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The Claims Department Handles Complaints Of The Policyholders

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Question:

1.Explain how the claims department handles complaints of the policyholders ?

2.Interaction of the claim department with other functions in the handling of the policyholder’s complaints?

3.Recommendations for improving the interactions with other functions in handling policyholder’s complaints?

 

Answer:

Introduction:

Customer satisfaction is the most important in any business as the cost of attracting new customers it need more effort, will be 5 times more difficult than keeping the existing one.

Policyholders are the nervous system of all the insurance companies all over the world, especially in competitive small market like United Arab Emirates (UAE), the insurers business depending upon the policyholders’ satisfaction and providing an extra ordinary services that can differentiate them form each other. Therefore, the insurers should consider the customers complaints as a feedback on its services, product, and as an opportunity to improve the business and the customer satisfaction (BSA Ahmad Bin Hezeem & Associates 2017).

By analysing the complaint the insurer can determine the root cause of the issue and take necessary actions that is required to fix it. Once the insurer satisfy the customer requirements by enhancing the quality of the services will absolutely reflect on improving the customer feedback, satisfaction and strengthen customer loyalty.

There are many reasons for the complaints, some are related to insurer service, product and some are related to the policyholder’s knowledge, lack of understanding the policy terms conditions, and implementation of the new regulations.

The UAE Insurance Authority has issued a new motor insurance tariff system effective from January 1, 2017, on which premiums are based with  high copayment, this creates many complaints due to lack of  understanding of the new regulations and the sudden increase in premium  which cause a noticeable  impact on policyholders with high percentage of complaint (Al Tamimi & Company 2017).

More care is required by the insurer to satisfy their policyholders which will increase the competitive edge of insurance firms, so will create their brand value and reputation in the market, which is helpful in staying ahead from their competitors.

It is essential for the insurance companies to understand the expectations of the policyholders and making sure that the business/marketing plan is concentrating on this point in order to attract the consumers and increase their profit and market share.

 

1.

The classification of the complaint is done to realize the type, nature and the origin of the complaint. This is also useful in segregating a complaint from a request or query of a policyholder. The complaints are classified according to the following criteria:

Legal Complaint: In this case the policyholder sends a legal notice to a motor insurance organization

Sales Complaint: It refers to the complaints where the policyholder alleges of forgery, fraud and mis-selling (D'Mello, S. 2017).

Service Complaints: these are the types of the complaints where the clients complain about any sort of service that is undelivered or the service delivered is faulty.

Complaint regarding claim: there are various complaints with regard to claims as the policyholders may not be satisfied with the nature in which the claim was settled, managed or the duration taken to process the claim. Complaints are mainly due to claim denial where the customers ask the reason why the claim was not approved. There are even cases when it is seen that even if the claim is approved the settlement of the claim takes a lot of time. The customers may not be happy with this as this may lead to wastage of time and loss of finance. The most common among the complaint regarding claim is unsatisfactory settlement by the motor insurance firms as the claim that was expected by the customer is not granted by the firm (dubizzle UAE blog 2017). The insurance organizations provide satisfactory reason and highlight certain clause laid down in the contract that reduces the claim amount even though the customer feels unjustified and cheated.

Delay: There is customer complaint with regard to the postponement in the delivery or service.  The complaints may arise when there is a delay in quotation of the policy, invoice and cards. In case of repair of cars it is the duty of the insurance organizations to provide a service vehicle. Complaints may arise when there is a delay in the delivery of the service vehicle. If the executives of the insurance firms do not respond to the customer’s calls and emails regarding any concern, they may file a complaint against this issue (Duwheels.com 2017).

Financial: There are instances, where it is seen that the customers lodge a complaint regarding financial matters like overcharging of premium, payment delay etc. It is seen that when it comes the financial matters, the insurance companies try to provide the least settlement amount possible. There are instances where there is delay in refunds and over charging with respect to various legal and organizational charges (Emirates 24|7 2017).

Product: The policyholders are always not satisfied with the product that are provided to them. They are mostly not satisfied with the suitability of the product as the executives while suggesting the product to the customers do not provide accurate product knowledge and clarification of the coverage.

Inaccuracy in document: This is a type of complaint that is least seen in the insurance organization. The customers may be unsatisfied with the defective information with respect to any document that is submitted to the customer. The customers in this case may file a complaint against the fact that they have been misguided that may lead to any loss for the customer (Guardian Global Solutions 2017).

