ABA Insurance Commercial Ltd – Complaints Procedures

Background  

A complaint is any expression of dissatisfaction, whether oral or written, and whether  justified or not, from or on behalf of an eligible complainant which alleges that the  complainant has suffered (or may suffer) financial loss, material distress or material  inconvenience and relates to an activity of our firm or any other firm with whom we  have some connection in marketing or providing financial services or products which  comes under the jurisdiction of the Financial Ombudsman Service. 

Customer complaints help us in assessing our levels of service and provide us with  an opportunity to look positively at any areas requiring improvement, they also allow  us to evaluate whether we are treating our customers fairly. 

It is recognised that a complaint does not necessitate a need for disciplinary action  and Managers are tasked to identify whether any training or internal procedural  changes are required as a result of the complaint, as an alternative to disciplinary  action. 

Senior management of our Firm must: 

Ensure someone at a senior level is appointed as Complaints Manager and the  appointment notified to the FCA within the Standing Data on the Firm, in the  FCA’s Connect system  

Inform the FCA of any change in the Complaints Manager 

Ensure an internal procedure is in place providing appropriate information which  allows complaints to be made by any reasonable means free of charge and  recognising complaints as requiring reasonable and prompt handling and  resolution. 

Ensure that the Firm’s Terms of Business Agreement includes reference to the  complaints handling procedure and that a copy is provided to customers at the  point of sale; on request; and with every complaint acknowledgement letter 

Ensure staff are and remain familiar with the Firm’s Complaints Handling  Procedure 

Any person who receives a complaint must: 

Accept any expression of dissatisfaction (whether justified or not) on any matter  relating to our business, made orally or in writing

Take full details of the complaint  

Apologise to the customer and try to resolve the complaint where prudent to do  so 

If the complaint cannot be resolved to the customer’s satisfaction within one business day, explain to the customer that they will receive an acknowledgement  letter from the Complaints Manager within the next 5 business days and that we  aim to resolve complaints within 4 weeks. Provide the customer with details of  the Complaints Manager’s name and contact details 

Inform the Complaints Manager immediately of all complaints received so that  they can be logged 

In the event that the complaint relates to the Complaints Manager, where possible  refer to the Deputy Complaints Manager or another senior person who is  independent of the complaint 

Be aware of who is the nominated contact point within our business for customer complaints 

Understand fully the Firm’s Complaints Procedure at all times and undertake an  annual assessment of understanding 

The Complaints Manager must: 

Be a senior member of staff or management 

Be competent to deal with complaints 

Be independent of the complaint subject (wherever appropriate) • Have authority to settle complaints or have access to someone with this authority 

Remind all staff on an annual basis of the Firm’s complaints handling procedures  and their duties in the event that they receive a complaint from a customer 

Record all complaints in the Complaints Register.  

Record each reportable complaint on an individual Complaints Record Form • Maintain comprehensive records of all circumstances relating to a complaint 

Ensure that all correspondence relating to a complaint is retained for 3 years from  the date the complaint is closed 

Analyse each complaint so as to identify root causes common to types of  complaint and to identify if there is a need for training, a change of procedure or  disciplinary action and record this on the Complaints Record Form and Breaches  Register (if appropriate).

Analyse the Complaints Register on a monthly basis and ensure necessary action  is taken and recorded on the Complaints Record. When doing so take into  consideration: 

•  Number of complaints received 
•  Number of complaints outstanding 
•  Number of complaints settled 
•  Any trends identified 
•  Any corrective action taken or required 

In the event of a complaint being made against another party, record this in our  Complaints Register and redirect the complaint to the relevant party by e-mail or  in writing within 1 business day and advise the complainant who this has been  passed on to, in writing, on the same day 

Collate relevant complaints data for the 6 monthly Reg Data Return 

The following complaints do not have to be included in our 6 monthly Reg Data  Return: 

• Complaints redirected to a third party; or 
• Made by non-eligible complainants  

We do however include these in our Complaints Register to enable  accurate analysis, and should therefore be logged as Include in Reg Data  Return 

Keep a sufficient supply of the Financial Ombudsman Service (FOS) leaflets  

Look at each customer complaint on an individual basis and consider the facts of  what actually happened. Refer to the customer file and review documentation,  and where applicable any previous complaints made by the customer including  any previous FOS decisions. Where necessary obtain a statement from the  member of staff involved 

Consider whether the subject matter of the complaint may affect other customers  and identify wider action to be taken to address these issues 

