Lloyd s minimum standards

Lloyd s minimum standards Lloyd s minimum standards Ms11 Conduct Risk Ms12 - Operating at Lloyd s June 2014 July 2014 Disclaimer 1

Introduction The Franchise Board is concerned to protect the interests of Lloyd s Customers. It has therefore issued the following minimum standards (shown in text boxes) that are designed to meet the requirements of the Financial Conduct Authority and to provide practical guidance for their implementation having particular regard to the operation of the Lloyd s market, the roles of brokers and intermediaries, the roles of leaders and followers in the Lloyd s market and the roles of coverholders and service companies in the distribution of products. Defined terms have been capitalised and definitions are set out in the glossary. Territorial application The standards set out in CR 1 (Fair Treatment of Lloyd s Customers) and CR 2 (the Role of the Board, Management and Staff) apply in respect of Lloyd s Customers wherever they are located worldwide The standards and guidance set out in CR3 to CR17 apply only in respect of Lloyd s Customers domiciled or registered within the European Economic Area. Elsewhere [, whilst managing agents may wish to give consideration to the matters set out in CR3 to CR 17 as may be appropriate,] managing agents must implement effective and proportionate controls and arrangements for the fair treatment of Lloyd s Customers having careful regard to the conduct requirements and good business practices in the territory in question. The Financial Conduct Authority The FCA has reviewed Lloyd s Conduct Risk Minimum Standards and Guidance and has confirmed that it will take them into account when exercising its regulatory functions with regard to Lloyd s managing agents. 2

Contents CR 1: Fair Treatment of Lloyd s Customers 4 CR 2: Role of the Board, Management and Staff 4 CR 3: Product Oversight Group 5 CR 4: Effective and Proportionate Product Controls 7 CR 5: Assessing and Recording Product Risk 8 CR 6: Product Design - General 11 CR 7: Product Design High Product Risk 12 CR 8: Obtaining Assurance from Others 17 CR 9: Product Sales 19 CR 10: Product Service 19 CR 11: Product Service Handling and Determining Claims 20 CR 12: Product Service Complaints 21 CR 13: Conduct Management Information 22 CR 14: Product Review 29 CR 15: Distributor Appointment, Review and Audit 30 CR 16: TPAs 33 CR 17: Training 33 CR 18: Miscellaneous 34 CR 19: Glossary 36 3

CR 1: Fair Treatment of Lloyd s Customers CR 1.1 A managing agent must pay due regard to the interests of Lloyd s Customers and treat them fairly at all times. CR 1.2 This approach must be led by the managing agent s board and be central to the managing agent s corporate culture whenever decisions need to be made about Conduct Risk and what is acceptable and what is not. This approach must have careful regard to the conduct requirements and appropriate business practices in the territory in which business is being undertaken and recognising the regulatory expectations and sensitivities in those territories. Reference in this regard should always be had to Lloyd s Crystal database. CR 2: Role of the Board, Management and Staff CR 2.1 The board of a managing agent must lead a corporate culture which pays due regard to the interests of Lloyd s Customers and treats them fairly at all times. A managing agent s corporate culture must be one based on winning and maintaining trust and confidence of Lloyd s Customers. Members of the board should regularly demonstrate their commitment to that corporate culture in their decision making, their management of the business and, in particular, in their presentations and communications to staff and to their Distributors. The board of a managing agent must demonstrate appropriate support for directors, any Product Oversight Group and for other individuals who provide Customer Challenge. CR 2.2 The board of a managing agent must consider its approach and strategy to the management of Conduct Risk generally and how that is integrated and is reflected in its approach and framework for the management of risk generally. CR 2.3 The board of a managing agent should regularly discuss Conduct Risk at its meetings and be able to evidence those discussions. 4

Care should be taken in setting agendas for meetings to ensure that all elements of Conduct Risk set out in these standards are discussed from time to time and that these discussions make the best use of the managing agent s Conduct Management Information. A managing agent should be able to evidence that members of the board ask good questions with regard to Conduct Risk and that any action points are properly followed up by the board. CR 2.4 The board of a managing agent must provide appropriate Customer Challenge and that should be reflected in its overall business strategy, in syndicate business plans and in its approach to Product distribution. In particular, the board should consider the Conduct Risk, reputational and financial implications of selling Products with a high Product Risk to a large number of Lloyd s Customers especially where they have little or no experience of selling such Products. CR 2.5 The board of a managing agent must ensure that appropriate Conduct Risk objectives are set for the managing agent s directors and staff and ensure that these are assessed. CR 2.6 The management of a managing agent must support the board in establishing a corporate culture which pays due regard to the interests of Lloyd s Customers and treats them fairly at all times. CR 2.7 A managing agent must avoid or effectively manage any conflict of interest which might lead to the unfair treatment of Lloyd s Customers. CR 2.8 Issues which may be raised under a managing agent s whistleblowing or speaking-up policy must include the unfair treatment of Lloyd s Customers. CR 3: Product Oversight Group CR 3.1 The board of a managing agent must decide whether it is appropriate to establish or designate a Product Oversight Group. Where a board decides not to, it must consider and record why not 5