It is seen that these are the main causes of complaint that are prevalent in motor insurance and it is seen that there has been in a rise in the frequency of complaint after the new motor regulation act has been introduced by the UAE Insurance Authority in order to safeguard the interests of both the motor insurance companies and the persons who are the policyholders of motor insurance.

The following are the steps and details that are necessary in recordingthe complaints of an individual:

Customer’s name and Address: The acceptance of the grievance is undertaken after the name and the address of the customer is taken just to review the authenticity of the policyholder and to contact the policyholder whenever deemed necessary (GulfNews 2017).

Date of Receiving the Complaint: The date of receiving the complaint is even noted down just to keep a record for the date of complaint and to find out the duration within which the grievances of the policyholders are handled (Tadesse 2014).

Nature of the Complaint: There are various natures of the complaint that comes from the side of the policyholders and therefore, it is essential to note down the nature of complaint with accordance with complaint of the policyholder so that the complaint of each policyholder can identified with ease (BSA Ahmad Bin Hezeem & Associates 2017).

Receiving the Complaint:  The process of receiving the complaint is even noted down. It is because there are various ways of receiving the complaint either directly by meeting the department of claims, sending a letter or mail or by telecommunication (Thomas 2015).

Receiving and Acknowledge the Complaint: The claim department even needs to record the service with regard to which the policyholder has complained so that proper monitoring and supervision of the department can be undertaken and with respect to the answers obtained from the concerned department, the complaint with respect to the service can be determined and the authenticity of the complaint can be attained (Guide2dubai.com 2017). There is a designed path through which every complaints pass and proper scrutiny at every stage leads to the rectification of the problem.

Frontline Resolution Stage: The first stage is the frontline resolution where the complaint is filed. In this stage the initial evaluation is done and the date on which the complaint was closed is noted down. The competition of the complaint in this stage leads to transfer of the complaint to the next stage that is known as the investigation stage. In this stage, the complaints are scrutinized and each and every aspect of the complaint, with respect to the date, time and authenticity of the complaint and whether the complaint stated really took place (GulfNews 2017).

Escalation to the Investigation Stage: The complaint is escalated in this stage and every perspective of the complaint is discussed in detail among the employees working in this section of claim department (Dionn 2013).

Action taken at the Investigation Stage: After the complaint has been judged valid, the complaint is closed and the date is noted down to justify the date on which the complaint has been justified and rectifications will be made to satisfy the policyholder with respect to their complaint. All the outcome that have been arrived at each and every step are recorded so that it can be revealed to the policyholder along with keeping a proper record for the later future, which can be looked down upon for reference (Ia.gov.ae 2017). The underlying cause of the complaint, like any misconduct or harassment with the policyholders with respect to their claim is explained thoroughly so that such mistakes can be avoided in future.

Claim handling in Motor Insurance

The complaint handling procedure of the claim department involves primarily receiving the complaint from the policyholders and understanding the reason of the complaint. Once the complaint is received, it is acknowledged to the policyholder stating that the complaint will be preceded and an appropriate result will be given to them. The complaint after being acknowledged is critically investigated and the authenticity and the validity of the complaint are evaluated. The analysis of the complaint is undertaken by looking at the various aspects of the complaints and the ideal result that will suit the policyholder is evaluated (Insurance Times 2017). The next step involves escalation of the complaint so that complaint can be handled appropriately with respect to any previous complaints that had similar characteristics so that the complaint can be dealt with ease (Pearson 2015). The last step in this process involves reporting the result obtained and conveying to the policyholder in order to satisfy them and close the complaint.

 

2.

In the above question, we have discussed the how the claim department handles the complaints of the policyholders efficiently. The effective handling of the complaints of the policyholders is only possible if they maintain a smooth and understanding relationship with the other departments that are functioning in an insurance company. The various other departments are even liable for smooth tackling of the grievances of the policyholders. It is seen that there are various types of complaints that come from the policyholders to the claim department and it is the responsibility of the claim department to investigate the problem and discover the department who is liable for this action and takes further step to rectify the solution (International Investment 2017). The claim department interacts with the concerned department and tries to find out the main reason behind the problem and discuss with the department to come to a conclusion, which will be effective in handling the complaint successfully.

