Handling Complaints at Lloyd s: Guidance for managing agents and their representatives

Transcription

1 Cmplaints May 2017 Llyd s cmplaints Handling Cmplaints at Llyd s: Guidance fr managing agents and their representatives This guidance nte prvides a practical prcess fr handling UK cmplaints received frm eligible cmplainants at Llyd s. It is intended t assist managing agents and their representatives t cmply with Part 2 f Llyd s Cde fr Underwriting Agents: UK Persnal Lines Claims & Cmplaints Handling ((the Cde ). The Cde, and this guidance, applies t UK cmplaints nly frm eligible cmplainants (as that term is defined by the UK Financial Cnduct Authrity (FCA), althugh the Cde des include certain requirements that apply t verseas cmplaints, as set ut in the intrductry sectin f the Cde. Reference shuld be made t the Cde fr thse requirements. Cmplaints arising in territries utside f the UK will als be subject t lcal rules fr cmplaints handling. Managing agents shuld therefre ensure they are able t cmply with any lcal rules as well as Llyd s lcal arrangements fr handling cmplaints in that territry. Any questins shuld be directed t Cmplaints team r the lcal Llyd s general representative. Nte: This nte is nly intended t prvide summary guidance. It is imprtant that managing agents cntinue t refer t the Cde fr Llyd s detailed requirements fr cmplaints handling as well as t any applicable rules f the UK (r relevant verseas) regulatr, including thse set ut in DISP. Fr mre infrmatin abut cmplaints handling at Llyd s, r t view a cpy f the Cde, see: Expressin f dissatisfactin by cmplainant t managing agent/representative Managing agents must have in place prcedures that allw cmplaints t be made by any reasnable means, including rally. The definitin f a cmplaint t be applied is the ne set by the Financial Cnduct Authrity (FCA) in the FCA Handbk. In summary, this is any expressin f dissatisfactin. On a weekly basis, managing agents r their representative (which culd be a cverhlder) must cmplete the Llyd s Cmplaint Ntificatin Template, prviding details f all cmplaints received frm eligible cmplainants (as that term is defined in the FCA Handbk). Frmal cmplaints shuld be ntified within 7 days f receipt whereas infrmal cmplaints shuld be ntified within 7 days f the Cmmunicatin being issued. There is n need t ntify cmplaints which have been brught t the attentin f the managing agent by Llyd s. Cmplaints nt ntified t Llyd s within 14 days f receipt will incur an Additinal Administratin Fee charge. Llyd s cmplaints Page 1 f 8

2 The Cmplaint Ntificatin Template shuld be dwnladed frm and sent nce cmpleted via t: The fllwing table explains hw t cmplete the Cmplaint Ntificatin Template. Cmpletin f all fields is mandatry, except where stated. Managing agents shuld ensure that they prvide the infrmatin in a way that is cmpliant with the Data Prtectin Act Field Infrmal / Frmal* Submitting cmpany Cverhlder Plicyhlder Title Plicyhlder Frename Plicyhlder Surname Plicyhlder Cmpany Name Cmments Infrmal cmplaints are thse reslved by clse f business n the third business day fllwing receipt and a summary reslutin cmmunicatin is issued. This is the name f the managing agent r its representative, whichever f the tw is cmpleting the template. If the plicy was underwritten by a cverhlder, insert the cverhlder name in this field. This field is ptinal and selected frm drp dwn list. This field is ptinal. This is the name f the insured individual. Either the surname r cmpany name must be cmpleted. This is the name f the insured entity. Either the surname r cmpany name must be cmpleted. Address Line 1 Address Line 2 Address Line 3 Cunty Pstcde Insert a crrespndence address fr the cmplainant. This field is ptinal. Insert a crrespndence address fr the cmplainant. This field is ptinal. Insert a crrespndence address fr the cmplainant. This field is ptinal. This field is ptinal. Insert the cmplainant s pstcde. Cmpletin f this field is required t facilitate identificatin f duplicate cmplaints. Plicy number Date received Date acknwledgement Insert the date the cmplaint was received by the managing agent r its representative. Fr example where the cmplaint was received by a cverhlder frm the plicyhlder and the cverhlder subsequently ntifies the managing agent, the date the cmplaint was received by the cverhlder shuld be included. This field is ptinal. Llyd s cmplaints Page 2 f 8