and how Customer Challenge will otherwise be delivered. A managing agent which underwrites a large number or a high proportion of Products with a high Product Risk (see CR 5) should generally establish or designate a Product Oversight Group in order to support the board with regard to the management of Conduct Risk and to contribute to the delivery of appropriate Customer Challenge when judgements need to be made about Conduct Risk generally and, in particular, (a) the managing agent s business model, syndicate business plan and overall business strategy particularly with regard to Products with a high Product Risk and (b) whether a particular Product should be sold and, if so, what Product Controls are appropriate throughout the Product s Lifecycle; the analysis of and reporting on Conduct Management Information and, in particular, (a) extracting key information and trends about the managing agent s Conduct Risk, (b) preparing or agreeing reports to the board which readily illustrate and explain that information and trends and (c) making recommendations to the board for improving the effectiveness of the Product Controls; and reviewing regulatory developments with regard to Conduct Risk and, in particular, (a) preparing or agreeing reports to the board which readily illustrate and explain the impact that those developments may have on the managing agent s Conduct Risk, and (b) making recommendations to the board for improving the effectiveness of the Product Controls having regard to those developments. CR 3.2 A Product Oversight Group must include appropriate individuals who can provide Customer Challenge. A Product Oversight Group should generally include individuals who have experience of maintaining successful long-term underwriting relationships; preparing clear and fair Product Documentation; handling and determining claims from consumers; handling policyholder complaints, analysing complaints data and dealing with the Financial Ombudsman Service; and ensuring compliance with the Financial Conduct Authority s requirements and with similar requirements overseas. There is no need for every member of a Product Oversight Group to be an insurance professional, expert or specialist and often it may be helpful to have members who are not. Members may therefore be drawn from any part of the managing agent s operations. A Product Oversight Group may integrate its work and activities with other existing groups, committees and activities (for example, underwriting peer review) as may be appropriate to provide Customer Challenge effectively and efficiently. It may be useful to include underwriters as members of the Product Oversight Group but an underwriter should not be directly involved in providing Customer Challenge for a Product which he or she designed or helped to design. Any questions or disagreements between the Product Oversight Group and those involved in the Product s Design (particularly questions of policy) should be referred to the managing agent s board or other relevant committee for consideration. 6

CR 3.3 A Product Oversight Group must meet regularly and as and when required. A group must also establish effective working arrangements between its members so that it can continue to fulfil its functions outside of formal meetings effectively. CR 3.4 Where a Product Oversight Group is established or designated its existence, the names of its members and its terms of reference should be made available to the managing agent s staff generally and, where appropriate, to its Distributors. The submission of questions, comments and suggestions to the Group with regard to Conduct Risk should be encouraged by the Group and by the board of the managing agent. CR 4: Effective and Proportionate Product Controls Effective and Proportionate Product Controls CR 4.1 A managing agent must have effective Product Controls which are proportionate to the Product Risk of each Product and form part of a coherent framework of controls. Initial assessment of Product Risk CR 4.2 A managing agent must make an assessment of the Product Risk of each Product prior to underwriting that Product and decide whether or not it is appropriate to sell that Product having regard to its Product Risk. Where a managing agent intends to sell a Product in substantially the same form and manner to a number of Lloyd s Customers the assessment of the Product Risk will be an integral part of Product Design. In respect of an Open Market Placement the assessments may ordinarily be undertaken by each underwriter as part of the normal underwriting process (see CR 8.1). Assessment of Product Risk to be kept under review CR 4.3 A managing agent must keep the assessment of its Product Risk under review throughout the 7

Product s Lifecycle and adjust the Product Design and Product Controls as may be appropriate. CR 5: Assessing and Recording Product Risk Assessing Product Risk CR 5.1 The assessment of the Product Risk of a Product shall be made having careful regard to Customer Risk; Product Complexity; Sales Risk and having particular regard to how the Product will be sold; Service Risk; and any other relevant factors or criteria set by the managing agent s board, as described below. Each factor does not necessarily need to carry the same weighting in the assessment of Product Risk and they may overlap. Customer Risk may often carry the largest weighting. It may be convenient and efficient to perform a preliminary assessment of Product Risk by reference to a risk code or a risk type but this must not obscure the underlying purpose of the assessment which is to understand properly the Conduct Risk associated with the Product in question. CR 5.2 The assessment of the Customer Risk of a Product shall be made having careful regard to the financial sophistication and expertise of the Lloyd s Customer to whom it is intended the Product will be sold. This should take into account the ability of the Lloyd s Customer to assess the Product and whether it will meet their needs and reasonable expectations. The lower the financial sophistication of the Lloyd s Customer the higher the Customer Risk (as illustrated below). The Customer Risk of a Lloyd s Customer who is an individual is likely to be high. The Customer Risk of a Lloyd s Customer who is an insurer or reinsurer is likely to be very low. 8

