Chapter I
BASIC PRINCIPLES
Art. 1. (1) These Rules shall be based on the principles of objectivity, timeliness, reliability, fairness and correctness in the examination and preparation of responses to complaints and signals received from users of insurance services to the Broker.
(2) These Rules are aimed at establishing a general procedure for receiving, examining and analysing complaints and signals received by the Broker from Users of insurance services, protecting the rights and interests of Users of insurance services, preventing litigation and preserving the good name of the Broker.
(3) The Broker shall be guided by the following basic guidelines in preparing its response to complaints and signals:
- Comprehensive clarification of all facts and circumstances relating to the subject matter of the complaint or alert;
- drafting the response in clear, understandable and accurate language;
- responding to each complaint/alert within a short period of time, which shall in any event be no longer than one month from receipt of the complaint/alert;
- offering the complainant a possible solution to the problem, if one exists;
- a written response to any complaint/whistle submitted to the Broker.
Art. 2. (1) Complaints may not be considered and resolved by the persons, employees of the Broker, against whose actions they are filed or who are related persons to the Insurance Service User filing the Complaint.
(2) Employees of the Broker shall not refuse to accept complaints and signals from Users of Insurance Services.
(3) Anonymous Complaints shall not be considered.
Art. 3. All time limits referred to in these Rules shall be counted in calendar days. The day of receipt of the relevant Complaint or Alert shall not be counted. Where the last day of the period is a non-attendance day, the period shall expire on the first following attendance day. Written responses shall be deemed to have been made within the time limit if sent by mail, courier or electronic address by the expiration of the twenty-fourth hour of the last day of the time limit.
Chapter II
ACCEPTANCE, EXAMINATION AND DRAFTING
REPLY TO COMPLAINTS
Art. 4. (1) The broker shall examine complaints and signals addressed to the head office and the address of the management - city of Varna, Varna Blvd. 21A Maria Louisa, office or to any of the Broker's offices.
(2) The Broker shall consider complaints and signals submitted also to the addresses indicated on the Broker's website www.lexins.bg and telephone number 00359887461914.
(3) Where the Broker has received a complaint from a user of insurance services, the Broker shall forward the complaint to the insurer on whose behalf the Broker acts within three days of receipt. The Broker shall inform the complainant in writing of the forwarding of the complaint to the insurer and shall provide the complainant with the insurer's contact details and information on the procedure and time limits within which the complaint must be dealt with.
The broker must, if this can be ascertained from the content of the complaint, forward the complaint to the insurance products distributor to whom it relates and inform the complainant in writing of the forwarding of his complaint and provide him with the contact details of the insurance products distributor. Where the complaint does not identify the insurance distributor to which it relates, the insurance broker shall specify this in the written information to the insurance user and return it to him.
Art. 5. (1) When lodging complaints and signals at the offices and the address of the Broker's management, the users of insurance services or their authorised persons shall be given the opportunity to fill in a complaint/signal form (Annex No. 1), indicating: first name, surname and family name, resp. The name, surname, forename and surname; company name; personal identification number/EIC number; exact correspondence address; contact telephone number; subject of the complaint/signal; date of submission and signature, attaching a copy of the documents on which the complaint/signal is based, if any.
(2) In the case of complaints and signals by telephone, the officer receiving the call shall request the following information from the user: first name, surname and family name, or company name; personal identification number/EIC number; exact correspondence address; contact telephone number, subject of the complaint/signal. The data shall be recorded on the complaint/alert form by the employee and signed by the latter, noting the date and time of the call, and then sent to the address of the central office.
(3) When submitting a complaint to the e-mail address indicated on the website or via the contact form, if not all the data for the identification of the user and for feedback are provided, an employee of the Broker shall additionally contact the client at the e-mail address indicated by him to request the specific data, with the response period starting from the receipt of the data.
(4) The employee of the Broker who receives the complaint or alert at the address of the management or office shall inform the user of insurance services of the time limit within which the latter will receive a response, as well as the contact details of the Broker, through which the status of the complaint/alert can be checked, and shall inform the user of the registration number of the alert. Upon receipt of the complaint/alert by e-mail, the employee who received the complaint or alert shall return information to the client on the incoming number, also providing him with the information referred to in the preceding sentence. The submission of complaints is free of charge for the persons concerned.
Art. 6. (1) In order to provide and maintain uniform comprehensive statistical information on complaints and signals received, the Broker shall maintain a Complaints Register at Head Office.
(2) Complaints and signals shall be registered on the day of their receipt at the Broker's Head Office in the Complaints Register by the responsible officer referred to in Article 9(2).
(3) The Complaints Register shall contain the following information: Serial number; Incoming number; Date of receipt; Place of lodgement, Type of complaint/signal; Complainant (natural or legal person); Identity number/EIC; Concerning (subject matter of the complaint); Complainant's legal details, date forwarded; Outgoing number of the response; Date of outgoing number of the response; Validity of the complaint/signal, subject matter of the complaint and summary of the complainant's allegations and claims, available information concerning: class of insurance; name of insurance product, policy number; summary contents of the complaint response; brief description of the consequences of the complaint; information about the archiving of the complaint file.
