Lloyd’s has set out the process to be followed for international (non-UK) complaints in Market Bulletin Y4961 – International Complaints Handling: Expansion of New Procedures. For Canadian complaints the process to be followed is modified in a number of respects as set out in Market Bulletin Y5154, the most notable difference is that Canadian complaints are handled in accordance with a two stage process. These changes reflect local regulatory and legal requirements and market practice.
Lloyd’s arrangements for international complaints are intended to allow for the oversight of complaints handling, consistent with the regulatory expectations of the UK Financial Conduct Authority (FCA), whilst allowing flexibility for managing agents in the way they handle complaints in accordance with local rules.
Guidance for Managing Agents
Complaints Handling Summary
Guidance for Coverholders and TPAs
Definition of a complaint
A complaint is the expression of at least one of the following elements that persists after being considered and examined at the operational level capable of making a decision on the matter:
• a reproach against an organisation;
• the identification of a real or potential harm that a consumer has experienced or may experience;
• a request for a remedial action.
Complaints are generally expressed in writing through correspondence, e-mail, fax or other form that allows a complaint to be kept on file. Where a consumer makes a complaint by phone or in person and the complaint is handled and examined by the person responsible for the examination of complaints and designated as such in the organisation’s policy, the complaint must be documented so that it can be kept on file.
The initial expression of dissatisfaction by a consumer, whether in writing or otherwise, will not be considered a complaint where the issue is settled in the ordinary course of business. However, in the event the consumer remains dissatisfied and such dissatisfaction is referred to the person who is responsible for the examination of complaints and designated as such in the organisation’s policy, then it will be considered as a complaint.
However, organisations must refrain from any undue delay in referring a matter to a higher level solely for the purpose of avoiding reporting requirements.
Where a consumer remains dissatisfied after a reasonable attempt has been made to settle the issue, organisations without a multilevel complaint examination structure are then considered to have received a complaint.
Lloyd’s operates a two stage process in Canada. In total, the insurer has 56 calendar days from the complaint being received to when the final position letter is issued to the insured by the Lloyd’s Complaints team.
The managing agent or their representative, ie Third Party Claims Administrator/Coverholder has 10 business days to attempt to resolve the complaint. The stage one response must outline the right of the complainant to request a stage two by Lloyd's and then to escalate their complaint to the relevant external dispute resolution (EDR) service. Lloyd's Canada will contact the insured to ensure that they are satisfied with the response.
If the complainant remains dissatisfied they can request a stage two review within 10 business days of receipt of the stage one response. This review will be conducted by Lloyd’s Complaints team that has the balance of the 56 calendar days to resolve the complaint. If the matter cannot be resolved at stage two and/or it has been more than 56 calendar days since the complaint was made, the complainant will be advised of their right to elevate the matter to relevant EDR.
External Dispute Resolution
When responding to a complaint, the complainant must be informed that if they remain dissatisfied they may be able to refer their complaint to the either the General Insurance Ombudsman Service or the Autorité des marches financiers for review.