whether the Lloyd s Customer is considered to be a consumer having regard to the regulatory definition of consumer (or the equivalent term) in the territory in which the Product will be sold. A consumer will generally have a high Customer Risk; and whether the Lloyd s Customer will be advised on the Product by an insurance broker or other suitably qualified adviser. Receipt of advice will significantly lower the Customer Risk. Assessing Product Risk Product Complexity CR 5.3 The assessment of Product Complexity shall be made having careful regard to the complexity of the Product Documentation (including when compared with the documentation for products of a similar type from competitors where this is available); the novelty of the Product; the familiarity that the Lloyd s Customer might be expected to have with the words and expressions used in the Product Documentation; and the time that the Lloyd s Customer might be expected to give to considering the Product Documentation. Assessing Product Risk Sales Risk CR 5.4 The assessment of Sales Risk shall be made having careful regard to the number of Products planned to be sold; the number of Distributors planned to be appointed (especially where they are located in more than one country); how the Product Controls will be implemented by the Distributors and overseen; and the alignment between Sales Risk and Sales Incentives for each Distributor; 9

CR 5.5 Careful regard should be had to the Sales Risk associated with selling the Product if it is an Add-on Product via a call centre; or via the internet including via a price comparison site. Assessing Product Risk Service Risk CR 5.6 The assessment of Service Risk shall be made having careful regard to the likely demands of the Lloyd s Customer to require Product Service. Generally, it may be expected that the Service Risk of a Product placed by a Lloyd s broker will be low. Recording Product Risk CR 5.7 The assessment of the Product Risk of each Product must be recorded by the managing agent in such a way that would enable a person who was not involved in the assessment to understand, in broad terms, how the assessment was made; supports a consistent approach within each managing agent to the assessment of Product Risk generally; and allows simple comparisons to be made between the Product Risk of different Products. In respect of a Product that is individually negotiated with a broker, the recording of Product Risk may be undertaken by the underwriter as part of the normal underwriting process. Examples of Products with a high Product Risk CR 5.8 Without prejudice to the analysis required above, the following Products will generally have a high Product Risk. [Further examples are requested] extended warranty Products; mobile phone or gadget insurance; travel insurance; pet insurance; Add-on Products; home emergency cover; 10

guaranteed asset protection; [ ] CR 6: Product Design - General Identify the prospective Lloyd s Customers CR 6.1 When a managing agent (or its agent) is involved in the development of a new Product to be sold to Lloyd s Customers (or making a material change to an existing Product) it shall first identify the Lloyd s Customers to whom it is intended the Product will be sold and consider what their needs and reasonable expectations are likely to be and how those needs and expectations may properly be addressed. A material change to an existing Product might include a material change to the terms and conditions of the Product (for example, the inclusion of a significant exclusion clause) or a material change to how the Product is to be sold. CR 6.2 A managing agent must give careful consideration, in that context, to preparing appropriate Product Documentation; determining how the product should be sold and, if appropriate, identifying suitable Distributors; and determining what Product Service will be required and how this will be provided. Regard may be had to the further guidance set out in CR 7 as may be appropriate to any particular aspect of the Product. Sales Incentives CR 6.3 When establishing Sale Incentives for Distributors a managing agent must seek to ensure that they will not incentivise the Distributor to sell the Product to Lloyd s Customers for whom they were not designed or will not meet their needs and expectations. The importance of considering and managing any risks arising from Sales Incentives is demonstrated by the Financial Conduct Authority s Final Notice in a case against Lloyds TSB Bank plc - Remuneration schemes play an important role in setting the sales culture of a firm, influencing how and what staff sell to customers. They can create a culture of mis-selling and may 11

undermine a firm s positive efforts to treat customers fairly in other areas. While the Authority recognises that firms may want to incentivise staff to sell particular products, firms must ensure that their systems and controls are sufficiently robust and sophisticated to mitigate effectively the risk of any adverse impact the incentives may have on staff behaviour. This should include appropriately focused risk-based monitoring. Consideration should always be given to the question, If I was selling this Product how would the Sales Incentives affect my approach to sales? Effective Product Controls CR 6.4 A managing agent must then design and integrate effective Product Controls which are proportionate to the Product Risk of the Product in question. CR 7: Product Design High Product Risk CR 7.1 A managing agent must take the following additional steps set out below in respect of Product Design of Products with a high Product Risk. Where a service company, coverholder or other intermediary or Distributor has designed a new Product on behalf of a managing agent, the managing agent must nonetheless satisfy itself by conducting adequate due diligence that the Product Design meets these standards and guidance. Assessing customer needs high Product Risk CR 7.2 When assessing Lloyd s Customers needs and reasonable expectations, a managing agent must give careful consideration to using qualitative research and quantitative data; working with proposed Distributors to use their experience of dealing with the potential customers; and where proportionate and appropriate, using a focus group to assess the suitability of the Product and of the Product Documentation. Providing valuable cover high Product Risk CR 7.3 A managing agent must take reasonable care to ensure that the Product will provide the Lloyd s Customer with insurance cover which meets their needs and reasonable expectations, on which they can realistically claim and which is not generally provided in some other way. 12

