1. Introduction

NESS Consulting Services Pty Ltd (“NESS”), as an authorised financial services provider, has a responsibility to conduct itself honestly, with integrity, fairness, dignity and ethically wherever it operates, with due regard to the environment, the societies in which it operates and its other stakeholders. NESS is committed to attending and resolving our client’s complaints in the most efficient manner. NESS is therefore establishing a formal complaint handling platform through this framework in order to improve the client experience goals of making NESS a trusted brand; optimise our approaches to complaints handling thus improving client retentions, loyalty and converting clients into being NESS evangelists.

The Complaints Management Framework serves:

• To promote fairness and transparency thus strive to ensure that the customers’ reasonable treatment is at the heart of our business and is essential to NESS’s success;

• To ensure that decisions relating to Client Complaints handling are made having full regard to the NESS guiding principle of Integrity, Simplicity, Responsive and Agility 

• To meet the requirements of Section 62 of the Long-Term Insurance act i.e., Rule 18 of the Policyholder Protection Rules and the requirements of the FAIS Act. It needs to ensure fair treatment of policyholders and beneficiaries and must be reviewed regularly.
  

2. Complaints management mission

The Framework must be maintained, operated adequately and effectively and to ensure the fair treatment of complainants that:

• is proportionate to the nature, scale and complexity of the NESS’s business and risks;
• is appropriate for the business model, policies, services, policyholders, and beneficiaries of NESS;
• enables complaints to be considered after taking reasonable steps to gather and investigate all relevant information and circumstances, with due regard to the fair treatment of complainants; and
• does not impose unreasonable barriers to complainants
• must address and provide for, at least, the matters provided for in the Policyholder Protections Rules rule 18

The objective of the framework is to ensure that customers are provided with the best possible complaint resolution service and to align the actions of the personnel of NESS with the prescriptions of the law regarding Complaints management in a Financial Service Industry, as regulated.

As an authorized FSP in terms of the Act (FAIS act 37 of 2002) we are committed to providing our clients with quality service and undertake to manage the affairs of our client in such a way that it would not be necessary to have a complaint about our service. However, should it happen that the client does have a complaint, we undertake to:

• Resolve the client complaint in a fair manner to the client, the business, and our staff
• inform all our clients of the procedures established for the internal resolution of their complaint in detail and in writing
• Ensure access to our complaints resolution facilities by way of Email, Web, WhatsApp, telephone or post
• Empower and properly train our staff to deal with complaints to the benefit of both the client and the business.
• Deal with complaints in a timely manner, with each complaint being treated on a case by case basis, based on the merits of the matter;
• Offer full and appropriate redress in all cases where a complaint is resolved in favour of the client.
• Inform clients of their right to refer their complaints to the relevant Insurer and/or Ombudsman should a complaint not be resolved to their satisfaction within six weeks from the date on which the complaint was received.
• Maintaining records of all complaints received which will specify the outcome of all complaints lodged for a minimum period of 5 years or as required by law 
• Implement follow-up procedures to:
  • Implement remedial actions to prevent similar complaints from occurring
  • Improve service and procedures where necessary in the business

3. Definition

“Complaint” means an expression of dissatisfaction by a complainant, relating to a product or service provided or offered by the FSP, or to an agreement with the FSP respect of its products or services and indicating that:

(a) the FSP or its service provider has contravened or failed to comply with a law, or an agreement, or a rule, or a code of conduct which is binding on the FSP or to which it subscribes;

(b) the FSP or its service provider’s maladministration or wilful or negligent action or failure to act, has caused the complainant harm, prejudice, distress, or substantial inconvenience; or

(c) the FSP or its service provider has treated the complainant unfairly and regardless of whether such an expression of dissatisfaction is submitted together with or in relation to a customer query.

“Complainant” means a person who has submitted a specific complaint to the FSP or, to the knowledge of the FSP, to the FSP’s service provider and who –

(a) is a customer or prospective customer of the FSP concerned and has a direct interest in the agreement, product or service to which the complaint relates; or

(b) has submitted the complaint on behalf of a person mentioned in (a), provided that a prospective customer will only be regarded as a complainant to the extent that the complaint relates to the prospective customer’s dissatisfaction in relation to the application, approach, solicitation or advertising or marketing material contemplated in the definition of “prospective customer”.

“Reportable complaint” means any complaint other than a complaint that has been –

(a) upheld immediately by the person who initially received the complaint;

(b) upheld within the FSP’s ordinary processes for handling customer queries in relation to the type of agreement, product or service complained about, provided that such process does not take more than five business days to complete from the date the complaint is received; or 

(c) submitted to or brought to the attention of the FSP in such a manner that the FSP does not have a reasonable opportunity to record such details of the complaint as may be prescribed in relation to reportable complaints.

4. Scope of the Framework

• This framework applies to all complaints and queries made by customers in response to the service or services received from NESS or from service providers.
• Where NESS have agreements with outsourced business partners or Juristic Representatives that have any part to play in the complaints handling or resolution or record keeping process, it is recommended that those agreements may state minimum standards necessary for complaints management.

