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Consumer Complaints Information

Introduction

The Insurance Regulatory Authority (now herein referred to as ‘the Authority’) receives and handles complaints lodged against members registered with the Authority. The Authority’s role and powers are vested in the Insurance (Amendment) Act of 2006 and is mandated to regulate, supervise and develop the insurance industry.

The Authority has experienced and well qualified staff and advisers, who can competently handle your complaint. Generally they will deal with your complaint in writing, and you will be expected to do so too, since it will be important to keep a record of what is said.

There is no charge for using the Insurance Regulatory Authority’s services.

Complaints and Disputes

Individuals and bodies such as Brokers and Agents can ask the Insurance Regulatory Authority 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 bodies 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.

Generally in this booklet the term “complaint” is used to cover both disputes and complaints, unless it is necessary to make a distinction.

Who can Bring a Complaint to IRA for Resolution?

  1. An insured who holds a policy with an Insurance company.

  2. A third party who seeks compensation from an Insurance company.

  3. Brokers or Agents on behalf of the insured.

  4. Advocates but only where judgment has been passed in a court of law.

  5. Beneficiaries of an insurance policy.

  6. Members of the industry registered with IRA.

  7. Insurance service providers.

Who can the Complaint be Against?

Complaints may be lodged against Insurance companies and other members of the Insurance industry registered with the Authority such as:

  • Insurance Brokers
  • Medical Insurance Providers
  • Insurance Agents
  • Insurance Investigators
  • Motor Assessors
  • Loss Adjusters
  • Insurance Surveyors
  • Claim Settling Agents
  • Risk Managers

What will the Authority NOT Deal with?

Before Lodging a Complaint:

First.....

The complaint or dispute should always first be taken up in writing with the Insurance company or any other registered member thought to be at fault.

If the Insurance company or any registered member against whom a complaint is made have not been given the opportunity to issue their decision then the Insurance Regulatory Authority cannot deal with the matter.

Then…

The Insurance Regulatory Authority expects individuals who want to complain to first seek dialogue with their Insurer or registered intermediary or service provider. In many instances the dispute may arise due to lack of communication between the parties or misinterpretation of clauses in the policy terms and conditions.

Time limits:

As a general rule complaints and disputes should usually be made in writing to the Insurance Regulatory Authority within three (3) years of the act or omission complained about or disputed. If you did not know about the matter at the time, the three (3) years will run from the time that you knew or ought to have known about the act or omission.

How to Complain:

1. First check, using the preceding sections of this leaflet that you are a person entitled to complain, that your complaint is against the right people or organizations, and that the Authority will be able to deal with the complaint.

2. There is a form which you should use to make your complaint. It can be obtained from the Insurance Regulatory Authority‘s office or website.

3. Complaints reported by telephone, e-mail or through the Authority’s hotline should be confirmed in writing and by completion of a complaint form. When sending the form, you should supply all relevant information in your possession, including copies of letters and so on. Wherever possible, keep copies for yourself.

What will happen next

The Insurance Regulatory Authority will acknowledge your letter and, where applicable, ask for further information relating to your case. When the Authority’s staff has all the relevant papers, they will commence the complaints resolution process and copy all correspondence to you. If it cannot, they will tell you why.

The procedure for deciding complaints is set by the Authority and the following description fits most cases, but there may be variations.

If you are making an initial enquiry or complaint, we will:

1. Acknowledge it within seven (7) working days of receipt.

2. Advise you what to do if we cannot deal with the matter.

If a complaint or dispute is accepted for investigation, we will:

1. Process it as quickly as possible (our target is that the average time of all complaints from application to final decision will not be more than 90 days).

2. Keep all parties informed of progress and, if delays cannot be avoided, tell you and indicate the likely time scale.

You can telephone us:

1. On normal working days between 8.00 a.m. and 5.00 p.m.

2. We will answer the telephone promptly and connect you to relevant officer.

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 (but not about decisions reached), please write to us.

UPCOMING EVENTS

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The IRA Management is committed to upholding the highest standard of ethics. Please report corruption practises by sending an email to ethics@ira.go.ke