This may include consideration of whether the events covered by the Product are aligned with the needs of the Lloyd s Customers. In particular, consideration may need to be given as to the impact of any exclusions of cover included in the Product. Whilst exclusions can ensure that a Product is priced competitively and provides value for money, care needs to be taken to ensure that this is not at the expense of meeting the Lloyd s Customers needs and reasonable expectations; whether the benefit following a successful claim is likely to meet the needs of Lloyd s Customers. In particular, consideration may need to be given where limits of liability are placed on the level of cover that a Product provides; and whether the Product disadvantages any particularly vulnerable group and whether it meets all applicable obligations under the Equality Act 2010. Add-on Products high Product Risk CR 7.4 A managing agent must take particular care when designing an Add-on Product especially when it will be sold as an add-on to a more engaging product (for example a holiday, a car or a theatre ticket) to ensure that the Product will provide cover on which they can realistically claim; there is clarity around the price of the cover; and on-line opt-out selling (i.e. a Lloyd s Customer must deselect a pre-ticked box if he or she does not wish to purchase an Add-on Product) is not used. Product Documentation high Product Risk CR 7.5 When preparing the Product Documentation, a managing agent must take care to ensure that it is clear, fair and not misleading. Particular care should be taken with regard to the content of any policy summary; explaining the main benefits of the Product and what is covered; explaining what is not covered or is excluded (having particular regard to the application of the Unfair Terms in Consumer Contracts Regulations 1999); how claims may be made; providing examples of claims that will be acceptable under the Product and those that will not; how complaints may be made; how the Product may be renewed, switched or cancelled (including refund rights) and any fees that may be charged in this respect; which law the Product is subject to; and setting out which syndicate or syndicates have underwritten the Product. 13

It should be appreciated that standard terms and conditions which are entirely appropriate for Products with lower Product Risk may not be appropriate for Products with a high Product Risk especially where they use terms and expressions primarily used within the insurance industry. Selection of appropriate Distributors high Product Risk CR 7.6 When selecting appropriate Distributors for the Product, care must be taken to ensure that they are each capable of implementing the proposed Product Controls having regard to their own experience and systems and controls. Particular regard should be given to their sales monitoring, sales training, sales administration and any complaints or claims handling authority; providing appropriate Conduct Management Information to the managing agent; and giving any appropriate advice to the Lloyd s Customer in the context in which the Product will be sold. In this regard, consideration may need to be given to the Consumer Product Binding Authority Questionnaire. Providing Distributors with adequate information- high Product Risk CR 7.7 When preparing information for Distributors, a managing agent must take care to ensure that they will be provided with adequate information to properly understand and sell the Product; and appropriate Product Documentation, including point of sale materials. Where appropriate, managing agents should consider the adequacy of any sales scripts to be used in the sale process. Sales Incentives high Product Risk CR 7.8 A managing agent must give particular consideration to the design of the Distributor s Sales Incentives for its own sales personnel especially where they could lead to a pressurised sales environment. Consideration should be given to industry requirements and practices in the territory in question but factors that may suggest such an environment include 14

where the incentives are wholly or materially based on personnel achieving pre-determined sales or profit targets; where sales personnel are predominately paid by way of commission rather than nonvariable salary; where a salary increase is guaranteed solely by reason of reaching a sales target during a defined period; if the incentive includes any element of a retrospective accelerator where passing a target increases the level of incentive earned for all sales over a period, rather than just those sales above the target; where the incentives include disproportionate or unusual rewards including, for example, (a) awarding significant prizes to personnel for exceeding sales targets, (b) running a first past the post competition where the first sales personnel to exceed a target receives a reward, (c) having time bound accelerator periods where personnel only receive an additional reward if they exceed a target within a limited period of time, (d) awarding personnel higher rewards for selling one product rather than another substitutable product, or (e) where incentives can be paid early during a period subject to sales personnel maintaining sales targets; where the incentive schemes are overly complex or where the Distributor does not have enough information about the incentive scheme such that the Distributor cannot understand the effect the scheme is having on sales; and where the Distributor relies only on routine monitoring of its personnel rather than taking into account the specific features of the incentive scheme. Good incentive schemes and arrangements should generally include incentives that reward sales personnel by reference to sales quality. This may include incentives for personnel who sell products with a low cancellation or complaints rates. Accordingly payment of incentives may need to be deferred for a suitable period in order to establish the sales quality; penalties or full claw-back provisions of incentives where it is subsequently discovered that there have been inappropriate sales even if the individual has exceeded other targets or performance metrics. Monitoring and controls might therefore focus on sales personnel who (a) achieve the highest numbers of sales, (b) cause the highest numbers of cancellations or complaints; and (c) are close to being promoted or demoted; and the Distributor s managers bonuses are not solely based on the sales performance of the sales team they are overseeing. Product Service high Product Risk CR 7.9 When considering what Product Service will be required, a managing agent must take care to ensure that the Product can be properly serviced having regard to the adequacy of proposed resources and systems and Lloyd s Customers likely demand for service generally and, where appropriate, from time to time and from day to day. Post sales barriers high Product Risk 15

