|The 9 most common causes of complaints in 2018||The 9 most common causes of complaints in 2018||http://chad.ca/en/members/professional-oversight/the-syndics-office/574/the-9-most-common-causes-of-complaints-in-2018|
In 2018, the Syndic’s Office opened 249 complaint files, in which 525 causes of complaint were identified. All causes of complaint must be taken seriously because of the prejudice they can cause, not only to the customer, to other professionals and to the industry, but also because of the negative effects on the profession’s image. Learn about the
nine most common causes of complaints in 2018 and the relevant disciplinary decisions associated with each one.
1. FAILURE TO EXPLAIN, INFORM AND ADVISE
During a telephone conversion with a client about a replacement insurance contract (Q.P.F. No. 5), the personal lines damage insurance agent did not explain or describe the product properly. For example, he did not specify that the vehicle would absolutely have to be replaced in order for the client to receive this indemnity. Also, he did not inform the client that in the case of a partial loss, Q.P.F. No. 5 would apply if parts needed to be replaced.
As a specialist in damage insurance or in claims settlement, you have knowledge that your clients do not have. This is the reason why clients trust you when it comes to choosing the coverage that is appropriate for them, or after a loss, a time when they feel particularly vulnerable. Your duty to explain, inform and advise is important. The failure to give clients proper and complete information so that they can make informed decisions could, in certain situations, jeopardize their right to an indemnity in case of a loss and, generally speaking, cause them to lose confidence in you and in the industry.
For one year, a claims adjuster neglected to make follow-ups regarding the handling of his client’s claim, despite repeated requests from her. After 12 months, the insured finally received a settlement offer from her insurer, which the claims adjuster did not follow through on for another six months. The insured was finally indemnified almost three years after the loss for which the claim file was opened, and only after the intervention of the insurer’s ombudsman.
A professional who does not comply with the established directives, norms, requirements and obligations is acting negligently in his or her practice. Each day-to-day action that you make is important and none should be taken lightly. The care and attention you put into your actions, as well as their accuracy, are essential. The ChAD designed the mandatory course for 2018-2019 on negligence to remind you of their importance. You have until December 31, 2019, to complete this online course:
Focusing on Compliance: Preventing Negligence in your Practice.
3. ATTITUDE (LACK OF MODERATION AND OBJECTIVITY)
When two of his clients had just separated, a damage insurance broker allowed himself to make inappropriate comments during a telephone conversation with an ex-spouse. The broker allegedly asserted that the insured was “basically a thief” and that his ex-spouse “could accuse him of embezzlement.” The Disciplinary Committee found these comments to be “totally unacceptable” coming from a professional. In his defence, the broker declared he wanted to be sympathetic and show support to his client, who was going through a difficult situation related to her separation.
Even in the most difficult situations, professionals must show restraint in their actions, their writings and their words. They must show empathy towards their clients and listen attentively, but must avoid making negative or inappropriate comments. Such an attitude harms the profession’s image, because your clients expect to deal with a competent, trustworthy and respectful person.
4. POORLY EXECUTING THE MANDATE
When renewing many automobile insurance contracts, a personal lines damage insurance broker did not follow the instructions given by his clients, resulting in insufficient insurance for one of them. For another one, the broker did not forward the insured’s banking information to the insurer, causing him to lose the benefits of paying his premium through automatic monthly bank withdrawals, as had been offered by the insurer.
Failing to follow up on instructions from clients or to report back to them, or any other omission in the execution of a mandate, are reasons for complaint found in this category. To the public, to act with professionalism means that a task will be completed with the utmost care as opposed to amateurish work that is botched or done crudely.
5. FALSIFIED DOCUMENTS, FALSE REPRESENTATIONS
A damage insurance broker participated in the falsification of documents by issuing an insurance certificate confirming coverage for certain activities of the insured’s business, while he knew that they were not covered by the insurance contract.
Creating false documents or falsifying documents is an offence that can not only undermine the public’s confidence, but also create grave consequences for clients who could, for example, believe they are covered while they are not. This category also includes complaints received about false representations, another serious offence. Your clients count on your explanations and your advice to make enlightened decisions.
6. DISCLOSURE OF PERSONAL INFORMATION
A woman contacted her ex-spouse’s personal lines damage insurance broker to learn the status of the premium payments of the insurance contract. The broker gave her the information, and also told her about the cancellation of the contract and of the recovery procedures against her client, without having obtained his consent.
In a context where consumers are more and more concerned about the security of their personal information, insureds must be certain that damage insurance professionals take all necessary precautions to protect their information. The information can only be provided to third parties with the authorization of the client or in particular circumstances set out in the
Act respecting the protection of personal information in the private sector.
7. CONFLICT OF INTEREST
A damage insurance broker put himself in a conflict of interest situation on many occasions by providing clients of the brokerage with insurance premium financing through a company in which he was one of the directors and a shareholder. These financial links were not divulged to the clients.
This category groups together the causes of complaint associated with the appearance of conflict of interest, whether personal or professional, related to legal, commercial or financial interests, whether or not they cause a prejudice. In order to preserve your professional independence, avoid putting yourself in situations of conflict of interest or appearance of conflict of interest. Your clients must be able to trust that you will work in their interest and that your advice and actions have no other motivation than to offer service quality worthy of a professional.
8. APPROPRIATION OF FUNDS OR FAILURE TO REMIT THE FUNDS COLLECTED
With the complicity of the finance manager of the brokerage, a damage insurance broker misappropriated insurance premiums paid out by clients 60 times, for a total amount of more than $31,000. He could thus receive his commission while the brokerage could recover some of the unpaid premiums.
Misappropriation is one of the more serious offences, and a professional found guilty of this offence will be at least temporarily struck from the roll under the
Professional Code1. In their professional activities, representatives can, for example, collect an insured’s premium, remit amounts due by the insurer or, for claims adjusters, cash indemnity cheques of which a portion must be paid to a vendor. These amounts do not belong to them and must flow through the separate account, as provided for in the second paragraph of section 4 of the
Regulation respecting the pursuit of activities as a representative.
9. HINDERING, FAILURE TO ANSWER
During an investigation on another representative, a damage insurance broker directly or indirectly hindered the work of the Syndic’s Office, in particular by not communicating with the investigators and not responding to a request for information and to documents transmitted at the same time by electronic mail, registered mail and by bailiff.
The Disciplinary Committee has ruled many times on the obligation of professionals to collaborate with the Syndic’s Office. When a professional receives a request for information from the Syndic’s Office, he or she must respond as soon as possible. If the professional needs clarification, he or she can communicate with the Syndic’s Office. The mission of the protection of the public must prevail at all times.
1. Section 156 of the
Professional Code stipulates that “The disciplinary council shall impose at least temporary striking of the roll in accordance with subparagraph b of the first paragraph on a professional found guilty of having appropriated, without entitlement, sums of money or securities held by him on behalf of a client or of having used sums of money or securities for purposes other than those for which they were entrusted to him in the practice of his profession.”
|9/23/2019 12:55:32 PM|