Handling Complaints and Other Special Client Presentations

If you receive a client complaint, you must inform your VP, The Company Compliance Department and the insurance provider immediately (that same day).  You should cooperate with the investigation and provide copies of any documents, explanations, or statements requested.  You should never promise the client a specific result and you should not argue with the client.  The insurance provider and The Company (where applicable) will investigate the complaint and respond to the client.

Clients may contact you for a variety of reasons that could include service requests, inquiries, questions, concerns, lack of understanding, or a serious grievance. It’s important to listen to clients carefully and provide prompt and effective service.  If you receive or become aware of an “insurance complaint,” you must give it special handling.  Under the insurance laws of most states, a complaint is defined as written or verbal communication primarily expressing a grievance.  The client might send the complaint to you, to The Company, the insurance company, or file it directly with the State Insurance Department or other regulatory agency, or any combination of these.  It might be sent or filed by the client or by a representative or attorney for the client. In any of these cases, if the communication is in writing and expresses primarily a grievance, it’s considered a complaint.

Lawsuits and Policy Claims

Lawsuits, threatened lawsuits, death claims, or claims for other policy benefits are not necessarily complaints.  But, like complaints, they are serious presentations that require your prompt handling.  If you don’t handle them properly and promptly, they could lead to a complaint against you.

  • Report lawsuits or threatened lawsuits immediately.  Contact The Company on the same day and deliver a copy of any notice you’ve received.
  • Once you become aware of a lawsuit or threatened lawsuit, don’t comment on the case, its facts, or allegations to the client, client’s lawyer or representative, or any other third party—unless instructed otherwise.  Above all, don’t argue with clients.
  • If you’re notified, even verbally, of a death claim or policy claim, get details and contact the insurance company claims department immediately with the pertinent information.  It’s also good practice to advise the claimant to contact the insurance company claims department directly, as a backup.
  • While you may ascertain the claimant that the insurance company will process the claim, never guarantee or imply that the claim will, in fact, be paid, or how much, or when.  The final payment or determination of the claim will be communicated in writing by the insurance company.
  • Assist in getting information or documents requested by the Claims Department when asked.
  • Deliver the check promptly to the beneficiary if the insurance company sends the claim check to you.  Processing an insurance claim can be a complex process.  For example, the claim could be delayed by a necessary investigation.  There could also be questions regarding the proper beneficiary, or other factual or contractual issues.  Depending on the type of policy and its status (e.g. outstanding policy loans), the insurance company will have to verify the exact amount of benefit payable.  In rare instances, the policy may be contested by the insurance company for misrepresentation or the claim could be denied for fraud.  In any event, the insurance company will communicate the final payment or determination of the claim writing.

Handling Client Presentations

Maintaining a good filing system can help avoid problems later on.  Some good practices could include:

  • A separate file for each client.  A complete client file includes copies of all sales materials used, correspondence, fact finders, needs analysis, disclosure forms, illustrations, applications, etc.
  • A master compliance files.  This should include all sales materials approvals, records of audits, The Company insurance guide, bulletins or memos, and other relevant materials such as an insurance company agent guide.