CR 7.10 When considering how the Product will operate in practice, a managing agent must take care to ensure that there will be no unreasonable post-sales barriers for the Lloyd s Customer to changing or switching the Product; cancelling the Product; obtaining a refund; making a claim; or making a complaint. Design of effective Product Controls high Product Risk CR 7.11 A managing agent must then design and integrate effective Product Controls which are proportionate to the Product Risk of the Product in question. Stress testing of the Product and the Product Controls high Product Risk CR 7.12 A managing agent should conduct stress testing of the Product and the Product Controls to assess how they would perform in likely scenarios, including stressed scenarios, to ensure that the Product is likely to meet Lloyd s Customers needs and reasonable expectations and they will be treated fairly through the Product s Lifecycle. Stressed scenarios might include a large numbers of Lloyd s Customers requiring Product Service (including claims and complaints) following a catastrophe, the insolvency of a Distributor or an intermediary or a large number of claims being made where it is difficult to determine whether cover is provided under the Product. Product Review CR 7.13 A managing agent must set appropriate periods after which the Product will be subject to Product Review. Providing Customer Challenge CR 7.14 In providing Customer Challenge consideration might be given to the following questions 16

With regard to Product Design Imagine that the Product was designed to be sold to a loved member of your family. Would you personally recommend that he or she buys it? ; With regard to Product Documentation Having read the Product Documentation, would you personally be able to explain the key aspect of the Product to the proposed Lloyd s Customer ; With regard to valuable cover Is it expected that the Product will be so highly profitable that it calls into question the value for money for Lloyd s Customers? ; and Would you expect to be content to explain performance of the Product on a consumer programme on primetime television? CR 8: Obtaining Assurance from Others In the Lloyd s market, Product Design may often involve an insurance broker acting on behalf of the Lloyd s Customer, a lead managing agent (acting on behalf of the lead syndicate), a number of following managing agents (acting on behalf of the following syndicates) and one or more service companies or coverholders. This part of the Lloyd s minimum standards is to ensure that there is no unnecessary duplication of work in order to address Conduct Risk. Open Market Placement CR 8.1 Where a managing agent is presented with a contract of insurance (or reinsurance) by a broker regulated by the Financial Conduct Authority acting as the agent of a Lloyd s Customer in the placement of that contract, the managing agent may (unless the contract has a high Product Risk) assume that contract will meet the needs and reasonable expectations of the broker s client. The managing agent must nonetheless make an assessment of the Product Risk of the contract as part of the normal underwriting process at the underwriting box or elsewhere; and consider the Customer Risk of any person other than the policyholder who may make a claim on the contract of insurance (for example, employer purchased travel insurance on which employees may claim). For the avoidance of doubt, nothing in these standards is intended to make a managing agent responsible for the conduct of a broker (regulated by the Financial Conduct Authority or 17

otherwise) in his capacity as agent of a Lloyd s Customer. Lloyd s customer is a managing agent, insurer or reinsurer CR 8.2 Where the Lloyd s customer is a managing agent or an insurance or reinsurance company, the managing agent selling the Product may assume that it will meet the needs and reasonable expectation of that customer if the customer chooses to purchase the Product. Intermediary acting on behalf of a managing agent CR 8.3 Where a service company, a coverholder or other intermediary has designed a new Product on behalf of a managing agent, the managing agent must nonetheless satisfy itself by conducting adequate due diligence that the Product Design meets these standards and guidance (see CR 6 and CR 7). Leader and followers CR 8.4 Where a lead managing agent has designed a new Product (or has undertaken due diligence of the work of a service company, coverholder or other intermediary) it may provide such information as it decides in connection with that Product to following managing agents to assist them in meeting these standards. Provided that the information has been provided in good faith the managing agent shall bear no liability in damages or otherwise to the following managing agents or to any other person in that regard. Managing agents are encouraged to share their assessment of Product Risk (and to request others assessment of Product Risk) and to discuss the reasons for any variation in their assessments. Market Wordings CR 8.5 In undertaking Product Design, a managing agent may place reasonable reliance on wordings that have been specifically formulated by the Lloyd s Market Association for use in Products with a high Product Risk; and wordings that have been approved by the regulator in the territory in question for the purpose in question. 18

