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Insurance Complaint Procedures

Introduction

The Pensions and Insurance Authority receives and handles complaints lodged against entities registered by the Authority. The Authority’s role and powers are vested in the Insurance Act No 27 of 1997.

 The Authority has experienced and well qualified staff, who competently handles complaints. Generally the Authority will deal with complaint in writing, and you will be expected to do so too, since it is important to keep a record of all complaints.

 

Complaints and Disputes

Individuals can ask PIA to intervene in matters relating to insurance policies issued by Insurance companies which affect the rights and interests of policyholders.

Complaints must be that the Insurance company complained against or other registered entities or agents have behaved in a way which constitutes unsound practice and that the act or course of conduct has caused injustice.

Complaints can involve a disagreement concerning liability under policies issued, or amount offered for settlement. It can also be in respect of a delay in settlement of a payable claim.

 

What will the Authority NOT Deal with?

The Authority will not investigate the following:

• Complaints about employees of Insurance companies or employees of other corporate members  licensed  by the Authority.

• Complaints or disputes already subject to court proceedings dealings.

• Complaints from lawyers unless for matters where judgment has already been passed against a registered member.

 

Complaint  Procedure

The first step is for the policy holder to lodge in complaints with the insurance company on other insurers. Almost all insurance companies have inhouse complaint handling mechanism and it is important that policy holders exhaust this internal process before filing in the complaint with the PIA.

The policy holder is then advised to seek the intervention of Authority if he or she and the insurer fail to resolve the issue by:

  • Writing a formally to the PIA Registrar through a letter, email or filling in the complaint form on the website. Alternatively, you can use the complaint form which can be downloaded from the PIA website
  • Supplying all relevant information in your possession, including photocopies of letters between the insurer and yourself and any other documents related to the case. This makes it easy for the Authority to understand the case.

 

What will happen next?

Once PIA receives the complaint, we will acknowledge your letter and, where applicable, ask for further information related to the case. When the Authority’s staff has all the relevant papers, they will commence the complaints resolution process and copy all correspondence to you.

The Authority will let you know should it be unable to attend to your case and this will be done formally including the reasons.

If you are unhappy with our service, please let the person you are dealing with know. If you wish to complain formally about our service please write to the Registrar,  Pensions and Insurance Authority.