kK
kbisogno K

1 reviews | Active since May 2016

26 Oct 2022, 22:03

Open letter to the CEO & CFO / Not holding my breath / BREAKING COMPANY POLICY

Dear Mr Andrew Harvey / Mr Guy Close

Please find attached correspondence relating to the above subject matter, which is self explanatory.

On reading the Company "Complaints" Policy (see attached for your ease of reference) I feel it my obligation, to bring to your attention the "gross disregard" to this document, I have experienced in my dealings with One.za.com.

Below is a brief summary of what has transpired:

My daughters vehicle was part of an incident on the 11th July 2022, which resulted in the Third Party Claim No: 500260 There was a period of 3 weeks with my being discharged from Cancer Surgery in Italy, as well as trying to establish the procedure and what was required to submit the claim. If I recall correctly, and after much correspondence back and forth between the Agent, Danie from Prismcon, It was established that One.za.com was the insurer. Once the requirements were made clear to us, and further delays getting this information had to be endured, all the required documentation was submitted to the Agent, Danie from Prismcon on the 1st August 2022. I received my first correspondence from the One.za.com claims agent, Claudia Peck on the 2nd August 2022 to advise us that certain of the documents needed to be resubmitted. You will see from my correspondence that at this stage, I had already requested what documentation needed to be submitted on numerous occasions. On the 16th August 2022, the required final documentation was sent to Claudia Peck On the 23rd August 2022, I sent a mail requesting an update on the claim, just to be informed they were waiting for the client to pay the Section ii Excess, I made it clear to Claudia Peck, the urgency required as my daughter, a single mother, had recently started new employment and the vehicle was required to avoid the R200 per day transport costs. After no further contact, I again requested from Claudia Peck, on who was responsible to pay this excess, was it the driver of the insured vehicle, or was it the registered owner & insured? That was on the 2nd September 2022. I received a response 3 days later on the 5th September 2022 On the 13th September 2022, and after no updates forthcoming, I again sent a mail to Claudia Peck and Danie (the agent) requesting an update and voicing my dissatisfaction on no uncertain terms and another mail requesting the same information on the 19th September 2022. Received a response via the Agent on the 20th September 2022, advising me that the Client had paid the Section ii excess on the 16th September 2022 On the 21st September 2022, Claudia Peck requested a Proof of Payment for the transaction, and she advised that it did not reflect on her side. I was advised that a settlement agreement had been drawn up and sent to management for approval. I responded on the same date, requesting the figure of the settlement, with no response forthcoming. I then engaged my Attorney, and he sent a demand letter on the 21st September 2022. On the 28th September 2022, I again requested Claudia Peck give me a time indication, and later that day, received the settlement offer. I requested she resubmits the quotations for reassessment, as I had received interim quotations on used / secondhand parts, and I was unable to come out on the settlement figure proposed On the 28th September 2022, I advised Claudia Peck that I would be arriving in South Africa on or around the 1st October 2022 On the 5th October 2022, and after no further updates, I again mailed Claudia Peck, advising her I had arrived in Johannesburg, and gave her my contact details as well as requesting her details, in order to arrange a meeting to try get finality. At the same time, I advised her that my daughter had to leave her employment as she was unable to maintain the 2 months pluss of additional transport costs. I received a response on the 6th October 2022, advising that she had resubmitted the quotations to the assessors (8 days later) and gave me her telephone number. I responded saying I would be leaving Johannesburg the following evening and hoped there would be a response so we could meet and finalize all On the 10th October 2022, I sent an additional mail, asking for updates, and also informing her I had tried calling on a number of occasions with no response and no means of leaving a message. ZERO Response Again I sent mails and made calls on the 18th - 19th and the 20th October 2022 with no success On the 21st in desperation, I called the switchboard on the number found on the letterhead, and was informed, by one extremely rude and abrupt person, which I did not get a name of, that Claudia Peck was no longer in Third Party Claims and I should call the Johannesburg office, and the call was abruptly cut. I called 3 times further, trying to get any form of information, encountering similar treatment, until eventually I was put through to a helpful staff member, who gave me the name of Neandra Coetzee. At this point, I was livid. In my 64 years, never before have I been shown so much disrespect. On talking to Neandra, she advised me that the claim had been handed over to Janine, and she would send me a copy of the settlement figure and how they arrived at that amount. "as we speak" were the words used. On arriving home and checking mails, there was NO MAIL. I called again on 24th October 2022, and the mail was sent. I have voiced my opinions and still await a response. In closing, I ask myself the following? Is it acceptable, that after 4 months of dealing with the person handeling the claim, not to be informed of the person's details the claim has been handed to? Is it acceptable, that the original claims agent (Claudia Peck), just ignores my emails and attempts to make contact, for a period of 16 days , and does not have the courtesy to inform me as such, knowing full well I was arriving from Italy? In addition, I have had ZERO incoming correspondence or calls from the agent that the file has been handed to, Janine. Is that not the protocol one should follow, or is leaving the customer stranded, uninformed and frustrated the norm? Been spoken to in the manner that I was when I called to try to find out information,not once, but 3 times. Is that acceptable?. Definitely not in my books Is it acceptable that a claim takes this amount of time largely due to miss information, delayed information, or no information? (Mails attached clearly indicate this) The impression one gets after my experience with One.za.com, is the lack of responsibility shown by the staff, professionalism and efficiency, is not one I, as a former owner / director of companies, would like my personal to portray. I have further concerns, so request a competent person, of some authority, that can make the decision, to contact me per phone, in order to get finality without further delay.

