USA

Definition of a Complaint

A complaint is any written communication where there is an expression of dissatisfaction with an insurance product or service.

Definition of a Complainant

• Personal lines policyholders (private individuals);
• Small commercial policyholders (where the policyholder has fewer than 10 employees and a gross revenue or annual balance sheet that does not exceed $2.5m);
• A charity which has an annual income of less than $2.5m at the time the complainant makes the complaint;
• A trustee of a trust which has a net asset value of less than $2.5m at the time the complainant makes the complaint

Application of Lloyd’s procedure and local complaint regulations

All US policies

Timescale

• A prompt acknowledgement of the complaint, where possible within three business days of receipt.
• Full response to be provided where possible within two weeks but in any event no later than eight weeks of receipt of the complaint.
• If a full response cannot be provided within four weeks then a holding letter should be sent.
• Complaints resolved within three days of receipt do not require a full written response.

EDR scheme and eligibility

The applicable state Department of Insurance (or equivalent agency).

DOIs have different approaches to the complaints but will generally consider most insurance related complaints

Lloyd’s Complaint Notice

Prescribed complaints notices are required in a number of states. Further details can be found on Crystal.