This change will be determined by the CEO.  

Categorisation of Complaints: 

Any complaints received will be recorded in our complaints management system (Excel spreadsheet at present). We will categorize complaints as follows in the complaints excel spreadsheet until the complaints details as required is created within our system: 

  1. Query (i.e. a complaint that is resolved within five days),
  2. Flawed design of the financial product or service (including fees and premiums),
  3. Information provided,
  4. Advice related,
  5. Financial product or service performance,
  6. Client service (including premium collection and lapsing),
  7. Product accessibility, changes or switches (including investment redemptions),
  8. Complaints handling,
  9. Claims (including non-payment of claims),
  10. Other.  

Escalation and Review

Should a complaint not be resolved by the initial complaints handler it will be escalated to the Claims Manager and thereafter CEO.  When reviewing any complaint, the complaints handler will ensure they take a balanced and fair approach to ensure the interests of all parties are addressed. Should they be unsure they will liaise with their immediate manager who may then escalate the claim to the Claims Manager should they see fit to do so.       

Decisions:

Where The Liability Company commits to any payment in regard to any complaint we will make the payment within 3 work days or the within the number of days as agreed with the complainant.

 

Where we reject a complaint we will provide the complainant with clear and adequate reasons for the decision as well as the options they have to take the issue further and the applicable time limits as described in our complaints handling process below and encapsulated in our draft letters. 

The details of the relevant Ombudsman and Adjudicators offices are as follows: 

The National Financial Ombud Scheme handles both Short-term Insurance as well as Long-term Insurance complaints and can be contacted through the following:

Telephone: 0860 800 900

Website: https://nfosa.co.za

Email: [email protected]

Jurisdiction limits – Short-term: R 3.5 million for general complaints excluding homeowners, R 6.5 million for homeowners, complaint cannot be under litigation or under contemplation of litigation with an attorney, a complaint regarding a claim cannot have exceeded the prescription period of the Prescription Act, 1969. 

The FAIS Ombud

Telephone: 012 762 5000

Website: faisombud.co.za

Email: [email protected] 

Jurisdiction:  Complaints must be in regard to events occurring on or before 30 September 2004, limited to R 3.5 million, complaint cannot be under litigation or under contemplation of litigation with an attorney, in terms of the FSOS Act the FAIS Ombudsman may not deal with a complainant who has a net asset value, annual turnover, or annual income of more than R 8 million. 

Records of Complaints: 

The Liability Company understands the importance of accurate and reliable information regarding complaints and will ensure that it is kept securely as part of our record keeping procedures and policy.  Our complaints will initially be maintained in excel until programmed within our policy management system which will then record the following information in terms of all complaints:

  1. Name, applicable policy number and contact details of the complainant and their representative,
  2. Copies of all relevant evidence, correspondence and decisions,
  3. The category of the complaint,
  4. Status of the complaint,
  5. Date stamps of actions including interactions with complainants.

Our complaints in either excel or in our policy management system will enable us to draw the following information:

  1. Number of complaints received,
  2. Number of complaints decided in favour of the client (in part or completely),
  3. Number of complaints rejected,
  4. The reasons for rejected complaints,
  5. Number of complaints escalated by complainants,
  6. Number of complaints referred to an Ombud,
  7. Results of complaints referred to an Ombud,
  8. Number of compensation payments made (i.e. where we were at fault),
  9. Amount of compensation payments made,
  10. Number of goodwill payments made (i.e. where we were not at fault but choose to resolve the complaint in this manner),
  11. Amount of goodwill payments made,
  12. Number of complaints outstanding. 

This information will be sent to the The Liability Company management team at the beginning of the second week of every month. 

As part of our ongoing efforts to enhance our services the Management team will review the complaints information at least every month and take any rectifying action they feel is necessary.  This information enjoys the protections of our POPIA policy. 

Communication with Complainants: 

The Liability Company is committed to a transparent and accessible complaints process. As such we will:

  • Never charge complainants to submit complaints,
  • Ensure all communications are in plain language, and
  • Provide each complainant with a single contact point for their complaint. 

To facilitate submission of complaints by policyholders we will provide a link to the following online complaints email address [email protected] 

Should a complaint be lodged with a service supplier rather than directly with ourselves we will treat notification from the client to the policyholder as notification to us. Should we not have the necessary information below we will follow our complaints procedure and request the information directly from the complainant. 

To ensure we handle complaints fairly we will request the complainant provide the following information in writing via the email address provided:

  • The policy number of the policy in question,
  • The details of the individual who initially dealt with the client (if applicable),
  • An explanation of the client’s complaint,
  • An explanation of the client’s expectation from us, and
  • Copies of any relevant documents at the client’s disposal. 