CR 9: Product Sales Giving of advice or personal recommendations CR 9.1 A managing agent must carefully consider the implications of any agent appointed by it in order to give advice or make personal recommendations with regard to a Product before any such advice or recommendations are given. Provision of information regarding Products with a high Product Risk CR 9.2 A managing agent must ensure that it takes reasonable steps to ensure that a Lloyd s Customer is given appropriate information about a Product with a high Product Risk in good time so that the Lloyd s Customer can make an informed decision about the Product. Provision of contract documentation CR 9.3 Contract documentation must be sent to the insured (or the insured s agent) promptly and, in any event, within 7 working days for consumers and 30 calendar days for other Lloyd s Customers in accordance with the Contract Certainty Code of Practice issued by Lloyd s and the market associations from time to time. Cold calling CR 9.4 A managing agent must take particular care that any agent appointed by it follows all of the laws and regulations with regard to cold calling in the territory in question. CR 10: Product Service Effective arrangements and adequate resources CR 10.1 19

A managing agent must ensure that it and its Distributors have in place effective arrangements and adequate resources to properly provide Product Service to Lloyd s Customers having regard to Lloyd s Customers likely demand for service generally and, where appropriate, from time to time and from day to day. Product Service high Product Risk CR 10.2 A managing agent must ensure that, in respect of a Product with a high Product Risk, that it does not impose unreasonable barriers (including by way of fees or charges) to requests or instructions from Lloyd s Customers for information relating to a Product; to cancel, terminate or switch Product; to amend a Product as may be appropriate; and that responses are provided in a timely way. CR 11: Product Service Handling and Determining Claims CR 11.1 A managing agent must have effective Product Controls which ensure that it handles claims from Lloyd s Customers fairly. This must include ensuring that there are no unreasonable barriers to a Lloyd s Customer making a claim; handling claims promptly and fairly and in the way that the managing agent has led them to expect and, in particular (a) not unreasonably rejecting a claim, (b) not unreasonably terminating or avoiding a contract of insurance so as to unreasonably reject a claim or (c) settling claims promptly (either to the Lloyd s Customer or to its agent) once settlement terms have been agreed; and providing reasonable information to a Lloyd s Customer (or its agent) on the progress of a claim. In so doing, a managing agent should have regard to the Customer Risk of the Lloyd s Customer in question and adapt its claims handling approach accordingly. Claims should always be fully investigated before any decision is made to reject a claim. A two stage claims process (i.e. one where claims are initially routinely rejected) must never be adopted. CR 11.2 The delegation by a managing agent of the handling of a claim to another entity must have no adverse effect on a Lloyd s Customer. Accordingly the managing agent must ensure that the entity 20

is provided with sufficient information as to the managing agent s expectations and requirements for the handling of claims; and is properly managed and monitored by the managing agent. Managing agents must comply with Lloyd s standards for the management of external service providers as set in the Claims Management Principles and Minimum Standards in this regard. CR 12: Product Service Complaints CR 12.1 A managing agent must have effective and proportionate Product Controls to ensure that it handles complaints from a Lloyd s Customer fairly having regard to their needs and reasonable expectations. This must include ensuring that that there are no unreasonable barriers to a Lloyd s Customer making a complaint; ensuring that a Lloyd s Customer can make a complaint by any reasonable means and that this is made clear to those customers; recording all complaints from Lloyd s Customers accurately and consistently; providing reasonable information upon request to the Lloyd s Customer about the progress of a complaint; ensuring that complaints are investigated competently, impartially and in a timely way and that underlying reasons for similar complaints (the root cause) are identified and addressed); explaining decisions about complaints clearly to the Lloyd s Customer having regard to the Customer Risk of the Lloyd s Customer; making fair offers of redress where a complaint is upheld; and reporting complaints to Lloyd s. In determining what does and what does not constitute a complaint, the managing agent shall have regard to the definition of complaint (or the equivalent term) in the territory in which the complainant is domiciled. CR 12.2 The delegation by a managing agent of the handling of a complaint to another entity must have no adverse effect on a Lloyd s Customer. The managing agent must ensure that the entity is provided with sufficient information as to the managing agent s expectations and requirements for the handling of complaints; and properly managed and monitored by the managing agent. CR 12.3 A managing agent must ensure that complaints personnel are remunerated in a way which incentivises them to treat all complaints fairly. 21

CR 12.4 A Managing agent must comply with Lloyd s Code for Underwriting Agents: UK Personal Lines Claims and Complaints Handling. CR 13: Conduct Management Information Managing agents may not currently be able or entitled to collect all of the elements of Conduct Management Information from Distributors that they may require to fully meet CR 13. Until 1.1.2016, managing agents must therefore use their best endeavours to comply with CR 13 using information that they are able or entitled to collect. CR 13.1 A managing agent must be able to compile adequate Conduct Management Information for it to determine whether it is treating Lloyd s Customers fairly at all times and, if it is not, what action needs to be taken by whom and by when. CR 13.2 A managing agent s Conduct Management Information must enable it to make good decisions with regard to Conduct Risk. The information must therefore be accurate, both with regard to quantitative and qualitative information; timely and available sufficiently quickly after relevant business activity to enable the managing agent to take appropriate action where that is required; relevant and proportionate to the Product Risks in question and focussed on outcomes for Lloyd s Customers rather than process; and compiled on a consistent basis to enable the managing agent to spot trends and patterns over time. CR 13.3 A managing agent s Conduct Management Information must be available to and seen by all appropriate levels of management and, in particular, the board and any Product Oversight Group; challenged by all appropriate levels of management; analysed and monitored and where issues or problems are identified particularly with regard to a Product or a Product Review that has been undertaken; and recorded, particularly to be able to provide evidence that actions have been taken to resolve problems and that those actions have been successful. CR 13.4 With effect from 1.1.2016 a managing agent must maintain a record of the names and 22

