Five Common Grounds for Complaint
In 2019, the Syndic’s Office opened 535 files containing 1,275 grounds for complaint. Let’s look at the most common grounds for complaints made against professionals, as well as a case illustrating each category of complaint.
This category includes grounds for complaints related to deadlines, communication of information, modes of operation (including keeping client records), and professional practice that does not comply with established directives, standards, requirements and obligations.
After suffering a loss, the insureds mandate a claims adjuster to represent them when making their claim. For five months, the adjuster neglects to follow up or provide any status reports despite their repeated calls. In exasperation, they decide to revoke his mandate; he ignores their request. In this case, the adjuster has acted negligently due to poor record keeping, and in particular, due to his failure to keep a time sheet of the work he did.
When a client asks for a status report on the mandate, the professional must respond quickly. In fact, the best way for a claims adjuster to show diligence in reporting is to anticipate his client’s expectations and keep him continuously up to date on the claims process.
If the client wishes to revoke your mandate, you must accept his decision and cease to represent him immediately after having ensured proper handover of his file.
You must also be careful and diligent in carrying out your responsibilities. Failing to note in the client record your actions, summaries of meetings or phone calls, mandates received and carried out, as well as any offers of compensation, are all examples of negligence.
2. Failure to Explain, Inform and Advise
This category includes grounds for complaint related to the obligations to inform and advise, communication with the client and client relations, as well as misleading the client.
During the term of an insurance contract covering a pleasure craft, the insurer decreases the value stipulated in the contract. The damage insurance broker does not notify his client of the change and fails to obtain her consent in writing.
It is a professional’s obligation to notify his client in writing of any changes to the coverage provided for in the contract, and to ensure that the client understands the consequences of such changes. Furthermore, if there is a decrease in coverage or an increase in the insured’s obligations during the term of the contract, the professional must obtain the client’s consent to the change in writing.
The duty to advise goes to the very heart of the professional’s activities. As a damage insurance specialist, you must provide your clients with all the information they require to make an informed decision. Failure to explain, inform and advise may have serious consequences for the client, who could, for example, be refused compensation for a claim.
3. Attitude (lack of moderation and objectivity)
This category includes grounds for complaints related to objectivity, the professional’s hard and soft skills, as well as the fundamental values of respect, transparency, integrity and professional integrity. .
A damage insurance broker learns that the insurer has denied coverage for a claim his client made. Unhappy with this outcome, he shares his feelings with the client, adding that he is considering ending his business relationship with this insurer. This behaviour shows the professional’s lack of objectivity, discretion, moderation and dignity.
In their actions, as well as in their oral and written communications, professionals must show restraint.
Despite sometimes trying circumstances, or decisions with which you may disagree, you must always maintain a respectful attitude towards clients, insurers and other certified professionals.
4.Poorly Carrying Out the Mandate
This category includes grounds for complaints related to the obligations to act promptly and honestly, as well as grounds related to reporting, collecting information and renewing contracts.
After receiving an assessment of the cost of rebuilding his property, an insured asks his broker to reduce the amount of insurance stipulated in his business lines insurance contract. The broker does not follow up on his client’s instructions and then shows a lack of transparency by wrongly telling him that the insurer has refused to change the amount of insurance during the term of the contract. Furthermore, the broker acts negligently by not renewing the contract in a timely manner.
A professional must follow up on his client’s instructions as soon as possible or notify the client if he is unable to do so. Moreover, he must carry out his mandate in a transparent manner, in other words, he must reveal all the relevant information to his client, without hiding anything.
You must also be proactive, and act with professional integrity and rigour when renewing a contract. This means, for example, that you must not wait for the client’s contract to expire before asking the insurer to renew it. One of the main reasons for this requirement is to avoid the client finding himself without any insurance coverage.
This category includes grounds for complaint related to the disclosure, or the illegal or prohibited communication of personal information. .
The owner of a building and his tenant both deal with the same brokerage firm. During a phone call, the personal lines damage insurance broker discloses information to the owner concerning the status of his tenant’s insurance quote without first asking the tenant for his consent.
Professionals must respect the confidentiality of all the personal information they collect regarding a client, and only use this information for the purposes for which it was obtained.
Keeping personal data secure is crucial to maintaining a relationship of trust with insureds; you must therefore take all steps necessary to protect its confidentiality. Furthermore, you must obtain consent from your client before sending information on him to a third party or use this information for purposes other than those for which the client gave his consent.