There are various complaints that are received by the claim department and they segregate the complaints according to the concerned departments so that they can be settled with ease (Suri and Adnan 2016). It is the duty of the claim department to properly segregate the complaints as if the complaints with respect to one department are listed down in some other department’s portfolio, and then there are chances that the complaint might not be handled properly and that may lead to additional difficulties.

 

The segregation of the complaints by the claim department are discussed below:

Claim: If there are any complaints with respect to the management of the claims, time taken to settle the claim and the delay in the processing time, then they are directly related to the claim department. In this scenario, as the problem is within their department, they can find the solution by interacting with the employees engaged in the claim department and find out the root cause and try to mitigate the problem in order to satisfy the customers (International-adviser.com. 2017). There are various other complaints like the delay in the settlement of the claim and unsatisfactory settlement, which are even handled by the department by examining all the documents and the records that are available to them with regards to the claim.

Service: If there are any grievances with respect to any of the employees of a department or a third party with respect to the quality of service offered, then they are directly transmitted to the service department. The claim department communicates with the service department to find out the root cause for the lack of efficiency of the service and problems with respect to repairs of the motor vehicles (Kassem 2017). The two departments jointly investigate the reason to reach a solution so that they can ideally tackle the problem and rectify the mistake.

Delay: The most significant complaints that arise in the claim department are the delay in any of the service or correspondence. It is seen that the policyholders mainly report with respect to the postponement in the Invoice cards, quotations and delay in the delivery of the vehicle. The delay in the quotation and with respect to the policies is discussed with the Underwriters who are mainly responsible for the preparation of the policies and quotations. The claim department closely analyzes the problem and tries to figure out whether the complaint delivered are valid (Middle East Insurance Review 2017). If the authenticity of the complaint is discovered by discussing with the underwriting department, then they are asked to find a remedy to the complaint so that they can be handled with ease and minimize the grievances of the policyholder.

Financial: The complaints that arise with respect to the delay in refund and additional charges being levied on the premium are transferred to the finance department and they are asked to go through the record and find out the reason why such actions were taken (Saeidi 2013). If the answers provided by the finance department to the claim department are justified then they are conveyed back to the policyholder and if an unjustified reason is found, then the claim department asks the finance department to undertake necessary steps to mitigate the problem by deducting the extra charges or compensating the policyholder for delay in refund.

Product: The complaints with respect to the dissatisfaction with respect to the products that are offered to the policyholders are transferred to the product department where the actual reason for the dissatisfaction is conveyed to them, so that the department by looking at the needs of the customers may provide them with a new set of products that will be suitable for them. If there any complaints with respect to knowledge about the product, the representatives of the insurance company goes down to the customer to give adequate knowledge about any of the products the client is interested in so that all their queries can be written off (RSA UAE 2017).

Marketing and Sales: This is one of the significant departments of an Insurance company as this department determines the market share and the revenue that the organization will be able to earn (Zawya.com 2017). Any complaints with regards to the business development team with respect to inappropriate advice and tactics with respect to high pressure are communicated to the marketing department and the supervisors of this department are asked to investigate so that all the complaints can be discovered and solutions that can satisfy the policyholder are gathered that are communicated to the client.

Inaccuracy in Document: There are instances when the policyholders are displeased with the documentation of the information with respect to an insurance product. In this scenario, the back office department who creates these documents are asked to review the documents and find out what are the mistakes seen in documentation and thereby rectifying them and sending them back to the claim department who conveys and resends the appropriate document to the policyholders (Wegner 2015).

Other: There are miscellaneous complaints come to the claim department and it is the duty of the policyholder to handle such petty issues by themselves by finding a solution that will satisfy the policyholder and reduce their level of complaints.

Therefore, it can be said that an effective communication with all the other departments is influential for rectifying the claims of the policyholders with ease reducing the level of complaints in an insurance organization with respect to motor vehicle insurance.

 

 3.

All policyholders, insurers, sales agents and the brokers should have guideline and standard procedure to follow, so they will have more control and better understanding for the policy terms / condition and the regulations that will improve the service and ultimately will reduce the complaints.

