Market practice and business plan guidelines 2014

1. Definitions

1.1 A reference in these Guidelines to a section 'X' or Part 'X' is a reference to a section of the Motor Accidents Compensation Act 1999 (the Act), as amended from time to time.

1.2 The terms used in these Guidelines have the following meanings:

2. Introduction

2.1 These MAA Market practice and business plan guidelines (Guidelines) provide Insurers with an enforceable framework that underpins the services they provide to Customers, and are issued under section 171 in Part 7.2 of Chapter 7 of the Act. The Guidelines also incorporate Guidelines for the preparation of business plans by Insurers as required under section 173 in Part 7.2 of Chapter 7 of the Act.

2.2 These Guidelines are based on principles. They articulate a set of objectives for the Issuing of CTP Policies and expectations for standards of market practices for Insurers. The adoption by the MAA of principles-based regulation of market practices is intended to encourage flexibility and innovation in the delivery of services to CTP insurance Customers and a competitive market and a level playing field for Insurers, while encouraging Insurers to act in good faith when interacting with Customers.

2.3 Insurer market practices including distribution arrangements must align with these Guidelines. Insurers are encouraged to act competitively without contravening the Guidelines.

2.4 To assist in the interpretation of these Guidelines, the MAA may publish Practice Notes.

2.5 The Guidelines do not apply to market practices for policies issued under the terms of the Conditional Registration and Unregistered Vehicle Permits contract.

3. Commencement and revocation of previous Guidelines

3.1. These Guidelines are effective for market practices and business plans from 1 November 2014 and will remain in force until they are amended or replaced. They supersede previous guidelines and related correspondence issued by the MAA which are revoked from 1 November 2014.

4. Application of these Guidelines

4.1. The MAA will monitor and review compliance with these Guidelines. This may include audits of Insurers from time to time.

4.2. Internal auditing of compliance with these Guidelines must form part of each Insurer’s own risk management and compliance program. Insurers have a responsibility to report to the MAA any results of audit programs conducted on CTP business.

4.3. If the MAA regards an Insurer and its Agents as having breached the Guidelines, the MAA may take regulatory and enforcement action against an Insurer for non-compliance, in accordance with the MAA Regulatory and Enforcement Policy. This action may include penalties and a requirement for remedial action for serious breaches. Serious or sustained breaches may result in additional conditions being placed on an Insurer’s licence, or in loss of licence.

4.4. All contracts or arrangements entered into by an Insurer in relation to the provision of quote and sales services for CTP Policies must comply with these Guidelines

5. Guiding principles

The first three principles apply to an Insurer’s portfolio as a whole and for all Customers as well as each Distribution Channel. The fourth principle applies to the Insurer’s portfolio as a whole and to all Customers in respect of at least one Distribution Channel.

5.1 Acting in good faith

As the MAA’s regulation of premiums includes an element of community rating, some policies are under-priced and others over-priced relative to insurance risk. Accordingly, it is in the Insurers’ financial interests to build portfolios that are over-weight in over-priced risks. Notwithstanding such financial interests, Insurers must have a genuine intention to make CTP Policies available to all Customers in a manner that complies with the other principles. In particular:

5.1.1 Insurers and their Agents are required to accept all properly identified vehicles presented to them for the issuance of a CTP Policy.

5.1.2 Insurers must avoid distribution methods and sales techniques that prejudice this obligation in any way.

5.2 Processes and business practices that do not unfairly discriminate

Insurers and their Agents must use processes and business practices that do not unfairly discriminate against individual Customers or groups of Customers. This applies to each Distribution Channel. In particular:

5.2.1 Each Insurer and its Agents must apply reasonable service standards to their processes and business practices. The MAA may impose standards or restrictions on any or all Insurers and their Agents for specific or general circumstances where it considers it to be in the public interest.

5.2.2 With the exception of pricing differentiation permitted under the MAA premiums determination guidelines, Insurers and their Agents must treat Customers in the same manner irrespective of the risk profile of the vehicle or its Owner or the term of the policy.

5.2.3 The total commission or remuneration paid by an Insurer to any Agent or Broker must not exceed five per cent of the premium payable for the CTP Policy.

5.2.4 All Customers who are due to receive a renewal notice must be provided with an offer of renewal within the prescribed timeframes as specified in Clause 5.3.5. A delay in sending renewal notices may only occur with prior approval from the MAA.