• This framework upholds the provisions of the FAIS Act as well as the PPR’s as amended.

5. Complaint Management Process and Categorisation of Complaints

5.1 Submitting a complaint

• A complaint must be submitted in writing by a complainant addressed for the attention of the Complaints Officer to complaints@nessgroup.co.za or WhatsApp 078 553 9210 or Fax: 086 683 1414 or call at 0117159700 or NESS offices.  
• The complainant must give a detailed description of the event that caused them to suffer any prejudice. 
• All communications with complainants must be in plain language.
• in the case of a client who cannot write they must be assisted by being provided complaints form to fill it in or assisted to fill in then, taken through what is written and get them to sign the complaints form.
• NESS will also monitor the relevant social media platforms including Hello Peter furthermore, ensure that regular monitoring is done on compliance with as well as the effectiveness of this framework generally. All online, media or public complaints must be attended to within 3 hours of detection and where the binder or underwriting agreement dictate, inform the insurer within the specified timelines in the agreement.
• Once a complaint is received an acknowledgement of receipt is sent to the complainant including reference to this Complaints Management Framework detailing the process to be followed (within a reasonable time after receipt), including:
  • contact details of the person/department that will be handling the complaint; and
  •  timelines;
  • details of the internal complaints escalation and review process and details of relevant Ombud where applicable.

5.2 Performance Standards and Complaints Resolution Process

• The complaint channels above will be monitored by the complaint handling staff daily.
• A complaint will be received by the customer services consultant who will log it on the complaints reporting system, acknowledge receipt to the complainant within 24 hours providing the following:
  • contact details of the person or department that will be handling the complaint;
  • indicative timelines for addressing the complaint;
  • details of the internal complaints escalation and review process if the complainant is not satisfied with the outcome of a complaint; and
  • details of escalation of complaints to the relevant Insurer and subsequently office of the ombud where applicable.

• We will investigate, attempt to resolve, and respond within 15 working days of receiving the complaint and/or any additional information requested on a previously submitted complaint, after taking reasonable steps to gather and investigate all relevant and appropriate information and circumstances, with due regard to the fair treatment of complainants. Please note that it might take longer to respond on exceptional or more complex cases.

• With regards to any business placed through Sanlam Developing Markets (SDM), all complaints will be handled by them as such their rules and timelines will apply including the resolution period.
• Complaints handler to update the complaints reporting system with all developments /activities and ensure all communication used during the investigation is indexed on Precision.
• As soon as the complaint is acknowledged to the complainant the Complaints handler or Officer will start the investigation process which will include determining the nature of the complaint or the category under which the complaint falls in order to follow the correct process for that complaint.
• A decision will be made on each complaint as soon as is reasonably possible but within a period not exceeding a maximum of 15 working days after taking reasonable steps to gather and investigate all relevant and appropriate information and circumstances, with due regard to the fair treatment of complainants.
•  Each complainant must be kept adequately informed of:
  • The progress of their complaint;
  • Causes of any delay in the finalisation of a complaint and revised timelines not exceeding 10 working days of receipt of the complaint.

• A written response will be sent to a complainant or their authorised representative once the complaint is finalised.
• Where a complaint is upheld, any commitment to make a compensation payment, goodwill payment or to take any other action will be carried out without undue delay and within any agreed timeframes.
• Where a complaint is rejected, the complainant will be provided with clear and adequate reasons for the decision and be informed of the escalation or review process, including how to use it and any relevant time limits.
• All staff are measured in terms of key performance areas that includes complaints management and are remunerated and rewarded accordingly.

6. Complaints Escalation and Review Process

6.1 Complex or unresolved complaints

• Complaint handling staff and complainants may refer complex or unresolved complaints to the Independent Complaints Officer for consideration or involve the  insurer’s Arbiter.
• The Independent Complaints Officer will acknowledge receipt of the complaint escalation within 24 working hours and inform the referrer of:

• Details of information required from referrer;
• Where, how and to whom the complaints and related information must be submitted;some text
  • Expected turnaround times to finalise the complaint escalation or review;
  • Any other relevant responsibilities of the referrer.

• The Independent Complaints Officer will inform the referrer of the outcome of the referral within 15 working days after receipt.
• The Independent Complaints Officer will ensure that decisions are impartial and will always have due regard to the fair treatment of customers.