I trust you see the gravity of the above in the same light as I have experienced

COMPLAINTS POLICY 1. Home 2. Complaints Policy One Financial Services Holdings (Pty) Ltd is the holding company for a group of companies which include financial services providers as well as service providers to the insurance industry. The ONE Group of Companies is committed to strict compliance with all legislation as they affect each individual company. This Group is committed to the establishment and maintenance of a Complaints Management Framework, which will ensure that all complaints are handled effectively and in a timely manner. This policy is in line with the Financial Advisory and Intermediary Services Act 37 of 2002 read in conjunction with any amended or subordinate legislation.

STAKEHOLDERS The FSP’s within the ONE Group fall within the ambit of the Financial Sector Conduct Authority (FSCA). These are One Insurance Underwriting Managers Pty Ltd (OIUM), FSP8783 and General & Professional Liability Acceptances (Pty) Ltd (GPLA), FSP3664. Both of these companies are governed by a binder agreement from an Insurer in the case of OIUM and a Lloyds Syndicate in the case of GPLA. Neither of these entities are mandated to deal with policyholders directly but merely provide products to a broker network that sell directly to a policyholder. Therefore, both ONE and GPLA have very limited access to policyholders. Most communication will be between a Broker and ONE/GPLA, where the Broker is representing the Policyholder. Within the Financial Services industry we are provided with guidelines in complaints handling via: • The General Code of Conduct issued under the Financial Advisory and Intermediary services Act 37 of 2002 (FAIS Act) SAIA code of conduct • Treating Customers Fairly Complaints Management Framework / Policy • Policyholder Protection Rules

The Framework designed by ONE encompasses the following aspects; • Proportionate to the size and complexity of the business. • Appropriate for the business model, design of policies and our policyholders. • It enables complaints to be investigated thoroughly when all the relevant and appropriate information/circumstances have been obtained. • We do not impose any unreasonable barriers to make a complaint.

DEFINITIONS Complainant means a person who submits a complaint and includes a; a. policyholder or the policyholder’s successor in title; b. beneficiary or the beneficiary’s successor in title; c. person whose life is insured under the policy; d. person that pays a premium in respect of a policy; e. member of a group scheme; or f. potential policyholder whose dissatisfaction relates to the relevant application, approach, solicitation or advertising or marketing material, who has a direct interest in the agreement, policy or service to which the complaint relates, or a person acting on behalf of a person referred to in (a) to (f); Complaint means an expression of dissatisfaction by a complainant, relating to a product or service provided or offered by a financial institution, or to an agreement with the financial institution in respect of its products or services and indicating 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 financial institution or to which it subscribes; b. the Insurer or its service provider’s maladministration or wilful or negligent action or failure to act, has caused the complainant harm, prejudice, distress or substantial inconvenience; or c. the financial institution or its service provider has treated the complainant unfairly

COMPLAINT VS QUERY: Complaint: is an expression of dissatisfaction by a complainant, oral or written, about the service or product that we have / are providing to them. The following guidelines can be used to assess whether the matter is a complaint, have we acted outside our SLA or fallen short of the standards set and communicated to our clients? Does the matter require escalation of a decision?

Has the complainant clearly stated they are dissatisfied or want to complain?

Have the clients stated they are unhappy with our service or product and requested a response?

Did the complainant use our formal complaints process? By sending a formal written complaint to a senior member of staff or ***?

Query: means a request to the insurer or its service provider by or on behalf of a policyholder, for information regarding the insurer’s policies, services or related processes, or to carry out a transaction or action in relation to any such policy or service.

Examples of a query could include; • When a client/broker requests details on a policy and this is dealt with and resolved immediately. E.g. wrong address, errors in a policy. • Questions such as; When will my claims be paid? How long will it take to resolve my issue? How far are you in processing my claim? • A general enquiry. • A follow up request. • ONE is committed to ensuring the Client, is central to our culture. All communication is done in a clear and unambiguous manner.

Reportable complaint: Means any complaint other than one which is: • Finalized immediately by the person who received it, to the satisfaction of the complainant and necessary corrective actions communicated and completed. • Finalized during the normal course of events for handling policyholder (normally submitted queries w.r.t. the type of policy/service complained about and this process does not take more than 5 days • Does not allow us a reasonable opportunity to record the details – i.e. a passing comment.

A query becomes a complaint when the complainant states in writing that they are dissatisfied and would like to make a complaint and require a response.

