LegalX Complaints Handling Framework
The aim of this COMPLAINTS HANDLING FRAMEWORK is to describe the internal
process of complaints handling (also in addition to the statutory prescribed process)
and to be used as a tool to improve service and prevent and/or minimize recurrence
of complaints, ensuring the fair treatment of complainants, free of any charge.
In the event of any conflict between the content of this process and the content of the
Financial Advisory and Intermediary Services Act 37 of 2002, the latter shall at all
times take precedence.
1. Receipt of complaint
2. Acknowledgement of receipt
3. Classification and identification of applicable department
4. Investigation of facts and merits
5. Feedback to Complainant
6. Recordal of outcome
7. Unresolved complaints
8. Regulatory Complaints
A Complaint in terms of the Policyholder Protection Rules (PPR) means an expression of dissatisfaction by a person to an insurer or, to the knowledge of the insurer, to the insurer’s service provider relating to a policy or service provided or offered by that insurer which indicates or alleges, regardless of whether such an expression of dissatisfaction is submitted together with or in relation to a policyholder query, that –
● (a) the insurer or its service provider has contravened or failed to comply with
an agreement, a law, a rule, or a code of conduct which is binding on the
insurer or to which it subscribes;
● (b) the insurer or its service provider’s maladministration or willful or negligent
action or failure to act, has caused the person harm, prejudice, distress or
substantial inconvenience; or
● (c) the insurer or its service provider has treated the person unfairly;
● Regardless whether submitted together with or in relation to a policyholder
All complaints lodged with the Ombudsman/ FAIS/ FSCA is to be dealt with by Guardrisk exclusively. All documents and information relating to such a complaint, must be sent to Guardrisk within 24hours of receipt of the complaint.
Note that there is no service fee charged for registering a complaint.
The definition of a Complainant – who may complain?
A complainant is a person who has a direct interest in the policy/ service or someone acting on behalf of a person with a direct interest in the policy/ service. For example: a policyholder/ a person that pays a premium, his/ her beneficiary, a policyholder’s spouse or registered dependents, a potential policyholder whose satisfaction relates to the relevant application, approach, solicitation,
advertising or marketing material.
Outcomes of a Complaint
1. Upheld: complaint was successful either
i. Wholly (complainant got exactly what he/ she was looking for);
ii. Partially (complainant and FSP found middle ground).
There are also two variations of a wholly or an upheld complaint:
a) Compensation Payment: to compensate a complainant for a proven or estimated financial
loss incurred as a result of the FSP’s wrongdoing.
This is either:
i. Payment Contractually due: the complainant should have received the assistance and help from the start, a justified complaint;
ii. Payment not Contractually due: the complainant does not have legal standing or a legal argument, however, due to the poor handling by FSP in the form of negligence, FSP for example refunds the complainant his/ her premiums and cancels the complainant.
b) Goodwill Payment: the complainant is not covered in terms of the policy, but FSP is willing and able to sponsor the matter due to extraordinary circumstances.
2. Rejected: complaint was rejected, and FSP regards the complaint as finalized after advising the complainant that FSP does not intend to take any further action to resolve the complaint. A formal repudiation letter with all complaint details will be sent. There are two variations of a rejected complaint:
a) Invalid: the complainant does not accept or respond to proposals to resolve the complaint within 7 days. This includes sending relevant documentation, acting upon the advice of FSP as well as not being able to reach the complainant via telephone, SMS and E-mail (if applicable);
b) Unjustified: the policy has been met, complainant has been treated fairly as far as possible, there is no legal leg to stand on to assist complainant, complainant refuses to accept outcome of merit assessment and nothing further can be done to assist complainant.
1.1 If possible, the policy holder should submit the complaint in writing. If applicable, the policy holder should attach all supporting documentation. Note that complaints logged using a telephone voice recording will be reduced to writing by the officer assigned to attend to your complaint;
1.2 A complaint form, which is available on the Website or will be provided on request must be completed for every complaint.
1.3 The complaint can be submitted electronically to email@example.com or telephonically at 0861102092.
1.4 The particulars of every complaint will be entered into an electronic Complaints Register, which is under control of the Complaints Officer, a dedicated trained staff member.
The Complaints Officer will acknowledge, in writing, receipt of the complaint to the policy holder informing him/her that the complaint is being given the necessary attention, providing him/her with details of the internal complaints procedure and expected timelines.
3.1 The Complaints Officer will classify the complaint, inform a director of the complaint and refer the complaint to the Head of Legal.
