The claims process is owned by the insurer who is obliged to follow the rules. Anyone involved in the claims process and has to assist with the rules. Very briefly these are,
- Reasonable guidance to the customer throughout the claim,
- Advising the customer if the intermediary is acting for the insurer for part of the claims service, for example in arranging claims forms and advising third party claims handlers,
- Advising the customer as soon as possible if the claim (or part of the claim) refers to a risk which is clearly not covered by the policy,
- Advising the customer of what is happening and what will happen next on the claim,
- If the insurer appoints a third party claims handling service to manage the claims on their behalf, or instructs anyone else to the claim, who will be in contact with the customer, then the insurer must advise the customer of this. The only exception is in some cases where fraud is being investigated.
- Insurers must make is clear when they accept or reject any part of the claim.
Complaints process
The rules provide for each firm to have a complaints system and if that is not satisfactory, then for an eligible customer to take their complaint to the Financial Ombudsman Service.
Firms must have an internal complaints system which,
- Has an address to receive complaints,
- Acknowledges complaints,
- Investigates complaints,
- Responds to complaints,
- Notifies complainants of their right to go to the Financial Ombudsman Service if they remain dissatisfied.
The firm must operate within certain maximum time frames when dealing with complaints.
- Acknowledge the complaint with 5 working days,
- Final or holding response within 4 weeks,
- Final response within 8 weeks or explanation why that can not be met.
- The final response to include explanation about the customer right to go to the Financial Ombudsman Service and to contain the FOS booklet.
Firms have to report complaints numbers bi-annually to the FSA and they need to make certain that they do not count those complaints which have been passed to the insurer to handle.