Acknowledge all complaints in writing promptly on receipt of the complaint 

Include in the acknowledgement letter the full name and contact details of the  person who is handling the complaint 

Ensure that the acknowledgement letter is clearly written, avoids jargon and  adequately address the subject matter of the complaint. Consider and respond to  each point raised by the customer

Include in the acknowledgement letter an indication as to when the customer can  expect a final written response unless the acknowledgement letter is also the final  written response 

Include a TOBA with every complaint acknowledgement letter and draw the  customer’s attention to the relevant section of the TOBA 

If we can resolve the complaint by the close of the third business day after receipt  of the complaint, we will send a ‘summary resolution communication’ and include that the complaint may be referred to the Financial Ombudsman Service (FOS); 

Within 5 business days of receipt of a complaint the client will receive a copy of  our complaint handling service standards together with a covering letter  identifying the details of the person dealing with their complaint. This is our  Acknowledgement Letter. If by this time we have been able to resolve the  complaint this will also be our Final Response Letter. 

Within 4 weeks of receiving the complaint, provide the customer with a final  written response or contact the customer to provide an update on the progress of  their complaint and indicate when they can expect the final written response which should be within 8 weeks of the date the complaint was initially received 

Within 8 weeks of receiving the complaint, provide the customer with a final  written response which must: 

Clearly state each element of the complaint and our reasons in  accepting or rejecting that element. 

In cases of redress, provide the customer with fair compensation (if  financial redress, consider a reasonable rate of interest). Retain  records of basis of calculation of settlement figure 

Advise the customer that we will consider the complaint closed after 8  weeks if no further response is received or advise the customer if they  will be required to provide their express acceptance of the final  response 

Inform eligible complainants that if they are dissatisfied with our final  response, they may contact the FOS within 6 months of receiving our  final response. 

Enclose a copy of the FOS leaflet and make reference to the leaflet  within the written response. 

• If unable to provide a final written response within 8 weeks of receiving the  complaint we must inform the customer in writing why it has not been possible to  provide a final written response and advise when they may expect to receive a  final written response. We must also advise eligible complainants that they may  refer the complaint to the FOS if they are unhappy with the delay.

We must: 

• Provide the FCA with details of complaints received from “eligible complainants”,  every 6 months. (Whilst we accept and respond to complaints from “non-eligible”  complainants, these do not fall within the FCA’s sphere of interest) 
• Collate complaints data regarding complaints closed within the reporting period  for the 6 monthly RMAR as follows: 

Number of complaints closed within 4 weeks 

Number of complaints closed after 4 weeks but within 8 weeks o Number of complaints closed after 8 weeks 

Total number of complaints upheld 

Total redress paid 

• Redress should be calculated based on the amounts paid or costs borne by the  Firm where a cash value can be readily identified. Examples include: 

Amounts paid for distress and inconvenience 

A free transfer to another provider which would normally be paid for o Interest on delayed settlements 

Waiver of policy excess 

Redress should not include repayments or refunds of premiums which  have been taken in error 

• Collate data regarding the nature of complaints opened within the reporting period  by product type and subject matter for the 6 monthly RMAR as follows: 
  

Payment Protection o Other General Insurance o Critical Illness 

Income Protection o Other Pure Protection 

Advising, selling and arranging o Terms and disputed sums/charges o General admin/customer service o Arrears related 

Other 

If a suitable classification does not exist or the classification does not reflect the  complaint sufficiently, use a classification of “Other” and provide a precise  description in the ‘Brief Summary’ box on the Complaint Record Form 

Ensure that the returns are submitted on-line and within 30 business days of our  financial year end and 6 months into our financial year 

Be aware that late submissions within 28 business days are met by a fine on an  expanding scale, based on the number of days late or if over 28 days late, more  severe penalties are imposed upon individuals operating for the Firm

Be aware that the FCA does not accept pressure of work as an acceptable  excuse for a delay in providing this information 

Co-operate fully with the Ombudsman. This means producing requested  documents, adhering to any specified time limits, attending hearings when  requested to do so and complying properly with any settlements or awards 

Be aware that whilst we take all complaints seriously, we will record in our FCA Complaints Register but not report complaints to the FCA, where we have taken  reasonable steps to determine, and have determined, that the complaint: 

Is not made by, or on behalf of, an eligible complainant; or 

Does not relate to an activity which comes under the jurisdiction of the  Financial Ombudsman Service; or 

Does not involve an allegation that the complainant has suffered, or  may suffer, financial loss, material distress or inconvenience; or 

Has been resolved by close of business on the business day following  its receipt; or 

Relates in its entirety to a third party. 