3.2 Complaints can be categorized as follows:
3.2.1 design of a policy or related service;
3.2.2 information provided to policyholders or lack of information and feedback provided to policyholder;
3.2.3 advice given by the sales representative;
3.2.4 policy performance and/or servicing, including negligence;
3.2.5 admin services such as premium collection;
3.2.6 policy accessibility, ability to change or switch;
3.2.7 complaint handling;
3.2.8 complaints relating to insurance claims, such as a repudiation of a claim for legal cost cover; and
3.2.9 other complaints.
4.1 Head of Legal to refer the complaint to the relevant role player to provide him / her with the opportunity to reply in full to the complaint.
4.2 Head of Legal will follow up with the relevant role player if no reply is received within 1 working day.
4.3 As soon as Head of Legal receives feedback from the relevant role player he/she should give full and fair consideration to all aspects of the complaint, as well as the relevant role player’s comments.
4.4 In the event of any uncertainty on the merits of a complaint, discretion should
be exercised in favour of the complainant, in terms of LEGALX Treat Customer’s Fair (TCF) policy.
4.5 Complaints should be finalised within 3 working days. If no feedback is received from the Head of Legal within the stipulated time The Complaints Officer will do a follow up.
4.6 If the relevant role player and / or Head of Legal need more time to investigate the complaint, the policy holder will be informed accordingly.
4.7 If evidence of poor service is found, appropriate remedial action will be taken within 24 working hours, which might include:
4.7.1 an apology;
4.7.2 corrective action to remove/minimize/prevent any prejudice;
4.7.3 if applicable or warranted, a refund of premiums;
4.7.4 follow up with relevant service provider, if applicable.
Compliance Officer (Any complaint)
eas-e Comply, Compliance practise number 28
Tel: 0861 266 759
E-mail address: firstname.lastname@example.org
Underwriter (Any complaint)
Guardrisk Insurance Company Limited
P.O. Box 786015
Tel: (011) 669 1000
The FAIS Ombud (Product or service complaints against the Insurer or Administrator)
Kasteel Park Office Park
Orange Building, 2nd Floor
546 Jochemus Street
Erasmus Kloof, Pretoria, 0048
PO Box 74571
Tel: 0860 663 247
The Short Term Insurance Ombud (Claims complaints)
1 Sturdee Avenue
1st Floor, Bock A
Rosebank, Johannesburg, 2196
PO Box 32334
Tel: (011) 726 8900 / Fax: (011) 726 5501
The Relevant Law Society (Attorney service provider complaints) Per location of Attorney
6.1 Head of Legal to Advise the Complaints Officer and the involved Director of the outcome of the complaint as well as any remedial action/s taken or to be taken.
6.2 The Complaints Officer to record the outcome of the complaint and filing of all relevant documentation.
6.3 The Complaints Officer to advise the Complainant of the outcome of the complaint, providing him/her with clear and adequate reasons for the decision.
6.4 The Complaints Officer to update the electronic complaints register.
6.5 Maintain record of complaint for a period of five (5) years after cancellation of the particular policy.
6.6 The following information must be recorded in respect of each reportable complaint:
6.6.1 relevant details of complainant and the subject matter of the complaint
6.6.2 copies of all evidence, correspondence and decisions;
6.6.3 the complaint categorization; and
6.6.4 progress and status of the complaint, including whether turnaround times were adhered to.
6.7 Enquire from the complainant whether he/she is satisfied with the outcome of the complaint.
6.8 Advise policy holder of his/her rights to report the matter to the appropriate authority within 6 months if he/she is not satisfied with the result of the investigation and provide the contact particulars of the involved Ombud and/or third party.
7.1 Complaints not finalised within 3 working days to be referred to a Director of Legalex (Pty) Ltd.
8.1 All complaints lodged with the Ombudsman of Long-term / Short Term Insurance or the FAIS Ombud and all legal proceedings in respect of the Insurer, the Policies and/or the Insurance Business must be dealt with exclusively by the Underwriter.
8.2 The binder holder and intermediaries/registered FSP must give all assistance and co-operation to the Underwriter in respect of any of the above and promptly furnish all documents / information and give all representations required in order to enable the Underwriter to defend any such legal proceedings, claims, potential claims, complaints or potential complaints.
8.3 The binder holder and intermediaries/registered FSP must, at its costs, as soon as is practically possible after receipt of a complaint, a notification from the Ombudsman for Long Term / Short Term Insurance or the FAIS Ombud; or any other legal document pertaining to the Underwriter, the Insurance Business and/or the Policies, provide a copy of such documents and any supporting
documents to Guardrisk.
The details are as follows:
Non-Life Ombud complaints: email@example.com
Repudiation requests: firstname.lastname@example.org
FAIS complaints – Non-Life: email@example.com