addresses of the policyholders named in each Product (including Products underwritten through coverholders and service companies) which it can independently access at all times. CR 13.5 A managing agent s Conduct Management Information must enable it to assess the effectiveness of its Product Controls and their proportionality to Product Risk; its Product Design; its approach to sales and the provision of advice; and its approach to Product Service including claims and complaints and to assess its approach to strategy and establishing an appropriate corporate culture with regard to Conduct Risk generally. It is essential that a managing agent carefully considers what Conduct Management Information will enable it to make good decisions with regard to Conduct Risk. Table 1 provides examples of Conduct Management Information indicators that might be collected for Products with a high Product Risk in order to assess and analyse whether conduct outcomes have been achieved with regard to Product Design, Product Sales, providing valuable cover, Product Service, claims and complaints. The term leading indicator is used for forward looking information and lagging indicator for information that looks back on events. Questions that the board, any Product Oversight Group and others might ask of these indicators are also set out. Table 2 provides examples of Conduct Management Information indicators that the board and any Product Oversight Group might collect relating to the managing agent s strategy and corporate culture with regard to Conduct Risk generally. These tables are intended to provide a useful starting point when a managing agent is considering what information to acquire, record and analyse. However, the tables are not intended to be comprehensive or definitive. Consideration should always be given to the advantages and disadvantages associated with collecting and assessing each indicator in the context of a particular case. 23

Table 1 Example Conduct Management Information High Product Risk with a large number of sales Management information indicators What are the indicators telling us? Conduct outcomes Product Design The needs and reasonable expectations of Lloyd s customers have been assessed and the Product has been designed accordingly Leading indicators To what extent was the input of experienced Distributors obtained and used in the design of the Product? To what extent was market research commissioned or focus groups established in the design of the Product? Was the Product referred to any Product Oversight Group? Lagging indicators Number and percentage of Products not taken up or terminated during cooling off periods Review of customer feedback Number and percentage of Product complaints relating to Product Design Number and percentage of such complaints upheld Number and percentage of such complaints referred to the Financial Ombudsman Service (or the equivalent overseas) Number and percentage of such complaints upheld Number and percentage of Product withdrawals relating to Product Design Estimate of resolution costs relating to poor Product Design including redress and compensation payments, fines, management time and external costs When was the last Product Review Do we have evidence of what Lloyd s Customers really value and require of the Product? Has our market research given us valuable insights into the design of the Product? Are we sure that the lessons learned from previous Products are being used in the design of this Product? Have we got the resources to manage this Product? Is our Product Design effective? Did the output of our Product stress testing match reality? Overall, what effect has any poor Product Design had on Lloyd s Customers? How much has any poor Product Design cost financially? Overall, how much has any poor Product Design affected our reputation? Product Sales The Product is only being sold to the Leading indicators Number of Product sales 24

Lloyd s Customers for whom it was designed planned (by appropriate periods) Number of Distributors (and individual sales personnel) to be authorised to sell the Product Lagging indicators Number of Products sold (assessed against plan) Reports of mystery shoppers Reports of telephone monitoring for telephone sales Review of customer feedback Review of Distributor audits Number of complaints relating to sales Number of such complaints upheld Number of such complaints referred to the Financial Ombudsman Service (or the equivalent overseas) Number of such complaints upheld Number of Distributors deauthorised to sell the Product Imposition of penalties and clawback provisions with regard to Sales Incentives Do we really know how well our Distributors are selling our Products? Do we really know that our Products are only being sold to those for whom they were designed? Providing valuable cover The Product will provide Lloyd s Customers with insurance cover on which they can realistically claim Leading indicators Planned loss ratio for the Product has been set which has regard to the requirement to provide valuable cover Lagging indicators Actual Product loss ratio (and compared to planned loss ratio) Number of claims Number and percentage of claims initially denied Number and percentage of claim subsequently paid on escalation Total claim payments compared to commissions paid to Distributors Is this Product so highly profitable that it calls into question the value for money for Lloyd s Customers? Having reviewed these indicators, would you still personally recommend the Product to a loved member of your family? Would you still be content to explain the performance of this Product on a consumer programme on primetime television? 25