3 sent Cmplaint cde Prduct type Placement Syndicate number Cmmunicatin Date Cmmunicatin Decisin Cmmunicatin Grunds fr Justificatin Cmmunicatin Actin Taken Cmmunicatin Redress Amunt Cmmunicatin Redress Date Paid Rt Cause Lead syndicate n the cverage. Mandatry fr Infrmal Cmplaints. Mandatry fr Infrmal Cmplaints d nt enter fr Frmal Cmplaints. Mandatry fr Infrmal Cmplaints d nt enter fr Frmal Cmplaints. Mandatry fr Infrmal Cmplaints d nt enter fr Frmal Cmplaints. Mandatry fr Infrmal Cmplaints d nt enter fr Frmal Cmplaints. If n redress is being paid, r figure is nt yet knwn enter Mandatry fr Infrmal Cmplaints if redress is being paid d nt enter fr Frmal Cmplaints. This field is ptinal. * Cmplaints are cnsidered infrmal fr the purpses f Llyd s reprting where they have been reslved within three business days fllwing receipt prvided that the reslutin is agreed with the cmplainant. Cmplaints will be entered nt the cmplaints mnitring database by Llyd s t enable effective mnitring and reprting t the relevant regulatrs. Managing agents must als keep their wn recrd f each cmplaint received and the measures taken fr their reslutin. Cmplaints Reslved by the Clse f the Third Business Day A managing agent may cnsider a cmplaint as reslved infrmally prvided that the prpsed reslutin is agreed with the cmplainant within three business days fllwing receipt f the cmplaint. A cmplaint can nly be cnsidered reslved if the cmplainant has cnfirmed their acceptance f the prpsed reslutin. Cmplaints which are regarded as having been reslved by the clse f the third business day fllwing receipt must be prvided with a summary reslutin cmmunicatin (SRC) within 5 business days f receipt f the cmplaint. The Llyd s template SRC must be used. Llyd s cmplaints Page 3 f 8

4 In the event that the cmplainant subsequently decides he is dissatisfied with the reslutin and ask Llyd's and/r the FOS fr a review, the managing agent will nt be given the pprtunity t review the matter and issue a stage ne respnse. All such case will be reviewed by Llyd's and/r FOS. Llyd's will mnitr the number f cmplaints that are escalated fr review by Llyd's / FOS that have been reslved infrmally. Managing agents d nt need t prvide a cpy f each cmplaint and SRC. Llyd s will review a randm selectin f these cases t ensure cmpliance. Stage One Acknwledgement f cmplaints All cmplaints are t be acknwledged prmptly and in writing. Llyd s expectatin is that acknwledgements shuld be sent within tw wrking days where pssible. The LMA has drafted a mdel wrding fr this purpse which can be used when acknwledging cmplaints (see LMA Bulletin LMA SM). The acknwledgement must enclse a cpy f Llyd s Hw We Will Handle Yur Cmplaint leaflet. Printed cpies f this leaflet are available n request, fr a charge, frm Cmplaints team r can be dwnladed/printed frm Cmplaints received in the first instance by Llyd s will be recrded and acknwledged by Llyd s (which will prvide the cmplainant with a cpy f the Yur Cmplaint - Hw We Can Help leaflet). Once the relevant managing agent is identified, the cmplaint will be ntified t the individual nminated by the relevant managing agent fr a Stage 1 review. Managing agents shuld ensure that Cmplaints team is made aware f wh their nminated recipient is fr new cmplaints and f any changes, including changes t cntact details. Respnse t cmplainant In all cases a Stage ne written respnse must be sent t the cmplainant within tw weeks f receipt f the cmplaint. (1) Offer f redress r remedial actin/rejectin f cmplaint Mdel letters have been prduced by the LMA fr (see LMA Bulletin LMA SM): (1) Accepted cmplaints. (2) Cmplaints that are nt accepted but where redress r remedial actin is ffered. (3) Cmplaints that are rejected. Whatever the respnse t a cmplaint, all stage ne respnses must utline the right f the cmplainant t request a stage tw review by Llyd s (with details f hw this can be dne) and Llyd s cmplaints Page 4 f 8