(4) In the Register of Complaints, complaints and signals shall be classified according to the nature of the complaint, such as:
(a) relating to quality of service and administrative matters;
(b) relating to insurance and/or reinsurance mediation carried out by the Broker.
Art. 7. (1) A response to a Complaint/Complaint shall be prepared after a thorough and impartial examination of the facts of the case and consideration of the explanations and objections of the parties concerned, and the Broker shall:
(a) fully uphold the Complaint / Alert submitted by offering the Payment Service User a possible solution to the problem, if any;
b) upholds the Complaint/Alert in part, giving reasons why the Complaint has not been upheld in full;
(c) reject the complaint/alert in its entirety, giving reasons why the complaint has been rejected;
(d) inform the complainant that he/she is not competent to rule on the complaint/allegation lodged, informing him/her to whom he/she may appeal.
(2) The prepared reasoned response shall be sent to the Insurance Service User and/or to the relevant Supervisory Authority or State Institution through which the Complaint was received, based on all information gathered in the case.
(3) In the case of a decision which does not fully or partially satisfy the complainant's request, the Broker shall substantiate the response with a comprehensive statement of the established facts and circumstances and exhaustive legal considerations with reference to the relevant statutory provisions and contractual clauses. In the event of a decision which does not satisfy the complainant's request in whole or in part, it shall inform the complainant of his rights to apply to the Financial Supervision Commission (or, where the complainant is carrying on business under the right of establishment or the freedom to provide services, to another competent supervisory authority); to refer the matter to an out-of-court dispute resolution body; to bring an action before a competent court; and to claim from the insurer under the insurer's compulsory professional indemnity insurance b
(4) In the event that the complaint is sent to the insurance broker through the Financial Supervision Commission, the Consumer Protection Commission, the Ombudsman or any other body protecting the rights of users of insurance services, the insurance broker shall send a copy of the reply to the relevant institution.
Sec. 8. (1) The response shall be prepared in writing by the Manager and shall be sent to the submitter within 20 days from the date of receipt of the Complaint or Alert by the Broker, regardless of the manner in which it was received. In any event, the response shall be prepared by a person who is not in a position to exercise discretion over his or her own insurance distribution activities.
(2) In the event of objective circumstances, the time limit referred to in the preceding paragraph may be extended, but not later than one month from the date of registration of the Complaint or Alert, of which the Complainant/Signal shall be notified.
(3) In the case of a Complaint sent through the Financial Supervision Commission, the Consumer Protection Commission, the Commission for Protection of Competition, the Commission for Protection of Personal Data, the Ombudsman or any other state institution, the time limits for response set out in the relevant law and set out as a requirement in the letter addressed to the Broker shall be observed.
(4) The same shall apply in cases where the Broker is required to provide explanations or may make objections before or after the drawing up of a statement of infringement.
(5) Replies to Insurance Service Users shall be sent by letter with acknowledgement of receipt or to the e-mail address of the sender specified in the complaint.
Chapter III
ANALYSIS, REPORTING AND MONITORING
Art. 9. (1) All employees of INSURANCE BROKER LEX INS LTD shall be responsible for ensuring compliance with the provisions of these Rules and exercising appropriate control.
(2) The registration and administration of complaints/signals and responses, the completion of the Register and the storage and archiving of documents shall be carried out by an employee(s) at Head Office designated by order of the Manager.
Art. 10. (1) On a quarterly basis, the designated officers shall analyze the Complaints/Complaints received and prepare quarterly reports to be submitted to the Broker's governing body.
(2) The reports shall contain information on the total number of Complaints and Alerts received for the period; the number of closed and substantiated Complaints; an analysis of the types of Complaints; a definition of recurring weaknesses in the formulation of procedures; and recurring weaknesses in service to users of insurance services, and the reasons therefor. In this connection, suggestions are made for improving the Broker's activities in the relevant area.
(3) In the event that, on the basis of the reports prepared pursuant to the preceding paragraphs, weaknesses in the Broker's operations are identified, the Management Body shall immediately take measures to eliminate the causes leading to the same, specifying the persons responsible and the time limits for eliminating the identified material weaknesses.
(4) In the event of identified need and/or opportunities for improvement (e.g. legislative changes, new guidelines or instructions from competent institutions, identification of conditions affecting the rights and interests of Insurance Service Users as a result of these Rules and the practice of their implementation), the Governing Body will review and update the Policy without delay, but at least once a year.
Art. 11 The Complaints Management function shall establish and maintain a file on each complaint, which shall be retained for the period of the statute of limitations within which claims may be brought in court in relation to alleged violations of the law, and where the complaint does not concern a violation of a justiciable right, the file shall be retained for a period of 5 years from the date of the response.