Product Service (information, cancellation, amendment etc) Lagging indicators Number of requests for information and correlation with complaints Number of requests to cancel or terminate Number of requests to switch product Average time taken to respond Outlier times taken to respond Review of quality of responses Is the Product Documentation clear? Is there a problem with the Product s Design? Do we have effective arrangements and adequate resources to provide Product Service? Claims Claims are handled promptly and fairly and as Lloyd s Customers have been led to expect Claims are not unreasonably rejected Contracts have not been unreasonably terminated or avoided Claims are settled promptly once settlement terms have been agreed Leading indicators Planned level of claims resources for a Product set during Product Design Planned timeframes (and other service levels) for the determination of claims set during Product Design Lagging indicators Number of claims Average time taken to determine claims (and compared to planned timeframes) Outlier times taken to determine claims Average time taken to determine claims by distributor or TPA Level of call abandonment to call centres Number and percentage of claims initially denied Number and percentage of claims subsequently paid on escalation (including by Distributor or TPA) Number of contracts terminated or avoided Average time taken to settle once settlement terms have been agreed Outlier times taken to settle Reports of mystery shoppers Reports of telephone monitoring for telephone sales Review of customer feedback Review of quality of claims correspondence and Do we have enough trained resource to determine claims in respect of this Product? Paying valid claims is the service we provide to Lloyd s customers. Are we good at it? 26

communication Complaints There are no unreasonable barriers to making a complaint Complaints are investigated competently, impartially and in a timely way Decisions about complaints are communicated clearly Fair offers of redress are made when complaints are upheld Leading indicators Planned level of complaints resources for a Product set during Product Design Planned timeframes (and other service levels) for the determination of complaints set during Product Design Lagging indicators Number of complaints Number of complaints per Distributor Number of complaints per terrritory Number of complaints upheld Number of complaints referred to the Financial Ombudsman Service (or equivalent overseas) Number of such complaints upheld Average time taken to determine complaints (and compared to planned timeframes) Outlier times taken to determine complaints Root cause analysis of complaints to determine underlying reasons for complaints Time taken to adjust Product Design to address root cause analysis output Estimates of resolution costs relating to complaints Number of arbitrations or court proceedings brought by Lloyd s customers Number of complaint overturned by Lloyd s Policyholder and Market Assistance Department at stage 2 of the Lloyd s complaints process Do we have enough trained resources to determine complaints in respect of this Product? What are we getting right and what are we getting wrong (and how can we use this in Product Design)? How effective are we at addressing customer complaints? Are we getting better or worse? How effective are each of our agents at addressing customer complaints? Should any of them be de-authorised? Table 2 Example Conduct Management Information Strategy and culture Management information indicators What are the indicators telling us? 27

Conduct outcomes The fair treatment of Lloyd s Customers is central to the managing agent s corporate culture Leading indicators Examples where the commitment to that culture has been set out in presentations and communications to employees and to Distributors Examples of where nonexecutive directors have had meetings with Complaints or Claims department or visited Distributors or made calls to call centres Would the Chief Executive Officer be prepared to attest that the fair treatment of Lloyd s Customers is at the heart of the managing agent s business? Lagging indicators Examples where the board has reviewed a failing Product and withdrawn or amended that Product due to Conduct Risk issues The managing agent provides proportionate and fair Customer Challenge with regard to the managing agent s business model and syndicate business plans Leading indicators Evidence of Customer Challenge in the agendas and minutes of any Product Oversight Group and the board with appropriate evidence of follow up Would the Chief Executive Officer be prepared to attest that the fair treatment of Lloyd s Customers is at the heart of the managing agent s business? 28

CR 14: Product Review CR 14.1 A managing agent must conduct regular Product Reviews of all of its Products as may be appropriate having regard to their Product Risk. With regard to Products with a high Product Risk, Product Reviews should be undertaken in accordance with the periods set as part of the Product s Design. In addition, consideration may be given to conducting a post-launch Product Review. CR 14.2 A managing agent must promptly conduct a Product Review where a material issue or problem has been identified relating to a Product. In addition, a managing agent should consider whether a Product Review should be conducted where a material issue or problem has been identified relating to products of a similar type or there have been relevant regulatory or legal developments relating to the Product. CR 14.3 Prior to commencing a Product Review, the managing agent must give careful consideration as to the appropriate scope of the review. The scope should include whether or not the Product is meeting the needs and reasonable expectations of Lloyd s Customers to whom it has been sold; and Lloyd s Customers have been treated fairly at all times. For a Product with a high Product Risk, the scope should generally also include a reassessment of the Product Risk of the Product; consideration of the effectiveness of the Product Controls having regard to the Conduct Management Information relating to the Product; deciding whether or not it is still appropriate to sell the Product and, if not, consideration as to what steps should be taken with regard to Lloyd s Customers who have already purchased the Product; deciding whether or not to change the Product Design; considering what instructions or feedback should be given to Distributors of the Product; and considering what information relating to the Product Review should be escalated to any Product Oversight Group or to the board. Where a material issue or problem has been identified relating to a Product, the Product Review should generally include an analysis of the root cause of the issue or problem and set out what action needs to be taken by whom and by when to address the cause of the issue or problem. 29