5 set ut the ultimate availability f the Financial Ombudsman Service (FOS). The respnse t the cmplaint must nt be described as a Final Respnse. The letter shuld set ut details f any redress r remedial actin being ffered. This includes: Payments t put the cmplainant back int the psitin the cmplainant shuld have been in had the act r missin cmplained abut nt ccurred, including any claim payments. Amunts paid fr distress and incnvenience. Gdwill payments and gdwill gestures. Interest n delayed settlements. Waiver f an excess. A cpy f the stage ne respnse tgether with a cpy f the riginal cmplaint must be ed t cmplaints-ntificatin@llyds.cm within the stage ne deadline. The cvering shuld cnfirm the cverhlder and rt cause f the cmplaint, selecting the main reasn frm : Claim cverage / terms and cnditins Claim custmer service Claim delay Claim quantum Claim standard / duratin / delay f repair Cancellatin / refund Custmer Service nn-claims related Prduct suitability Other (we wuld expect this ptin t be rarely used) Failure t: (1) prvide a cpy f the riginal cmplaint; (2) issue a stage ne respnse within the required timeframe; (3) prvide a cpy f the respnse t Cmplaints team; (4) prvide crrect and cmplete stage tw escalatin rights; (5) prvide details f the cverhlder; r (6) cnfirm the rt cause will incur an Additinal Administratin Fee charge t cver the csts assciated with the additinal administratin that will be required. (2) Incmplete investigatin In exceptinal cases, if investigatins int the cmplaint cannt be cncluded within tw weeks an investigatin nging letter shuld be sent t the cmplainant within that time explaining the psitin and indicating when it is expected a letter will be sent infrming the cmplainant f the utcme f the investigatin, which must be n mre than fur weeks frm when the cmplaint was received. The letter must infrm the cmplainant that they may nw request a stage tw review by Llyd s (with details f hw t make that request) and the ultimate availability f FOS. The LMA have drafted a mdel letter that is suitable fr these purpses (see LMA Bulletin LMA SM). All such letters issued will incur an Additinal Administratin Fee charge. Where an investigatin nging letter is sent, a cpy f the letter and full details f the riginal cmplaint (including a cpy f any crrespndence received) must be ed t Cmplaints team at cmplaints-ntificatin@llyds.cm within the stage ne deadline. Llyd s cmplaints Page 5 f 8