5.2.5 Insurers must not refer Customers to other Insurers or encourage Customers to take their business elsewhere. An Agent must not refer Customers to Insurers that the Agent does not have agency arrangements with.

5.2.6 Insurers must not advise Customers of the prices offered by any other Insurer. An Agent must not advise Customers of prices offered by Insurers that the Agent does not have agency arrangements with.

5.3 Transparent and practical processes and business practices

Insurers and their Agents must apply processes and business practices that are transparent and practical for the purpose of issuing quotes and policies to Customers. In particular:

5.3.1 All information provided to Customers must be clear, accurate, not misleading and expressed in plain language.

5.3.2 Insurers and their Agents must only charge premiums as filed and not rejected by the MAA. Insurers are to categorise vehicles correctly and charge the correct filed premium for that category. In order to charge the correct premium, Insurers and their Agents must take into account all risk factors and ITC status used to determine the Customer’s premium.

5.3.3 Each Insurer that has contracts with Agents or other third parties for the provision of quotes and sales must ensure that each such third party discloses to Customers the identity of all Insurers that have a commercial arrangement with it. This disclosure must occur prior to commencement of quoting or sales processes. An Insurer or an Agent acting for the Insurer may not enter into a commercial arrangement with an Agent or third party that accesses or retransmits results from the MAA’s Green Slip Calculator without the MAA's permission. The MAA will not unreasonably withhold such permission.

5.3.4 Where requested by a Customer, Insurers must act promptly and expeditiously in sending documents by mail or electronic means:

• All documents agreed to be sent by addressed mail must be lodged with Australia Post within five working days of agreeing to do so.
• All documents agreed to be sent by electronic means must be sent within 24 hours of agreeing to do so.

5.3.5 Offers of renewal, including eRenewals, must be sent at least four weeks and no more than six weeks in advance of the renewal date.

5.3.6 All information regarding Issuing of CTP Policies is to be sent to each Customer by post unless the Customer has consented to receiving policy information electronically.

5.3.7 Insurers must make reasonable endeavours to reissue policy information to Customers in all cases where an incorrect address has been used, including when a letter has been returned to the sender or an email address has failed.

5.3.8 When a Customer purchases a CTP Policy or renewal or on new registration, the Insurer must electronically transmit an eGreenSlip to Roads and Maritime Services (RMS) within the following timeframes:

5.3.9 A written quote or an offer of renewal for a CTP Policy must:

• Enable Customers to review the pricing factors applied to their CTP Policy, by clearly communicating all pricing factors relevant to determining the price
• Provide information to the Customer about how to notify the Insurer or its Agent, prior to the purchase of the policy, if any of the pricing factors applied to the Customer’s CTP Policy is incorrect
• Disclose the name of the Insurer. Where the Insurer operates under a trading name that is different from its Insurer name (as recorded in Schedule 1), disclose both the trading name and the Insurer name
• Provide the contact details for CTP Policy queries
• Detail the timeframe for eGreenSlips to be sent to RMS, including the timeframe associated with purchasing through different channels

5.3.10 An Insurer’s communication with the Customer must include any information required by the MAA. The Insurer must ensure that, when required by the MAA, the Insurers’ and its Agents’ sales persons use specific scripts.

5.4 Readily accessible and available

CTP Policies must be readily accessible and available to all Customers. Ready access and ready availability refer to both quoting and sale of CTP Policies. Insurers are required to give prompt and uniform access and availability to all Customers who approach them through each Distribution Channel, irrespective of the risk characteristics of the vehicle and its Owner. Insurers may use a range of Distribution Channels provided that every Customer has ready access to a CTP Policy available through at least one Distribution Channel.

Insurers must not use Distribution Channels to avoid sales.

In particular:

5.4.1 Insurers and their Agents must not refuse to provide a CTP quote for any motor vehicle required to be insured under the Act except in the circumstances specified in Schedule 2.

5.4.2 Insurers and their Agents must provide Customers with the ability to obtain a quote for any vehicle or vehicle class and to do so on a de-identified basis.

5.4.3 Insurers and their Agents must not refuse to provide a CTP Policy for any motor vehicle required to be insured under the Act, except in the circumstances outlined in Schedule 2.

5.4.4 Insurers and their Agents must make reasonable efforts to assist the Customer in providing information so that the Insurer can determine the correct premium in accordance with Clause 5.3.2.

