One Financial Services Holdings (Pty) Ltd is the holding company for a group of companies which include financial services providers as well as service providers to the insurance industry. The ONE Group of Companies is committed to strict compliance with all legislation as they affect each individual company. This Group is committed to the establishment and maintenance of a Complaints Management Framework, which will ensure that all complaints are handled effectively and in a timely manner. This policy is in line with the Financial Advisory and Intermediary Services Act 37 of 2002 read in conjunction with any amended or subordinate legislation
The FSP’s within the ONE Group fall within the ambit of the Financial Sector Conduct Authority (FSCA). These are One Insurance Underwriting Managers Pty Ltd (OIUM), FSP8783 and General & Professional Liability Acceptances (Pty) Ltd (GPLA), FSP3664. Both of these companies are governed by a binder agreement from an Insurer in the case of OIUM and a Lloyds Syndicate in the case of GPLA. Neither of these entities are mandated to deal with policyholders directly but merely provide products to a broker network that sell directly to a policyholder. Therefore, both ONE and GPLA have very limited access to policyholders. Most communication will be between a Broker and ONE/GPLA, where the Broker is representing the Policyholder.
Within the Financial Services industry we are provided with guidelines in complaints handling via:
The General Code of Conduct issued under the Financial Advisory and Intermediary services Act 37 of 2002 (FAIS Act) SAIA code of conduct
The Framework designed by ONE encompasses the following aspects;
Proportionate to the size and complexity of the business.
Appropriate for the business model, design of policies and our policyholders
It enables complaints to be investigated thoroughly when all the relevant and appropriate information/circumstances have been obtained.
We do not impose any unreasonable barriers to make a complaint
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 whose life is insured under the policy;
(d) person that pays a premium in respect of a policy;
(e) member of a group scheme; or
(f) potential policyholder 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 complainant, relating to a product or service provided or offered by a financial institution, or to an agreement with the financial institution in respect of its products or services and indicating 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 financial institution 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 complainant harm, prejudice, distress or substantial inconvenience; or
(c) the financial institution or its service provider has treated the complainant unfairly
COMPLAINT VS QUERY:
Complaint: is an expression of dissatisfaction by a complainant, oral or written, about the service or product that we have / are providing to them. The following guidelines can be used to assess whether the matter is a complaint, have we acted outside our SLA or fallen short of the standards set and communicated to our clients? Does the matter require escalation of a decision?
Has the complainant clearly stated they are dissatisfied or want to complain?
Have the clients stated they are unhappy with our service or product and requested a response?
Did the complainant use our formal complaints process? By sending a formal written complaint to a senior member of staff or firstname.lastname@example.org?
Query: means a request to the insurer or its 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.
Examples of a query could include;
When a client/broker requests details on a policy and this is dealt with and resolved immediately. E.g. wrong address, errors in a policy.
Questions such as; When will my claims be paid? How long will it take to resolve my issue? How far are you in processing my claim?
A general enquiry.
A follow up request.
ONE is committed to ensuring the Client, is central to our culture. All communication is done in a clear and unambiguous manner.
Reportable complaint: Means any complaint other than one which is:
Finalized immediately by the person who received it, to the satisfaction of the complainant and necessary corrective actions communicated and completed.
Finalized during the normal course of events for handling policyholder (normally submitted queries w.r.t. the type of policy/service complained about and this process does not take more than 5 days
Does not allow us a reasonable opportunity to record the details – i.e. a passing comment.
A query becomes a complaint when the complainant states in writing that they are dissatisfied and would like to make a complaint and require a response.
We confirm as follows:
Our Complaints Policy and Procedure is readily available to all our clients. Please email email@example.com to request a copy.
We will attend to, and resolve any complaints timely and fairly;
All relevant staff are trained about the resolution of complaints in accordance with current legislation, which includes FAIS, Policyholder Protection Rules (PPR) and SAIA codes.
Any employee can receive a complaint and all complaints which cannot be resolved immediately are referred to their line manager.
The Line Manager is to investigate the facts surrounding the complaint and reply to the complainant with 72hrs.
The complaint may require more specialised input and, in this case, will be referred to the following; Underwriting to the Regional Manager, Claims to the National Claims Manager, product or schedule complaints to the relevant Product Manager and all other complaints to the Compliance Officer.