6.2 Review or escalation of the Complaint

• Should a complainant not be satisfied with the outcome of a complaint, the complainant has the right to have the decision reviewed by the Independent Complaints Officer of NESS.
• If a complainant wishes to have a decision regarding a complaint reviewed:some text
  • NESS will treat it as a Dispute;
  • When a decision has been made, respond to the complainant in writing giving:
  • Reasons for the decision;
  • Provide information about how to access external dispute resolution or policyholder recourse mechanisms (i.e., through the Insurer Arbitrator or FAIS Ombud), and the time frame in which to do so.
  • Should the decision not be to the satisfaction of the customer, the customer has a right to refer the complaint to FAIS OMBUD

6.3 FAIS Ombudsman Details:

• If a complainant wishes to have a decision regarding a complaint reviewed:

• NESS will treat it as a Dispute;
• When a decision has been made, respond to the complainant in writing giving:some text
  • Reasons for the decision;
  • Provide information about how to access external dispute resolution or policyholder recourse mechanisms (i.e., through the Insurer Arbitrator or FAIS Ombud), and the time frame in which to do so.
  • Should the decision not be to the satisfaction of the customer, the customer has a right to refer the complaint to FAIS OMBUD
  • FAIS Ombudsman Details: 
  • If any complaint regarding advice given or intermediary services rendered to you was not resolved to your satisfaction, you can contact the FAIS Ombudsman.  

Postal Address: The Financial Services Board, PO Box 74571, Lynnwood Ridge, 0040

‍Telephone : +27 12 470 9080

‍Fax : +27 12 348 3447

‍E-mail :info@faisombud.co.zaWebsite:www.faisombud.co.za

6.4 Decision to uphold the Complaint

Where a complaint is upheld, the complainant will be advised of the decision by NESS and of the commitment, if any to make a compensation payment, goodwill payment.

6.5 Feedback to the Complainant

• The complainant must be given feedback on the progress on the complaint resolution process. some text
• The feedback referred to here could be in a form of a SMS or a telephone call advising the complainant of the status of the complaint.

7. Regulatory and Product Supplier’ Complaints

7.1 Long Term Insurance Ombud

• All complaints lodged with the Ombudsman for Long Term Insurance and all legal proceedings in respect of the Insurer, the Policies and/or the Insurance Business must be dealt with exclusively by the Insurer.
• NESS will give all assistance and cooperation to the Insurer in respect of any of the above and promptly furnish all documents /information and give all representations required in order to enable the Insurer to defend any such legal proceedings, claims, potential claims, complaints, or potential complaints.
• NESS shall within 24 (twenty-four) hours of receipt of a complaint, a notification from the Ombudsman for Long Term Insurance or any other legal document pertaining to the Insurer, the Insurance Business and/or the Policies, provide a copy of such documents and any supporting documents to the Insurer.

7.2 Complaints Relating to the Product Suppliers

• Complaints against product supplier must be referred to the product supplier concerned however NESS is responsible for ensuring the complaint is attended to and resolved to the satisfaction of all parties, if not that the complainant was advised of the available recourse.
• Where complaints are referred to the product supplier, the complainant must be appropriately informed of the process being followed and that NESS will take reasonable steps to monitor the outcome of the complaint.
• The relevant details of the Insurers:

Ombudsman for Long Term Insurance details as well in cases where that will be needed:

Long Term Insurance Ombud: 

Telephone: 0860 103 236 Facsimile: +27 12 674 0951 

E-mail Address: info@ombud.co.za

7.3 FAIS Ombud Complaint

• Any complaint received from the FAIS Ombud must be immediately reported to the Independent Complaints Officer or Compliance officer who will hold overall responsibility of nominating the Complaints Handler that will be in charge for all communications and investigations relating to such complaint. NESS shall inform the insurer of any Ombud complaints pertaining to the insurer and/or policies to the extent where NESS acted as an agent of the insurer.
• The Complaints Handler will immediately records complainant details as follows:some text
  • Record the date of receipt
  • Record the Ombud case manager’s name
  • Record the name of the complainant
  • Record the policy number
  • Record the case number / Ombud reference
  • Acknowledge receipt of the complaint to client
  • Record the claim amount/issue
  • Record the reason for the complaint
• The Complaints Handler responds to the Ombud acknowledging receipt and confirm that a full response will be sent to the Ombud within the timeline specified by the Ombud on their notification
• Complaints handler gathers information and documentation to submit to the Ombud and endeavour to resolve such complaint before the due date of submission.
• Once the investigation is completed the complaints handler will submit the findings to the Independent Complaints officer who will determine whether NESS accepts that they are on the wrong or will be challenging the facts provided by the client.
• In the case where NESS accept the wrong doing they will provide reasons and the Independent Complaints officer or delegated complaints handler feedback to the Ombud stating the steps NESS will take to rectify the situation
• Otherwise, submit a counter argument detail NESS’s version of events and including supporting documentation to the counter argument
• When the Ombud responds whether seeking further information or providing a recommendation, NESS will endeavour to respond to the Ombud within 2 weeks of receipt. Information will be gathered were necessary and a response will be prepared and sent to the Ombud.
• Once the Ombud has made a determination, NESS will act in accordance to whatever finding communicated by the Ombud the case will be finalised and closed.
• The Independent Complaint Officer will maintain specific records and carry out specific analysis of complaints referred to NESS by the ombud and the outcomes of such complaints; and monitor determinations, publications and guidance issued by the ombud with a view to identifying failings or risks in NESS’s policies, services, or practices.

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