6 If the stage ne respnse has nt been issued within 21 days f receipt f the cmplaint, we will send a further reminder t request the stage 1 respnse r an investigatin nging letter tgether with a cpy f the riginal cmplaint. All such requests will incur an Additinal Administratin Fee. Investigatins int the cmplaint shuld be cncluded at the earliest pprtunity fllwing an investigatin nging letter being sent, and in any event within fur weeks frm the cmplaint being received, at which pint a stage ne respnse letter must be sent t the cmplainant (see abve). The cmplainant must again be infrmed f their right t request a stage tw review by Llyd s and the ultimate availability f FOS. Cmplaints team will mnitr each cmplaint t ensure an apprpriate respnse is issued. Where an investigatin nging letter is issued, resulting in additinal administratin t recrd, re-diarise and mnitr fr the full stage ne respnse, an Additinal Administratin Fee charge will be levied. Cpies f all crrespndence must be ed t cmplaints-ntificatin@llyds.cm IT IS LLOYD S EXPECTATION THAT INVESTIGATION ONGOING LETTERS WILL ONLY BE REQUIRED FOR A VERY LIMITED NUMBER OF COMPLAINTS. Request by cmplainant fr a stage tw review by Llyd s If the plicyhlder remains dissatisfied with the stage ne respnse, r n stage ne respnse has been sent by the managing agent within tw weeks f receipt f the cmplaint, the plicyhlder can request Llyd s t undertake a stage tw review. At the inceptin f a stage tw review, Llyd s will issue a further acknwledgement letter t the cmplainant and will request, via , a full cpy f the managing agent s file, cpies f all plicy dcumentatin and cnfirmatin f the claim reserve. This dcumentatin must be prvided as a single pdf dcument within three wrkings days. Failure t prvide the dcumentatin within this timeframe and in the required frmat will attract an Additinal Administratin Fee charge per hur half taken t prepare the file. These papers, tgether with dcumentatin prvided by the cmplainant, will be reviewed by Llyd s with further infrmatin being requested as necessary as part f Llyd s investigatin and assessment f the cmplaint. This review will take int accunt guidelines frm FOS as well as rulings n previus, similar cases. Where the Llyd s prpsed reslutin t a cmplaint has a value f 500 r less (r where the prpsed reslutin invlves a nn-mnetary utcme) the decisin f the Llyd s Cmplaints team may be made binding by senir members f the Cmplaints team if agreement cannt be reached. Managing agents may appeal such decisins by appeal by cntact the Head f Market Cnduct within 2 business days. All such appeals must be authrised by a member f the MA s Bard. On cmpletin f its review, Llyd s will issue a written Final Respnse t the cmplainant, tgether with the reasns. The letter will infrm the cmplainant that they may refer the matter t Llyd s cmplaints Page 6 f 8

7 FOS within six mnths if they remain dissatisfied and will prvide a cpy f the FOS standard explanatry leaflet. In mst cases Llyd s will cmplete its investigatin and send the Final Respnse by the end f eight weeks after the cmplaint is received. Where Llyd s cannt prvide a Final Respnse at that time, Llyd s will send a letter t the cmplainant explaining why it is nt in a psitin t prvide a Final Respnse and when it expects t be able t prvide ne (an eight week letter). The eight week letter will als infrm the cmplainant that they may refer the matter t FOS if they remain dissatisfied and will prvide a cpy f the FOS standard explanatry leaflet. If the cmplainant takes mre than a week t request a stage tw review after receiving a substantive stage ne respnse (ther than an investigatin nging letter), Llyd s will nt include this time when calculating the eight weeks. A cpy f the Final Respnse letter will be prvided t the managing agent by Llyd s. Referral t FOS Cmplainants may request that FOS review their cmplaint within six mnths f the date f the SRC r Final Respnse r after eight weeks frm receipt f the cmplaint if n Final Respnse has been issued. Llyd s will act as the cmmunicatin channel between FOS and the managing agent. Details f FOS decisins will be sent t Llyd s wh will share this with the managing agent. If, fllwing an initial decisin by an adjudicatr a managing agent wishes t request a full Ombudsman review the Cmplaints case fficer assigned t the case will wrk with the managing agent t facilitate this. FOS publishes statistics abut the cmplaints referred t them, shwing the number they receive and the prprtin they uphld. These can be viewed at Assessment f Managing Agent Cmpliance with the Cde On a quarterly basis, Llyd's will review managing agents perfrmance against the published standards, KPIs and ther measures. Managing agents failing t meet the required standards will be required t explain the measures being taken t address any failings. Failure t imprve perfrmance may result in remedial r enfrcement actin. FCA cmplaints return Every six mnths, Llyd s is required t submit a return t the FCA, detailing the number f cmplaints received, hw quickly they were reslved, hw many were upheld in the perid and the amunt f redress paid. This cntains details f bth UK and nn-uk cmplaints. Managing agents will be required t cnfirm that they (and anybdy acting n their behalf) have ntified Llyd s f all cmplaints received by them. Llyd s cmplaints Page 7 f 8

8 Managing agents will be required t prvide details f the number f plicies in place fr eligible cmplainants, brken dwn int specific prduct categrisatins. As required by the FCA, Llyd s publishes these figures n its website at Llyd s cmplaints Page 8 f 8