5.4.5 Insurers must provide Customers with at least one option for payment methods for a quote or offer of renewal that is available 24 hours a day, seven days a week.

6. Information to be provided to the MAA by Insurers

6.1 Under section 173 of the Act, each Insurer is required to prepare and deliver to the MAA a business plan for its third party insurance business at least annually and when material changes are made.

6.2 For the purposes of section 173, the MAA requires each Insurer’s business plan to include a complete description of how its third party business for the Issue of CTP Policies is to be conducted. The complete description must include the structure and operating methods for each Distribution Channel and any plans for change within the next 12 months. The description will need to demonstrate how the conduct of the business satisfies the principles expressed in these Guidelines.

6.3 The MAA may require further details in order to clarify the business plan. Insurers may be required to provide the MAA with reports on any aspect of their market practices and their compliance with these Guidelines, in a format and timeframe determined by the MAA.

6.4 Insurers must notify the MAA of any breach of these Guidelines.

6.5 Insurers shall, on request from the MAA, submit copies of their Customer communication templates including CTP certificates and Customer information packs.

6.6 When requested by the MAA to do so, Insurers must submit scripts, training manuals or other supporting tools used by sales staff for review and approval. An Insurer shall, on request from the MAA, provide the MAA with other documents related to CTP Policies.

6.7 Insurers must amend any document submitted to the MAA if it is required to do so by the MAA.

7. Complaints

7.1 All complaints made to an Insurer or its Agents in relation to the issuance and administration of a CTP Policy must be handled in a fair, transparent and timely manner. A complaint is an expression of dissatisfaction made to an Insurer where a response or resolution is implied.

7.2 Information about how to make a complaint, complaints handling procedures and principles must be readily accessible and available to all Customers and provided to Customers on request.

7.3 Complaints handling procedures must explicitly refer to the rights of the Customer to escalate a complaint to the MAA if the Customer is dissatisfied with the internal review by an Insurer.

7.4 Each Insurer must keep a record, in a Complaints Register, of all complaints received by the Insurer and any of its Agents in relation to the Issuing of CTP Policies.

8. Variations and temporary arrangements

8.1 Insurers may vary their market and distribution arrangements, processes and business practices as long as the market and distribution arrangements, processes and business practices comply with the Guidelines and are disclosed to the MAA in accordance with Section 6 of these Guidelines.

Schedule 1: Insurers licensed under the Act

This schedule relates to the definition of Insurer and was last updated on 1 November 2014.

Schedule 2: Circumstances for refusal to provide a CTP Policy

This schedule relates to Clause 5.4.3 and was last updated on 23 March 2015.

Insurers and their Agents may refuse to provide a CTP Policy in the following circumstances:

• Where the Customer does not pay the required premium, the Medical Care and Injury Services levy and, where applicable GST, for the CTP Policy within the timeframe as agreed between the Customer and the Insurer or Agent.
• Where the vehicle is recorded as a statutory written-off vehicle on the NSW written-off vehicles register (WOVR).
• Where the Customer is seeking to purchase a CTP Policy from an Insurer:
  • for a vehicle not registered on RMS DRIVES database
  • for a CTP Policy with a different Insurer
  • for a CTP Policy with the same Insurer where the customer chooses to purchase a new CTP Policy for that vehicle rather than accepting an offer of renewal and the Customer does not provide the correct key identifiers used to locate and retrieve information held by RMS. Key identifiers are:
• • registration ID (also known as billing number) and plate number, or
  • a combination of:
    • a Customer identifier, one of:
      • NSW driver or rider licence number of the vehicle owner
      • NSW photo card number
      • RMS customer number

      and

    • a vehicle identifier, one or combination of:
      • vehicle identification number (VIN)
      • chassis number
      • engine number
      • plate number.

_Disclaimer:

_{This publication may contain information about the NSW Compulsory Third Party scheme. It may include some of your obligations under the various legislations that the MAA administers. To ensure you comply with your legal obligations you must refer to the appropriate legislation.}

_{Information on the latest laws can be checked by visiting the NSW legislation website legislation.nsw.gov.au.
This publication does not represent a comprehensive statement of the law as it applies to particular problems or to individuals or as a substitute for legal advice.}

_{You should seek independent legal advice if you need assistance on the application of the law to your situation.}

^{Catalogue No. MAA45 1014}