Wed | Nov 20, 2019

Cedric Stephens | The rules of client engagement

Published:Sunday | November 10, 2019 | 12:27 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, St Mary

INSURANCE HELPLINE:

Some 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 stacks 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-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 backup.

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 website of the Financial Services Commission (FSC) does not do the same.

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

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 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.

• 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.

FSC PAYMENT AND HANDLING RULES

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. Why are insurance consumers kept in the dark? One section of the rules speaks to a Claims Procedures Manual, but that document is “for internal use”.

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. 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:

i. insured event has been proved,

ii. liability under the policy has been agreed,

iii. amount payable by the insurer has been agreed, and

iv. 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 (i-iv) 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”?

The market conduct rules are not published on the FSC’s website. Why not?

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’s website contains a template that can be used to assemble information to prepare an insurance complaint. Bear in mind that details are very important.

When you 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.