Table of Contents
1 Definitions
2 Duties of insurers
3 Responding to complaints
4 Complaints resolution process
5 Reports
6 Publication
7 Expiry
Definitions
1 In this Regulation,
(a) “complaint”
means a complaint made under section 14 of the Premiums Regulation;
(b) “insurer”
has the same meaning that it has in the Premiums Regulation;
(c) “policyholder”
has the same meaning as it has in section 13(d) of the Premiums
Regulation;
(d) “Premiums
Regulation” means the Automobile Insurance Premiums Regulation
(AR 124/2004).
Duties of insurers
2 Before January 1, 2005, every insurer
must
(a) appoint
one or more persons to be responsible for receiving and dealing with complaints
from policyholders and notify the Superintendent of the name of the person or
persons, and
(b) establish
a complaint resolution process in accordance with this Regulation.
Responding to
complaints
3 The person appointed by an insurer to receive
and to deal with complaints by policyholders must
(a) be
reasonably available to respond to policyholder’s complaints,
(b) facilitate
the timely, expeditious and efficient management of complaints, and
(c) keep
the complaints resolution process of the insurer up‑to‑date,
including notifying the Superintendent of any changes to the person or persons
responsible for receiving and dealing with complaints.
Complaints resolution
process
4(1) An
insurer must establish and maintain a complaints resolution process, including
the following:
(a) a
written process describing the means by which complaints are received,
processed, considered and responded to within the time referred to in
subsection (2);
(b) the
means by which and the times at which policyholders will be notified of the
management of their complaint;
(c) the
opportunity that will be provided to policyholders to explain their complaint
and the manner in which the insurer will respond to the policyholder;
(d) a
written code of ethical conduct for the manner in which complaints are
processed, managed and decided;
(e) a
fair and efficient process for managing complaints that will allow the insurer,
in accordance with section 14(2) of the Premiums Regulation, to make an attempt
in good faith to resolve the policyholder’s complaint.
(2) Unless
the insurer and policyholder agree to extend the time period, the insurer must
notify the policyholder in writing of the insurer’s decision about the
policyholder’s complaint within 30 days of the date the insurer receives the
complaint.
Reports
5 On or before June 1, 2005, and once every
6 months after that, an insurer must file a written report with the
Superintendent covering all the following matters:
(a) stating
the number of complaints received;
(b) stating
the number of complaints resolved;
(c) categorizing
the general nature of the complaints received and the number in each category;
(d) providing
any other information the Superintendent requests.
Publication
6 An insurer must provide to its policyholders
information about the complaint resolution process established in accordance
with this Regulation and the person to whom and how complaints may be made.
Expiry
7 For the purpose of ensuring that this Regulation
is reviewed for ongoing relevancy and necessity, with the option that it may be
repassed in its present or an amended form following a review, this Regulation
expires on November 30, 2014.