ONE’S COMMITMENT We confirm as follows: • Our Complaints Policy and Procedure is readily available to all our clients. Please email *** to request a copy. • We will attend to, and resolve any complaints timely and fairly; • All relevant staff are trained about the resolution of complaints in accordance with current legislation, which includes FAIS, Policyholder Protection Rules (PPR) and SAIA codes. • Any employee can receive a complaint and all complaints which cannot be resolved immediately are referred to their line manager. • The Line Manager is to investigate the facts surrounding the complaint and reply to the complainant with 72hrs. • The complaint may require more specialised input and, in this case, will be referred to the following; Underwriting to the Regional Manager, Claims to the National Claims Manager, product or schedule complaints to the relevant Product Manager and all other complaints to the Compliance Officer. • Those tasked with investigation and/or resolution of a complaint are appropriately empowered to suggest/initiate/implement corrective action. • The employee who receives the complaint logs it on 1web (see how to load a complaint on1web policy). This is where all the relevant communication is e-filed. These records are kept for a minimum period of 5 years; • When the outcome of a complaint is not in favour of the client, the client will be given written reason(s) and will be advised that the complaint may be pursued, within a 6 months period, with the Ombud whose contact details are provided herein. • The time periods set-out in this complaints procedure will be adhered to as strictly as possible, however if necessary these can be varied. • In any case where a complaint is resolved in favour of the client, ONE will ensure that a full and appropriate redress is offered to the client without any delay. • To minimise complaints we provide product training to all our brokers at onboarding stage or as amendments are made to the product and regular communication is sent out to brokers highlighting various aspects of our products. • As part of the compliance function, together with the relevant role players, i.e. Regional Manager/Product Manager/National Claims Manager all complaints are investigated to understand the root cause, and how to prevent it from happening again.

CATEGORISATION OF COMPLAINTS All complaints are to be categorized as follows: • Complaints relating to the design of a policy or related service, incl. premiums/fees/or other charges related to the policy/service • Complaints related to information provided to policyholders • Complaints relating to advice • Complaints relating to policy performance • Complaints relating to service to policyholders, incl. complaints relating to premium collection/lapsing of policies • Complaints relating to policy accessibility/changes/switches • Complaints relating to complaints handling • Complaints relating to insurance risk claims, incl. non-payment of claims • Other complaints

HANDLING OF OMBUD COMPLAINTS ONE and all FSP’s within the group do not communicate or receive notification from the OSTI directly as all communication is done via the Insurer.

On receipt of a complaint by the Insurer this will be forwarded to the relevant FSP for investigation and resolution. Ombudsman complaints are dealt with by the Ombudsman Dispute Facilitators (ODF):

Willie Human – *** Rene van Coller – *** Ombudsman complaints originate mostly because of claims rejections.

All claims rejections are submitted to Head Office for review and signoff. The reason for this is to ensure that an independent person reviews the file and checks that the correct clauses/reasons for rejection have been used. This should reduce the number of instances referred to the OSTI.

All complaints originating via claims rejections from the OSTI should be known to the ODF team. Investigation will include interviews with various staff involved including claims managers and regional managers, all documentation will be reviewed again and lastly the policy wordings will be consulted for final response to the complainant or Ombud.

Ombudsman complaints are treated with the utmost urgency and every attempt is made to resolve the complaint directly with the complainant to reduce any costs incurred for Ombud complaints.

PROCESSING OF COMPLAINTS All complaints irrespective of whether they are submitted to a regional staff member, the Complaints Dispute Facilitator (CDF) or the Ombudsman Dispute Facilitator (ODF), these are logged on 1WEB. (See How to Log a Complaint on 1Web document)

These complaints can be logged and policy level or claim level, by selecting complaints under the View/Add notes and Tasks to do. When logging the claim on 1WEB it is necessary to input complete details, these include; • Summary of complaint – details of what complaint is about • date received and date finalised – to measure length of time to finalise complaint • who submitted it – to monitor trends • Type of complaint – Service related/Processing issues/Dispute of Rejection or Settlement related/Commission query etc… • who the claim is about – service provider/Broker/Staff member/process • was a TCF principle compromised – what can we amend to ensure our commitment to TCF compliance

if so what remedial action is necessary together with an action owner. Owner is the person mandated to make the necessary changes to policy schedule/wording etc…

All documentation regarding the complaint must be e-filed; • original complaint • acknowledgement of the complaint • communication with the complainant • resolution of the complaint

Since all complaints are logged on 1WEB the following info is readily available: • Breakdown in types of complaints • Number of complaints received • Number of complaints upheld • Number of rejected complaints together with related reasons • Number of complaints escalated • Number of complaints referred to Ombud • Number and amount of compensation payments made • Number and amount of goodwill payments made • Total number of complaints outstanding

0
Replies (1)
kK
kbisogno K's update28 Oct 2022, 10:19
Reviewer Update
UPDATE: Eventually after writing the letter above, I was contacted by a Mr Monty Tsatsimpe .
Within 24 hours he had come back to me and we came to a settlement. What a pleasure dealing with him.