Upon receipt of the complaint we will act as follows:

  • Assign the complaint to The Underwriting Director,
  • The Underwriting Director, will email the clients broker acknowledgement of receipt of the complaint within two hours of the business day that it is received and confirm their contact details and that further correspondence will be provided within 48 hours, {Draft Letter 1}
  • The Underwriting Director, will request information from relevant parties on that business day,
  • The Underwriting Director, will assess and investigate all the information provided in respect of the complaint on that business day,
  • The Underwriting Director, will contact the complainant’s broker to inform them of the progress and request any further information within [48 hours] of initial formal receipt of the complaint. Should a resolution or rejection be proposed at this point the details of the internal escalation process and relevant Ombudsman’s’ details and all parties’ responsibilities will be provided in this correspondence should the complaint be with their jurisdictions (as noted above). {Draft Letter 2}
  • Should it not be possible to propose a resolution or rejection with 48 hours, the above step shall inform the complainant of the reason for the delay and note that we will investigate further and provide further feedback within two weeks. The internal escalation process will be provided in this correspondence. {Draft Letter 2}
  • The Underwriting Director, will request and review any further information necessary,
  • Should it not be possible to propose a resolution or rejection within two weeks The Underwriting Director, will inform the complainants broker of the reason for the delay, note that we will investigate further and provide final resolution within four weeks, {Draft Letter 2}
  • The Underwriting Director, will request and review any further information necessary.
  • The Underwriting Director, will propose a resolution or rejection of the complaint.
  • Should any complaint be rejected the correspondence will include the details of the internal escalation process and relevant Ombudsman’ details and all parties’ responsibilities. {Draft Letter 2} 

Any further extensions to these timeframes is at the discretion of The Liability Company Management team. In such cases they will liaise with the client’s broker.     

Engagement with the Ombudsman: 

The Liability Company is aware of the vital role the various Ombudsman and Adjudicators play in creating fair outcomes for policyholders, intermediaries and providers in the financial services industry. As such our engagement with their offices and representatives will always be honest, professional and transparent.  To ensure our clients have access to the Ombudsman we have included the details of those relevant to our business in our disclosure document which is provided when we first begin to engage with a client and on our website. As noted in this document we will also provide the information to complainants during the complaints process.  Should a complainant approach the Ombudsman directly and not inform us of their complaint we will entertain their complaint and follow the procedures as described in this document upon notification of the complaint by the Ombudsman. 

We receive regular updates via the websites of the FAIS (www.faisombud.co.za) and the National Financial Ombud Scheme (www.nfosa.co.za). The cases are reviewed by the management team each month to determine if there are any possible adjustments to our business. 

Training: 

The Complaints policy will be available to all The Liability Company staff on the shared folders.    

Review: 

This policy will be reviewed in December every year and reissued if necessary. 

Letter 1 referred to above 

[Individual/Company Name]

[Postal Address]

[Suburb] [City]

[Postal Code]

Dear [Individual/Company Name],    

Complaint Regarding Policy Number [?]  We acknowledge receipt of your complaint submitted on [Date].  We are currently investigating the circumstances and will attempt to resolve it as soon as possible. Please note that we endeavour to resolve all complaints within 48 hours of receipt but dependent on the circumstances it may take up to six weeks to do so. We will inform you of progress of the investigation as often as possible.  Should you have any further information or have any questions please contact me.  Yours sincerely,

Letter 2 referred to above 

[Individual/Company]

[Postal Address]

[Suburb] [City]

[Postal Code] 

Dear [Individual/Company Name], 

Complaint Regarding Policy Number [?] 

We are writing to confirm the status of your complaint submitted on [Date]. 

(a) Thank you for the information provided previously, it has been most useful. Please note that we require the following information to be able to continue with our enquiries:  [??]  Please provide it as soon as possible to enable us to resolve your complaint as quickly as possible. 

(b) After careful consideration we are pleased to inform you that we are able to resolve your complaint in your favour and would propose we [pay you/[Company] R ??? as appropriate redress of your complaint. / resolve your complaint by ????].

Please confirm if this is acceptable and we will carry out the payment/resolution as soon as possible.     

Should you not be satisfied with the resolution proposed please let us know and we will escalate this issue to [Our MD] immediately. 

(c) After careful consideration of your complaint, regrettably we are unable to resolve it in your favour.  [Reason for rejection of complaint] 

You have the option of lodging a complaint with the FAIS Ombud or National Financial Ombuds office within six months of this letter. You also have the right to pursue any other avenue of law, should you wish to do so.

 

The FAIS Ombud deals with complaints submitted to the Office by a specific client against a financial services provider.

 

The FAIS Ombud

Telephone: 012 762 5000

Website: faisombud.co.za

Email: [email protected]

 

The National Financial Ombud Scheme handles both Short-term Insurance as well as Long-term Insurance complaints and can be contacted through the following:

 

Telephone: 0860 800 900

Website: https://nfosa.co.za

Email: [email protected]