Financial Ombudsman Service (FOS) 

Whilst we log and deal with all complaints, only certain categories of customers  (those listed below) can be offered the Financial Ombudsman Service facility: 

A Consumer – as defined in the FCA Handbook glossary 

From 1 April 2019, the eligibility criteria for complainants to refer unresolved  complaints to the Financial Ombudsman has been extended to include:  

1. SMEs with an annual turnover of less than £6.5 million and fewer than 50  employees, or a balance sheet total of less than £5 million 
2. Charities with an annual income of less than £6.5 million (prior to 1 April 2019 this  was an annual income of £1 million) 
3. Trustees of a trust which has a net asset value of less than £5 million (prior to 1  April 2019 this was on a net asset value of less than £1 million)  
4. A guarantor (an individual who is not a consumer and has given a guarantee or  security in respect of an obligation or liability of a person which was an SME at the  date that the guarantee or security was given).

In addition, when determining whether SMEs meet the criteria set out in point 1  above, account should be given to ‘partner enterprises’ and ‘linked enterprises’ i.e. if  the partner or linked enterprise does not meet the criteria set out in point 1 then  neither will the SME.  

Linked enterprises are those which have any of the following relationships with each  other:  

1. a) an enterprise has a majority of the shareholders’ or members’ voting rights in  another enterprise 
2. b) an enterprise has the right to appoint or remove a majority of the members of the  administrative, management or supervisory body of another enterprise 
3. c) an enterprise has the right to exercise a dominant influence over another  enterprise pursuant to a contract entered into with that  

enterprise or to a provision in its memorandum or articles of association 

1. d) an enterprise, which is a shareholder in or member of another enterprise, controls  alone, pursuant to an agreement with other shareholders in or members of that  enterprise, a majority of shareholders’ or members’ voting rights in that exercise. 

Partner enterprises are all enterprises which are not classified as linked enterprises  (as per the criteria above) where the enterprise holds either jointly with one or more  linked enterprises, 25% or more of the capital or voting rights of another enterprise. 

If in any doubt about the eligibility of a business, charity or trust, we treat the  complainant as if they were eligible. The Ombudsman will then determine eligibility  by referring to audited accounts or VAT returns. 

In addition, FOS jurisdiction extends to those who have a potential customer  relationship or an indirect relationship with the Firm. Some examples of indirect  complainants are: 

A person for whose benefit a contract of insurance was taken out or  was intended to be taken out 

A person on whom the legal right to benefit from a claim under a  contract of insurance has been devolved by contract, statute subrogation.

A beneficiary under a trust or estate of which the Firm is trustee or  personal representative

Employees covered by a group permanent health policy taken out by  an employer, which provides in the insurance contract that the policy  was taken out for the benefit of the employees 

It does not however extend to include the actions of the other driver in a car  accident. 

The Ombudsman cannot consider a complaint where it is received by the FOS: 

• Less than 8 weeks following receipt of the complaint by ourselves, unless we  have sent the customer a final response within this period 
• More than 6 months after the date on which the complainant was advised by us in  our final response, that they may refer their complaint to the FOS 
• More than 6 years after the event complained of or (if later) more than 3 years  from the date on which they became aware (or ought reasonably to have become  aware) that they had cause for complaint 

When rejecting a complaint on this basis we provide a final response to the customer  explaining this and advising that the Ombudsman can consider complaints outside  the timescales in the latter two points when in their view; failure to comply with the  time limits was a result of exceptional circumstances. 

The Ombudsman will check: 

• The complainant’s eligibility  
• That the complaint meets the time limits mentioned earlier 

Appropriate action will then be taken by the Ombudsman who will keep us informed  of progress. Where the Ombudsman feels that there is a reasonable prospect of  resolving the complaint by mediation, they may attempt to negotiate a settlement  between the parties. 

The Ombudsman may dismiss a complaint without consideration of the merits if they: 

• Are satisfied that the complainant has not suffered any loss, material distress  or material inconvenience 
• Consider the complaint to be vexatious or frivolous 
• Considers we have made a reasonable compensation offer to the  complainant 
• Are satisfied that the complaint has already been the subject of court  proceedings

The Ombudsman will determine a complaint by reference to what is in their opinion,  fair and reasonable in all circumstances of the case. They will take into account the  relevant law and regulations that they consider to have been good industry practice  at the relevant time.