Fri | Nov 22, 2019

Cedric Stephens | Ignored by insurer

Published:Sunday | October 13, 2019 | 5:41 AM

QUESTION: I submitted a claim to my motor insurer three months ago. Since then, I have tried many times to contact them by telephone and email to find out when payment will be made. Those attempts ended in failure. On one occasion a few weeks ago, I used my cell phone to try to speak with the claims handler. I spent 90 minutes waiting and eventually hung up. No one took the call. Because I work with The Office of Utilities Regulation, OUR, I know that there are rules that say how these companies should treat customers. Are similar protocols in place for insurance companies? Also, what can I do to get my claim paid?

− F.L., Port Maria

 

INSURANCE HELPLINE: An estimated 99.9 per cent of the persons who ask questions about how insurers treat customers, unwittingly or ­otherwise, view their services as being vastly different from other kinds of services. Why? They are so fixated on resolving their problems, nothing else matters. They seldom look outside the insurance industry and compare how the help and advice that an insurer or ­broker offers stack up against those of other service providers.

One friend recently told me that she sat and waited in a broker’s office for two hours to get a motor cover note. I spend less than five minutes to make a credit card payment – in the bank or via the Internet. My certificate of insurance is sent to me by email, and I store it on my mobile phone. Will the authorities accept it as valid? I do not know. I keep a hard copy as back-up.

I visited the OUR’s website and made a great discovery about how it regulates the utilities. Unlike the insurance regulator, it devotes an entire section to consumer affairs. For some reason, the Financial Services Commission’s does not do the same.

I also learnt that the OUR has entered into minimum service level agreements with the utilities. These agreements guarantee that its standards, which are framed to “ensure value to customers”, are met.

The OUR places the onus on licensees to demonstrate compliance. There are also ‘overall standards’ that apply throughout the life of the tariffs. Here are a few examples that apply to the electricity provider:

• Planned outages – All customers to get at least 48 hours’ notice;

• Meter reading – 99 per cent to be read within time stated in billing cycle;

Billing punctuality – 98 per cent of bills to be mailed within time specified after being read;

• Responsiveness of call centre reps – 99 per cent of calls to be answered in 20 seconds; and

• Street lighting – 99 per cent of ­complaints to be resolved within 14 days.

Even though both regulators say that serving customers is at the centre of what utilities and insurers do, there are sharp differences in how the rules are constructed and applied.

The FSC’s rules for the handling and payment of motor claims are notable for their lack of specificity. There are, for example, no guidelines that speak to insurers’ communication systems and their responsiveness to customer calls or how quickly they should respond to letters or emails. The FSC conducts examinations to see if the rules are complied with. The OUR also imposes financial penalties when its standards are not met.

The FSC’s 2019 Market Conduct Guidelines have not received much public attention. One section of the rules speaks to a Claims Procedures Manual, but that document is “for internal use”. For example, how many consumers are familiar with Rule 11.7?

It says insurers and intermediaries “should make every effort to settle legitimate claims with unavoidable delay (sic)”.

Regulations 132 to 139 stipulate the actions that an insurer and insured should take in the event of a claim. Regulation 135 requires that claims be settled with unavoidable delay if the insured event has been proved, liability under the policy has been agreed, the amount payable by the insurer has been agreed, and entitlement of the claimant to receive payment has been established.

The claim must be paid by the insurer within 30 days when the conditions listed above have been satisfied.

“If payment of the claim is delayed for 30 days or more when the four conditions have been met, then the insurer must pay interest to the claimant at the prescribed rate in accordance with Regulation 135.”

I believe that I know what the FSC means by this rule, but I am not 100 per cent sure. What is ‘unavoidable delay’?

Complaint handling is discussed in Section 10 of the rules. It reads: “The complaints of customers should be settled in a timely, effective and fair manner. Insurers … should have written procedures/policies in place for the proper handling of complaints … . The procedures/policies should be made widely available to policyholders (e.g. via the company’s website, notices, and noted in literature shared with the policyholders, etc).”

I have never seen an insurance company’s complaint-handling procedures since the new rules were enacted earlier this year.

The Consumer Affairs Commission has a template that can be used to assemble information to prepare an insurance complaint. Bear in mind that details are very important.

When you have put your case in writing, send it by email to the insurance company's CEO. If the matter is not resolved to your satisfaction in a reasonable time, send the complaint to the FSC. This option, from my experience, is more effective than the advice that is offered on the FSC’s website.

 

Cedric E. Stephens provides independent information and advice about the management of risks and insurance. For free information or counsel, write to aegis@flowja.com.