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Specific requirements

16.1 The insurer must have a documented internal complaint and review procedure, the terms of which must be set out in the insurer’s business plan.

16.2 An insurer who receives a complaint, request for review or dispute (whether verbal or in writing) must handle it in accordance with the documented procedure.

16.3 The insurer’s complaint and review procedure must be readily accessible to the public, including publication on the insurer’s website, and provided upon request.

16.4 At a minimum an insurer is required to:

  • 16.4.1 acknowledge a complaint, request for review or dispute in writing and provide the person with a copy of the insurer’s procedures and the details of the representative of the insurer handling the complaint, review or dispute as soon as possible but within five days from the receipt of the complaint or dispute
  • 16.4.2 provide the person with the opportunity of having the complaint, review or dispute considered by a more senior representative of the insurer independent of the original decision maker, and
  • 16.4.3 provide written reasons for a decision in relation to the complaint, review or dispute and information on the availability of external complaint or dispute resolution handling bodies (including the Authority, MAS and CARS) in the event that the person is dissatisfied with the insurer’s decision or procedures.

16.5 The insurer will keep a copy of complaints, review requests and disputes on the relevant claim file(s), including its response and written reasons and will provide data on complaints, review requests and disputes including this information to the Authority, in the manner requested, from time to time.

16.6 The insurer will co-operate fully with the Authority, including CARS and MAS, in respect of any complaint, review request or dispute.