Guidelines on the Handling of Complaints by Insurance Intermediaries

EIOPA | WesthafenTower | Westhafenplatz 1 | 60327 Frankfurt | Germany Phone: +49 69 951119(20 | Fax: +49 69 951119(19 | info@eiopa.europa.eu | www.eiopa.europa.eu ©EIOPA 2014

EIOPA(BoS(13/164
Guidelines on the Handling of Complaints by Insurance Intermediaries

2/7
© EIOPA 2014
Guidelines on the Handling of Complaints by Insurance Intermediaries Introduction

1. Pursuant to Article 16 of Regulation (EU) No 1094/2010 of the European Parliament and of the Council of 24 November 2010 establishing a European Supervisory Authority (European Insurance and Occupational Pensions Authority), amending Decision No 716/2009/EC and repealing Commission Decision 2009/79/EC1, and taking into account recital 22 and Article 10 of Directive 2002/92/EC of the European Parliament and of the Council of 9 December 2002 on insurance mediation (Insurance Mediation Directive – IMD)2, the following is provided:

• “Appropriate and effective complaint and redress procedures should be established in Member States to resolve disputes between insurance intermediaries and consumers, making use, where appropriate, of existing procedures”3.
• “Member States shall ensure the establishment of procedures enabling consumers and other interested parties, in particular consumer associations, to lodge complaints about insurance and reinsurance intermediaries. All complaints shall be answered”4.

2. To ensure adequate protection of policyholders, the complaint-handling procedures of insurance intermediaries with regard to all complaints they receive should be subject to a minimum level of convergence in the supervisory field.
3. These guidelines enter into force on the date of their final publication.
4. These guidelines apply to competent authorities responsible for supervising the handling of complaints by insurance intermediaries located within their jurisdiction. This includes circumstances where the competent authority, in accordance with European Union and national law, supervises the handling of complaints by insurance intermediaries who carry out their activity within its jurisdiction on the basis of the freedom to provide services or the freedom of establishment.
5. In applying these guidelines, competent authorities should ensure a proportionality system that takes into account the type and size of insurance intermediaries, as well as whether the insurance intermediary carries out insurance mediation as its main or additional professional activity.

1 OJ L 331, 15.12.2010, p. 48.
2 OJ L 009, 15.1.2003, p. 3 – 10.
3 Recital 22.
4 Article 10.

3/7
© EIOPA 2014
The principle of proportionality is also explained in the Best Practice Report on Insurance Intermediaries’ Handling of Complaints5 (“Best Practice Report”).
6. For the purposes of the guidelines set out below, the following approximate definitions have been established and are not superseded by identical definitions in national law:

• Complaint means:
  a statement of dissatisfaction made by any person to an insurance intermediary concerning its mediation activity, in accordance with the definition of “insurance mediation” in Article 2(3) of the IMD (a. Complaint handling should be distinguished from claims handling and from simple requests for contract performance or for information or clarification.
• Complainant means:
  a person who is considered to have the right to have their complaint examined by an insurance intermediary and who has already lodged a complaint, for example the policyholder, the insured, the beneficiary under an insurance contract and, in some legal systems, the injured third party.

7. These guidelines do not apply when: i. an insurance intermediary receives a complaint concerning activities that are not regulated by “competent authorities” in accordance with Article 4(2) of the EIOPA Regulation (or ii. an insurance intermediary handles a complaint on behalf of another financial institution in accordance with the legal provisions applicable to that institution.
8. In cases where the guidelines do not apply for the reasons set out in paragraph 7(i), the intermediary should, where possible, provide a response explaining why it is not the appropriate addressee of the complaint.
9. It is important that these guidelines be read together with the Best Practice Report, which explains the scope of the guidelines and the complaint-handling process for insurance intermediaries. The Best Practice Report also covers complaint management policy and the organization of the internal complaint management function.

