Most Common Grounds for Complaint in 2020
In 2020, the Syndic’s Office opened 357 case files containing 844 grounds for complaint. Let’s look at the most common grounds for complaint made against professionals, as well as a case illustrating each category of complaint.
1. NEGLIGENCE
This category includes grounds for complaint related to deadlines, communication of information, modes of operation (including client-record keeping), and professional practice that does not comply with established directives, standards, requirements and obligations.
The Case
An independent claims adjuster is mandated by an insurer to settle a claim in the wake of a fire that destroyed a commercial building. Swamped with work, the adjuster fails to promptly respond to the insured’s e-mails, leaving him feeling insecure and in doubt about how his claim is being adjusted. The adjuster also neglects to report to the insurer within the recommended timeframe; he does not do the necessary follow-up with the insurer to respond to its payment recommendations; and lastly, he does not write any notes or summarize in the client-file any discussions or contact he had with the various stakeholders.
Explanation
Claims adjusters must not drag out the claims settlement process. As soon as possible, you must act on the instructions you receive and proactively report to the insurer and the insured on the status of the file.
Remember!
Being overworked or short of time is no excuse for neglecting your ethical obligations. You must act promptly and diligently when carrying out any mandate entrusted to you. If you are short on availability or feel that you are unable to fulfill your professional obligations, you must notify your superior, who will take the appropriate steps to remedy the situation.
Negligence can take many forms, for instance: failing to provide the insured with the information he needs to understand the compensation process; failing to make notes in the file; or failing to be accountable to the insurer who gave the mandate.
2. FAILURE TO EXPLAIN, INFORM AND ADVISE
This category includes grounds for complaint related to the obligations to inform and advise, to ensure proper communication with the client and client relations, and to refrain from misleading the client.
The Case
A broker receives a call from an insured who is concerned about the two notices of cancellation she received from the insurer for her home and car insurance contracts. The broker fails to act as a conscientious advisor by failing to explain the situation and the steps that must be taken following the termination of her insurance contracts. Furthermore, he takes no steps to contact other insurers in order to place her risks elsewhere.
Explanation
The broker should have properly followed up to avoid leaving his client without coverage. If he was unable to place the risks with another insurer, he should have informed her promptly so that she could take the necessary steps. If need be, you must also terminate your mandate, in which case a termination of mandate letter is strongly recommended.
Remember!
The advisory role is an integral part of the service you provide. It is your obligation to inform and explain any changes to your client’s contract and make sure that she understands all the ins and outs and the consequences. Your goal must be to make sure that your clients have received the information they need to make an informed decision, and above all, to prevent them from being left without coverage.
3. 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.
The Case
An insured contacts his broker to purchase a car insurance contract for his new vehicle. In addition to the insured, the broker includes the client’s spouse on the contract as a named insured, even though she has no insurable interest since she is neither the vehicle’s owner, driver or creditor. Furthermore, the broker designates the wrong creditor in the insurance proposal and forgets to write the new address that the insured had given him.
Explanation
Agents and brokers are responsible for following through on the instructions their clients give them. You must be careful and ensure that you give the insurer accurate information.
Remember!
You must act with honesty, rigour, and accuracy, and be proactive when writing or renewing a contract. You must collect and transmit the information required to assess the risk requiring coverage and make sure that it is all accurate.
4. ATTITUDE (LACK OF MODERATION AND OBJECTIVITY)
This category includes grounds for complaint related to objectivity, the professional’s hard and soft skills, as well as the core values of respect, transparency, integrity and professionalism.
The Case
In the wake of a loss, the insured learns from his insurer that the damages are not covered and that he will not be compensated. In a panic, he contacts his broker to understand the situation. The broker tries to be reassuring and tells the client that the insurer must certainly have been mistaken. He adds that this insurer is known for never wanting to pay and often seeks by all possible means to deny coverage.
Explanation
The broker should have shown moderation, objectivity, and dignity when speaking to the insured. He must refrain from making comments that could discredit the industry in which he works.
Remember!
Whether through your actions, your words, your writings, or on social media, you must strive to maintain a neutral tone, an open attitude and behave in a manner conducive to maintaining good relations with everyone at all times. Even under difficult circumstances, you must always behave professionally.
5. PERSONAL INFORMATION
This category includes grounds for complaint related to the disclosure, or the illegal or prohibited communication of personal information.
The Case
The owner of a building suffers water damage. While adjusting the claim, the claims adjuster informs the insured that the previous owner—who had been insured with the same insurer—had also made a claim for water damage.
Explanation
The former owner did not consent to the claims adjuster disclosing his claims history. You must always respect the confidentiality of the personal information you receive concerning a loss and use this information for the purposes for which you obtained it.
Remember!
Protecting personal information is of paramount importance. You must always obtain the insured’s consent before communicating information about him to a third party, or if you use his information for purposes other than those provided for under the law.
Read The Most Common Grounds for Complaint to find out more about the complaints that were most frequently reported to the Syndic’s Office in 2020
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