Those tasked with investigation and/or resolution of a complaint are appropriately empowered to suggest/initiate/implement corrective action.
The employee who receives the complaint logs it on 1web (see how to load a complaint on1web policy). This is where all the relevant communication is e-filed. These records are kept for a minimum period of 5 years;
When the outcome of a complaint is not in favour of the client, the client will be given written reason(s) and will be advised that the complaint may be pursued, within a 6 months period, with the Ombud whose contact details are provided herein.
The time periods set-out in this complaints procedure will be adhered to as strictly as possible, however if necessary these can be varied.
In any case where a complaint is resolved in favour of the client, ONE will ensure that a full and appropriate redress is offered to the client without any delay.
To minimise complaints we provide product training to all our brokers at onboarding stage or as amendments are made to the product and regular communication is sent out to brokers highlighting various aspects of our products.
As part of the compliance function, together with the relevant role players, i.e. Regional Manager/Product Manager/National Claims Manager all complaints are investigated to understand the root cause, and how to prevent it from happening again.
CATEGORISATION OF COMPLAINTS
All complaints are to be categorized as follows:
Complaints relating to the design of a policy or related service, incl. premiums/fees/or other charges related to the policy/service
Complaints related to information provided to policyholders
Complaints relating to advice
Complaints relating to policy performance
Complaints relating to service to policyholders, incl. complaints relating to premium collection/lapsing of policies
Complaints relating to policy accessibility/changes/switches
Complaints relating to complaints handling
Complaints relating to insurance risk claims, incl. non-payment of claims
Complaints are reviewed monthly;
to ensure complaints do not remain unattended to
communication/feedback requirements are adhered to
root cause analysis is conducted to identify errors in procedures and rectification thereof
Reporting of claims and trends identified is done to the Management team monthly
Quarterly reporting of all claims and trends identified to the Board
All information gathered in the review process is collated to determine trends with regards to product/region/service providers etc…
Specific focus is given to complaints received by the OSTI/FAIS Ombud complaints, the resolution and reporting thereof to the various management teams
HANDLING OF OMBUD COMPLAINTS
ONE and all FSP’S within the group do not communicate or receive notification from the OSTI directly as all communication is done via the Insurer.
On receipt of a complaint by the Insurer this will be forwarded to the relevant FSP for investigation and resolution. Ombudsman complaints are dealt with by the Ombudsman Dispute Facilitators (ODF):
All claims rejections are submitted to Head Office for review and signoff. The reason for this is to ensure that an independent person reviews the file and checks that the correct clauses/reasons for rejection have been used. This should reduce the number of instances referred to the OSTI.
All complaints originating via claims rejections from the OSTI should be known to the ODF team. Investigation will include interviews with various staff involved including claims managers and regional managers, all documentation will be reviewed again and lastly the policy wordings will be consulted for final response to the complainant or Ombud.
Ombudsman complaints are treated with the utmost urgency and every attempt is made to resolve the complaint directly with the complainant to reduce any costs incurred for Ombud complaints.
PROCESSING OF COMPLAINTS
All complaints irrespective of whether they are submitted to a regional staff member, the Complaints Dispute Facilitator (CDF) or the Ombudsman Dispute Facilitator (ODF), these are logged on 1WEB. (See How to Log a Complaint on 1Web document)
These complaints can be logged and policy level or claim level, by selecting complaints under the View/Add notes and Tasks to do. When logging the claim on 1WEB it is necessary to input complete details, these include;
Summary of complaint – details of what complaint is about
date received and date finalised – to measure length of time to finalise complaint
who submitted it – to monitor trends
Type of complaint – Service related/Processing issues/Dispute of Rejection or Settlement related/Commission query etc…
who the claim is about – service provider/Broker/Staff member/process
was a TCF principle compromised – what can we amend to ensure our commitment to TCF compliance
if so what remedial action is necessary together with an action owner. Owner is the person mandated to make the necessary changes to policy
All documentation regarding the complaint must be e-filed;
acknowledgement of the complaint
communication with the complainant
resolution of the complaint
Since all complaints are logged on 1WEB the following info is readily available:
Breakdown in types of complaints
Number of complaints received
Number of complaints upheld
Number of rejected complaints together with related reasons