Personal Lines Policy Notice of Complaint

Personal Lines Policy Notice of Complaint

PERSONAL LINES POLICY NOTICE OF COMPLAINT

NB: PLEASE ENSURE YOU COMPLETE ALL DOCUMENTATION AND ALL FIELDS FROM PAGE 6 AND SEND TO US

1.To be completed and returned to us

Please use any one of the communication methods below to submit your complaint, email is our preferred method of communication which will assist in a quicker turnaround time of your complaint

  1. Email : ; or
  2. Fax:Attention Complaints Co-Ordinator 086 568 0475; or
  3. Post:Attention: Complaints Co-Ordinator

PO Box 8651

Edenglen

1613

  1. Alternatively you can complete a complaints form at

2.By submitting this complaint I declare:

  • My complaint is not in the hands of an attorney for any purpose other than the drafting of this complaint and is not subject to litigation or arbitration.
  • Thus far I have not been assisted to my satisfaction and want to lay a formal complaint in writing to ensure that my rights as a customer have been heard and considered in this matter.
  • My complaint covers my own personal lines insurance policy with Affinity Underwriting Mangers for private and domestic cover and does not involve statutory third party or industrial or commercial insurance, or anyone else’s Insurer. (Please note that there is a separate application form for commercial complaints)
  • After being advised that my claim has been rejected, or my complaint ignored, I have tried unsuccessfully to resolve my complaint/dispute through approaching the Underwriter and/or the Underwriter’s agent and therefore, requesting in writing that my complaint be lodged officially into Affinity Underwriting Managers complaints register.
  • I agree to follow the complaints procedure, assist where I am required to do so and agree that I am willing to allow this process to be followed and completed as per the Affinity Underwriters process as set our below.

3.I understand and agree that by submission of this form:

  • The amount in dispute does not exceed R2 million in total, and in the case of home owner or building policies, the amount in dispute does not exceed R4 million in total;
  • the matter will be regarded as confidential as between myself, Affinity Underwriting Managers and/or the Broker;
  • I acknowledge that any finding of the complaints procedure shall not be binding upon me and that my legal rights against the Insurer are not affected thereby;
  • documents brought into being as a result of my complaint shall not be liable to disclosure or be the subject of a discovery order or subpoena in the event of proceedings between myself and the Insurer and/or the Broker;
  • This complaints procedure is not the same as those rendered by a professional legal adviser and are confined purely to recommendation, mediation or conciliation in an attempt to settle your complaint;
  • I hereby understand and agree that I agree to allow Affinity Underwriting Managers and their agents the opportunity and time to correctly investigate the basis of my complaint.
  • I hereby agree to follow the complaints procedure as set out in point 4 below (Complaints Procedure)
  • I understand that in terms of the legislation Affinity Underwriting Managers are given 6 weeks to address my compliant before I may refer this complaint to the Ombudsman
  • I am aware that I enjoy the right to appeal the complaints procedure’s findings and decision and may refer the matter to the Ombudsman for Short Term Insurance or the FAIS Ombudsman after this process has been fully completed or after 6 weeks
  • Please ensure that all documentation / fields below are completed to assist in dealing with your manner more efficiently.
  • Our preferred method of communication is email, please send all related queries to so that all communications are documented and we can ensure that all the relevant time lines are followed, our complaints co-ordinator will automatically revert your complaint to the correct hierarchy at the allocated time line to ensure that your complaint is handled as efficiently as possible.
  • If you have not received any confirmation of receipt of your complaint or any correspondence within 5 days, please contact our offices to confirm that your complaint has been received.

I ______(name) ______(ID number) hereby declare that I have read and understand the above and declare that all information I provide is true and correct.

