Resolving Disputes

Question 1

What is the definition of a complaint?

Answer 1

Complaints may be defined as an expression of dissatisfaction that includes a request for the complaint to be remedied.

Question 2

What are the 3x common requirements that make an effective complaint process?

Answer 2

1- Identifying the complaint

2- Recording the complaint

3- Resolving for referring the complaint

Question 3

What is the complaints procedure followed by loss adjusters who are members of the Australasian Institute of chartered loss adjusters?

Answer 3

As loss adjusters who are members of the AICLA are subject to strict code of conduct, any complaints need to be directed to the regional office of the AICLA. Decisions are limited to member compliance only, and not to commercially related outcomes.

Question 4

Discuss identifying the complaint?

Answer 4

Before you can fix a complaint, you have to be sure what the complaint is.

Question 5

What are the key skills you need to employ when identifying the complaint?

Answer 5

1- Active listening skills

2- Double checking that you understand

3- Controlling your tone of voice and body language

Question 6

Discuss recording the complaint?

Answer 6

Once you are confident you understand exactly what the problem is, you need to record it. Recording a complaint ensures you are in a position to always know how a complaint has been handled and resolved. Recording complaints can also enable you to identify frequently received complaints. This can allow you to put into place preventative measures to reduce the occurrence of similar complaints.

Question 7

To record a complaint you will need to do what?

Answer 7

1- Write down the complaint and check that the complainant agrees with what you have written

2- Collect any documents that could provide information about the complaint

3- Record the complaint in a complaint register. This register will include details such as the date and time of the complaint, the complainant’s details and the nature of the complaint etc

Question 8

Discuss resolving or referring the complaint?

Answer 8

Whether you try to resolve the complaint or refer it to someone else will depend on your organisations guidelines for handling complaints. You should, however, be quite clear about what your responsibilities are. More complicated problems might need to be referred on to someone with more expertise.

Question 9

What is it important to do if you refer a complaint?

Answer 9

1- Provide the person now responsible for the complaint with all the relevant information

2- Keeping the complainant informed about what is happening. This involves regularly checking what progress has been made and then passing this information on to the complainant

Question 10

What is the definition of a dispute?

Answer 10

Disputes may be defined as unresolved complaints. If the complainant is dissatisfied with your service and you cannot find a resolution to the complaint, it then formally becomes a dispute.

Question 11

What happens once a complaint becomes a dispute?

Answer 11

Once a complaint becomes a dispute, it goes to the next stage of the process, which is known as the dispute resolution process.

Question 12

With regards to complaints and disputes, what process are members of the ICNZ required to have?

Answer 12

Formal internal complaint and dispute resolution processes, which they must use to try and resolve customer complaints and disputes. They also have a duty to provide customers with details of their internal complaints procedures.

Question 13

With regard to the fair insurance code, what must and insurer do when a formal complaint is received?

Answer 13

1- Acknowledge the customers complaint within 3x working days

2- Investigate the customers complaint and advise the customer of its progress or outcome within 10x working days

3- If unable to resolve the complaint, inform the customer within 2x months. The company must also advise customers of their right to take the complaint to the insurance and savings ombudsman.

Question 14

What is the process if an organisations internal dispute resolution process does not resolve the dispute?

Answer 14

The next step is to use an external dispute resolution facility such as-

1- Small claims tribunal’s
2- Insurance and savings ombudsman scheme

Question 15

Discuss taking a claim or dispute to the small claims tribunal?

Answer 15

Where a dispute is unresolved and the principal is a non-insurer, the complainant has the option of taking the case to court to resolve the dispute. Dispute tribunal’s operate from most district courts. The dispute tribunal typically hears cases based on the Consumer Guarantees Act 1993, the Sales of Goods Act 1908 and insurance matters.

Question 16

What monetary amounts do Disputes Tribunals in New Zealand deal with?

Answer 16

The dispute tribunal can process unresolved disputes between parties up to $7000 NZ, or $12,000 NZ if parties agree.

Question 17

Why was the insurance and savings ombudsman’s scheme established?

Answer 17

It was established to resolve disputes between consumers and insurance or savings organisations that are part of the scheme.

Question 18

What are included within the insurance and savings ombudsman’s responsibilities?

Answer 18

1- Fire and general insurers
2- Marine and aviation insurers
3- Life insurers
4- Providers of personal superannuation policies
5- Fund managers
6- Health insurers
7- Investment product providers

Question 19

What are the various requirements of the insurance and savings ombudsman’s scheme?

Answer 19

1- Participants in the scheme have to have their own internal complaints procedures

2- Participants in the scheme have to publicise their existence and availability of the procedures, and of the scheme

3- Resolution of the dispute must first be attempted through an insurers internal complaints procedure

4- The dispute must have reached a stand-off between the complainant and the insurance or savings organisation, or must’ve been going for more than two months without a decision, before it can be taken to the ISO

5- The ISO only considers complaints about domestic and personal insurance or saving services provided by participating organisations in New Zealand and not involving amounts over $100,000 NZ

Question 20

The ISO can only be used if?

Answer 20

1- A complaint is not resolved by following the participant companies internal complaints procedure

2- The customer has received a letter of deadlock from the insurance company they have to dispute with, and the complaint is made to the ISO within two months from receiving that letter

3- The matter has not been resolved within two months from submitting a formal complaint in the ISO considers a deadlock has been reached

Question 21

What is the dispute resolution process?

Answer 21

1- Customers must send their deadlock letter into the ISO office along with any other applicable information

2- The ISO will send a confidentiality waiver form to the client. It must be signed and returned to the ISO, allowing it to obtain information from the insurance company

3- Using this information, an investigating officer will assess the complaint and come to decision. If the client and the company accept these views the file is closed

4- If the client or the company does not accept this assessment, then either can request a recommendation, which results in a review of the complaint by the insurance and savings ombudsman.

5- If the client and the company except the recommendation, the file is closed.

6- If the client does not accept the recommendation, the file is closed and the client is free to refer the complaint elsewhere.

7- If within one month the company does not accept the recommendation that the complaint be upheld, then the insurance and savings ombudsman issues an award specifying the amount that the company must pay.

Question 22

What would happen if the insurer had rejected the ISO’s decision?

Answer 22

The ISO may terminate the participants membership, or refer the matter to the securities commission.

Question 23

What would happen if the complainant had rejected the ISOs decision?

Answer 23

The complainant may take alternative court action against the participant at any time.

Question 24

What are other bodies that can investigate a complaint against an insurance company, its agents or employees?

Answer 24

1- The Human Rights Commission- hears discrimination complaints
2- The Privacy Commissioner- hears complaints about breach of privacy
3- The Ministry of Consumer Affairs- hears complaints to do with consumer rights
4- Securities Commission
5- The Consumer Institute of New Zealand
6- The New Zealand Association of Citizens Advice Bureau Inc
7- Disputes Tribunal
8- Community Law Centres