 

  • In order to handle the policyholder’s complaints properly and efficiently the team should investigate the root cause of the issue and preventive measures should be taken to avoid the same in the future.
  • The complaints report should be monitored by senior managers and the recorded details should be investigated thoroughly, so the insurer will be able to use the outcome to enhance the service, follow -up the process and for training of the staff.
  • Maintaining the Turnaround Time for all services from issuing the quotation till settlement of the claims.
  • The insurers should have proper survey system that can be used by the policyholders to control and reduce the incident and satisfy the customer/policyholders.
  • To keep the customers and enhance their opinion, the insurers should have proper communication channels and procedure in place to escalate to higher management if they are not satisfied with complaint handling procedure or result or with services that provided by the junior’s employees.
  • The claims department should have an effective procedure to interact with other functions in case of any dispute or complaints that causes by them.
  • The claim department should have good management and better understanding of the company product and should be expert enough to handle the complaints and the investigation process and capable to give direct advice to the customer while receiving the complaint.
  • The insurers should develop their procedure by educating their staff and provide awareness session to the policyholders on how to submit the claim, understand the policy terms, conditions and the exclusions with proper guideline and assistances.
  • The insurer’s staff should understand the value of the policyholders and deliver the best in practice while handling the policyholder’s complaints and always treat customer fairly to meet the regulators requirements and company ethics and strategy.
  • The insurer should evaluate the complaint handling procedure and the team performance regularly to identify the weakness and strengthen or improve the service as per the outcome.
  • Identify the cause of the complaints and if there is delay in delivering the services or the settlement of the claim, serious steps should be taken to fix the issue and avoid repeating it in the future.
  • The regulators must conduct market study with proper customer’s education and awareness before issuing new regulation to be acknowledged by all categories and ensure feasibility in practical practice. Better to implement gradually.
  • The insurer must communicate to all team members the transparency and clarity of their process with proper guideline and procedure so they can deliver the same to the customers.
  • The insurers should communicate with policyholder efficiently and clarify all policy benefits and the hidden charges if any, also should guide them properly by provide them the list of the documents that required to get the service or submit the claim.
  • The policyholders are responsible to understand their policy covers, the exclusion also should know the required documents for submission and the claims notification requirements.
 

Reference List

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Company, A. 2017. The Regulation of Insurance Brokers in UAE - Al Tamimi & Company. [online] Tamimi.com. Available at: https://www.tamimi.com/en/magazine/law-update/section-14/october-6/the-regulation-of-insurance-brokers-in-uae.html [Accessed 30 Mar. 2017].

Dionne, G. ed., 2013. Contributions to insurance economics (Vol. 13). Springer Science and Business Media.

D'Mello, S. 2017. UAE announces new price limits for car insurance - Khaleej Times. [online] Khaleejtimes.com. Available at: https://www.khaleejtimes.com/nation/uae-car-insurance-to-cost-minimum-dh750 [Accessed 30 Mar. 2017].

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Kassem, M. 2017. New UAE motor insurance rules mean you will get a courtesy car after an accident | The National. [online] Thenational.ae. Available at: https://www.thenational.ae/business/economy/new-uae-motor-insurance-rules-mean-you-will-get-a-courtesy-car-after-an-accident [Accessed 30 Mar. 2017].

Middle East Insurance Review. 2017. UAE: Insurance Authority enforces pricing review. [online] Available at: https://www.meinsurancereview.com/News/View-NewsLetter-Article?id=37804&Type=MiddleEast [Accessed 30 Mar. 2017].

Pearson, R., 2015. The development of international insurance. Routledge.

RSA UAE. 2017. New Unified Motor Insurance Policy: Insurance Authority Requirement. [online] Available at: https://rsadirect.ae/news/new-unified-motor-insurance-policy-insurance-authority-requirement [Accessed 30 Mar. 2017].

Saeidi, S., 2013. A Look at the Insurance Industry and its Key Prices and three Effective Factors in Analysis of Insurance Companies. Website of Iranian Insurance.

Suri, A.K. and Adnan, J., 2016. Educational Institutions and Information Asymmetry Observation in UAE. J Glob Econ, 4(213), p.2.

Tadesse, F., 2014. Insurance selection decision: Factors that influence the choice of insurance services in selected insurance companies. A master thesis in Jimma University.

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Zawya.com. 2017. INTERVIEW: UAE plans new regulations to boost insurance industry - Insurance Authority head | Zawya MENA Edition. [online] Available at: https://www.zawya.com/mena/en/story/INTERVIEW_UAE_plans_new_regulations_to_boost_insurance_industry__Insurance_Authority_head-ZAWYA20170212033627/ [Accessed 30 Mar. 2017].

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