Dispute Resolution

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Proclaim’s goal in dealing with any customer complaint is to provide a prompt, transparent and fair process for the resolution of complaints and disputes.

Why does Proclaim have an Internal dispute Resolution Policy?

Proclaim’s Internal Dispute Resolution Policy (IDR Policy) incorporates the standards and requirements prescribed by the Corporations Act 2001 and The Insurance Council of Australia Code of Practice.This includes the following general requirements:

  • We will conduct complaints handling in a fair, transparent and timely manner
  • We will make available information about our complaints handling procedures.
  • We will only ask for and take into account relevant information when deciding on your complaint.
  • You will have access to information about you that we have relied on in assessing your complaint and an opportunity to correct any mistakes or inaccuracies.
  • Where an error or mistake in handling your complaint is identified, we will immediately initiate action to correct it.
  • We will keep you informed of the progress of our response to your complaint.

In the event your complaint is not resolved, it will be treated as a dispute and will enter our “Internal Dispute Resolution” (IDR) process. The issue will then be considered by an independent and impartial Officer of Proclaim with the appropriate experience, knowledge and authority to deal with it. In some cases this function will be performed by our insurer client.By documenting our IDR policy in this way, we aim to ensure our staff:

  • Understand and comply with the IDR procedures; and
  • Promote accountability and transparency of the IDR policy.

How do you make a complaint?

A complaint can be made by telephone, in person or in writing. If a complaint is made in writing all responses will also be in writing.If you tell us you want our response reviewed, we will: a. Treat it as a dispute; b. Notify you of the name and contact details of the employee assigned to liaise with you in relation to your dispute; and c. Respond to your dispute within 15 business days provided we receive all necessary information and have completed any investigation required.In cases where further information, assessment or investigation is required we will agree reasonable alternative timeframes. If we cannot reach agreement you can report your concerns to Lloyds Australia.

How do you contact us?

A complaint can be made by contacting us in any of the following ways:Internet:

Website: www.proclaim.com.au
Telephone:    03 9660 5200
Mail:  Proclaim, Level 9, 271 Collins Street, Melbourne, Vic, 3000

What are the time limits for responding to complaints?

If all the relevant information has been received by us, then we will, within 15 business days of receipt of a complaint, either: Complete the investigation and advise you of the outcome; or

  • Refer the matter to our client (where it falls outside our authority): or
  • Advise you of the need for more time to complete our investigation.

What happens next

When we have completed our investigation of your complaint, we will advise you, in writing, of the outcome of the investigation. If the outcome is not in your favour, we will:

  • Advise you of the reasons for our determination; and
  • Advise you that the dispute may be referred to an External Dispute Resolution scheme.

In special circumstances or where a claim is being or has been investigated, we may decline to release information but we will not do so unreasonably. In these circumstances, we will give you reasons. We will provide our reasons in writing upon request.

Lloyd’s Policies

Where the complaint or dispute arises out of a policy issued under a binding authority with an Australian coverholder and we are unable to resolve the issue, the dispute may be referred to Lloyd’s Australia. Further details on this process can be found in the Lloyd’s IDR Leaflet and Proclaim’s Internal Dispute Resolution Policy.

Complaint referral to our Lloyd’s clients

If complaints authority has been delegated to us, we will be required to refer complaints information. In most circumstances we will be required to specifically report complaints reported that have not been resolved by the conclusion of the following business day. Generally the following minimum information must be included within the complaints submissions:

  • Certificate Reference
  • Assureds Name
  • Reason for Complaint: Denial of Claim, Settlement Delay, Partial denial of Claim, Settlement Value queried, Coverage or terms and conditions, standard of/duration/delay of repair, cancellation or refund, customer service, product suitability, other
  • Complaints outcome in the form of: Resolved or Passed onto Insurer
  • Complaints upheld or rejected?
  • Date complaint was upheld or rejected
  • Date of escalation to Ombudsman / regulator where relevant
  • Outcome of Outcome / Regulator decisions

External Dispute Resolution

Where the complaint or dispute arises out of a policy defined as a ‘retail’ insurance product a complainant can escalate an unresolved complaint as follows:

  • To the Financial Ombudsman Service until 31 October 2018
  • To the Australian Financial Complaints Authority (AFCA) on or after 1 November 2018

 

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