Signed on this day the ______of ______2015

______

Signature

4.Affinity Complaints Procedure Flow

5.COMPLAINTS HANDLING PROCEDURE

A.STEP 1 - COMPLAINT SUBMITTED TO COMPLAINTS CO-ORDINATOR ()

  1. Complaint form to be completed by client (document can be downloaded or completed and submitted at )
  2. Completed document must be sent to Affinity by the following mediums:
  3. Email : ; or
  4. Fax:Attention Complaints Co-Ordinator 086 568 0475; or
  5. Post:Attention: Complaints Co-Ordinator

PO Box 8651

Edenglen

1613

  1. Alternatively you can complete a complaints form at
  1. Complaint to be submitted to Complaints Co-Ordinator or captured at
  2. Once complaint lodged, focus is on the quick and fair resolution of the complaint.
  3. In order to keep the client informed and the complaints register constantly up to date feedback must be given to the complainant on an ongoing basis by the Complaints Co-Ordinator.
  4. In accordance to legislation and insurance laws, we have 6 weeks from the date of initial log to resolve the dispute, if the dispute is not resolved in that period the client may approach the Ombusdman.
  5. Claim is captured into complaints register
  6. Co-ordinator sends complaint to relevant department manager
  7. Daily feedback sent to complaints co-ordinator and to client
  8. If claim is not resolved to the client’s satisfaction within 5 working days the claim is escalated to department Director

B. STEP 2 – COMPLAINT ESCELATED TO DEPARTMENT DIRECTOR

  1. Director to be supplied with all necessary supporting documentation.
  2. Director to investigate matter
  3. If required matter will be referred and discusses in weekly claims/complaints meetings
  4. Director to finalise feedback within a maximum of 2 weeks

C. STEP 3 – KEY INDIVIDUAL

The Key Individual of a FSP is ultimately responsible for the correct procedures being followed through out any dealings between a client and a FSP.if the complaint has not been resolved to the clients satisfaction or the Complaint has not been attended to within 1 week by the department director or two weeks from initial date, the complaint handler will email the complaint to our key individual who will address the complaint urgently

Email:

F. STEP 4 - COMPLIANCE OFFICER ()

  1. The compliance officer is our external compliance officer who monitors Affinity's compliance to legislation and the laws within these legislations. We have an external compliance officer who we believe gives us a more holistic overview as opposed to an internal compliance officer
  2. Once the Key Individual has looked at the complaint and the client is still not happy with the outcome of their complaint all documentation will be sent to our external compliance officer for consideration and suggestion on an outcome/resolution

SDK Compliance Consultants

Tel: 011425-4603

Email:

Postal:PO Box 131459, Northmead, 1511

6.COMPLAINTS RESOLUTION DEPARTMENT ()

If the matter is still not resolved to your satisfaction and is specifically is as a result of a claim, please contact the Complaints resolution Department , a non-biased complaints mediator who will look at all the facts presented and suggest a ruling to Affinity Underwriting Managers.

If you as the consumer are still not satisfied with the outcome or you are not happy with the time it has taken us to respond you may refer the matter to the Ombudsman for short term insurance or the FAIS Ombudsman.

The Office of the Ombudsman for Short-Term Insurance provides consumers with a free, efficient and fair dispute resolution mechanism. It offers consumers a “no risk” mechanism to resolve disputes with insurers/FSP's in short-term insurance claims related problems which are not resolved to your satisfaction.

Telephone Number : 0860 726890

Facsimile: 011 726 5501

email:

Website:

You may submit complaints to the FAIS Ombudsman, if the intermediary/insurer/FSP was not able to resolve your complaint about a financial Services product purchased, varied, replaced or terminated after 30 September 2004

Telephone Number : 012 470 9080 or

0860 32 47 66

Facsimile: 012 348 3447

email:

Website:faisombud.co.za

7.PARTICULARS OF COMPLAINT

a.Information of policy holder (complainant):

Mr/Mrs/Miss/Ms(*)
Identity Number(*)
Surname(*)
First Names(*):
Physical Address(*)
Code
Home Telephone Number
Cell Number
Work Number
Email Address

b.Policy Information

Policy Number
Claim Number
Type Of Policy
Date of Claim Rejected (If applicable)
Date of Accident/Loss

c.Details of Complaint

Please legibly set out all the facts which you consider to have bearing on this complaint, including dates, places and names. Attach copies of all relevant documents. If the space is not sufficient, you may add additional pages. The details should set out (a) the facts which gave rise to the claim, (b) the reasons for the rejection of the claim and (c) why you are dissatisfied with the insurer’s decision.

d.Complaint Resolution (How do you suggest we resolve your complaint)

Affinity Client Complaints Procedure (Last Updated May 2015)Page 1 of 6

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