5 EIOPA(BoS(13/171

4/7
© EIOPA 2014
Guideline 1 – Ensure that the complaint is resolved by the appropriate institution
10. Competent authorities should ensure that: a) in cases where an insurance intermediary (for example, a tied insurance intermediary) receives a complaint for which another financial institution is competent, and that insurance intermediary does not handle the complaint on behalf of that financial institution, the insurance intermediary should inform the complainant and refer the complaint to the relevant financial institution if it can be identified. b) in cases where an insurance intermediary complies with the requirements of Guideline 1, it is not obliged to handle the complaint in accordance with Guidelines 2 to 8.
Guideline 2 – Complaint management policy
11. Competent authorities should ensure that: a) insurance intermediaries establish a complaint management policy. This policy should be determined and approved by the senior management of insurance intermediaries, which should also be responsible for its implementation and monitoring of compliance with it. b) this complaint management policy is established in a (written) document, for example within the “general (fair) treatment policy” (which applies to actual or potential policyholders, insured persons, injured third parties, beneficiaries under insurance contracts, etc.). c) the complaint management policy is available to all relevant employees of insurance intermediaries through an appropriate internal channel.
Guideline 3 – Complaint management function
12. Competent authorities should ensure that insurance intermediaries have a complaint management function that enables complaints to be examined fairly and, with the exception of insurance intermediaries who are self-employed, identifies and mitigates potential conflicts of interest.
Guideline 4 – Registration
13. Competent authorities should ensure that insurance intermediaries register complaints internally in accordance with the national time frame and in an appropriate manner (for example, via a secure electronic register).

5/7
© EIOPA 2014
Guideline 5 – Reporting
14. Competent authorities should ensure that insurance intermediaries are able to provide competent national authorities or the insurance ombudsman with data on complaints and complaint handling. These data should include the number of received complaints classified according to a national or own criterion, as appropriate.
Guideline 6 – Internal monitoring of complaint handling
15. Competent authorities should ensure that insurance intermediaries continuously conduct data analysis regarding complaint handling to ensure they are able to identify and resolve all recurring problems and potential legal and operational risks, for example through the following measures: a) analysis of the causes of individual complaints to determine the main causes common to certain types of complaints; b) consideration of the potential impact of these main causes on other procedures or products, including those not directly subject to the complaint; and c) correction of these main causes when justified.
Guideline 7 – Providing information
16. Competent authorities should ensure that insurance intermediaries: a) provide written information regarding their complaint handling process upon request or when confirming receipt of a complaint. b) publish details of their complaint handling process in an easily accessible format, for example as a brochure, leaflet, contractual documentation or via the insurance intermediary’s website. c) provide clear, accurate and up-to-date information on their complaint handling process, which includes: i. details on how to lodge a complaint (for example, the type of information the complainant needs to provide, the name or title and contact details of the person or department responsible for receiving complaints);

6/7
© EIOPA 2014
ii. the procedure followed when handling a complaint (for example, when receipt of the complaint is confirmed, timeframes for complaint handling, availability of the competent authority, insurance ombudsman or alternative dispute resolution, etc.) and d) inform the complainant about further steps in handling the complaint.
Guideline 8 – Procedures for responding to complaints
17. Competent authorities should ensure that insurance intermediaries: a) strive to collect and examine all relevant evidence and information regarding the complaint; b) communicate in simple and understandable language; c) provide a response without unnecessary delay or at least within the timeframes prescribed at the national level. In cases where a response cannot be provided within the expected timeframe, the insurance intermediary should inform the complainant of the reasons for the delay and state when the insurance intermediary will approximately complete the investigation; and d) explain in detail, when issuing a final decision that does not fully meet the complainant’s requirements (or any final decision where national rules require it), the insurance intermediary’s position on the complaint and outline further options for the complainant regarding the complaint, for example the availability of the insurance ombudsman, alternative dispute resolution, national competent authorities, etc. This decision should be provided in written form if required by national rules.
Compliance and reporting rules
18. This document contains guidelines issued in accordance with Article 16 of the EIOPA Regulation (i. In accordance with Article 16(3) of the EIOPA Regulation (i, competent authorities and financial institutions should take all steps to comply with the guidelines and recommendations.
19. Competent authorities that are compliant or intend to comply with these guidelines should incorporate them appropriately into their regulatory and supervisory framework.
20. Competent authorities should confirm to EIOPA( whether they are compliant or intend to comply with these guidelines, stating the reasons for non-compliance, within two months from the date of their publication.

7/7
© EIOPA 2014
21. If a response is missing within that timeframe, the competent authorities will be considered non-compliant with the reporting rules and a report on this will be submitted.
Final verification provision
22. These guidelines are subject to EIOPA( review.