INSURANCE AND RETIREMENT FUNDS ADJUDICATOR
Established in terms of S. 91 of the Insurance Act, 2005 and S. 44 of the Retirement Funds Act, 2005.
RESOLUTION OF INSURANCE AND RETIREMENT COMPLAINTS IN A PROCEDURALLY FAIR, ECONOMICAL AND EXPEDITIOUS MANNER.
WHO CAN COMPLAIN TO THE ADJUDICATOR?
Retirement Funds Act, 2005
A complainant must be a member or former member of a pension fund; employer who participates in a fund; the Board of management of a fund; a member of the Board; any person who has an interest in a complaint.
Insurance Act, 2005
A complainant can be a person who is or claims to be the proposer of a policy; beneficiary; former beneficiary under a policy; a person who has financial interest in a complaint/policy.
WHAT YOU CAN COMPLAIN ABOUT?
RETIREMENT FUND COMPLAINT: must relate to the administration of a fund; the investment of fund asset; or application of fund rules. Additionally, the complainant must allege one or more of the following;
- That the fund has made a decision outside its powers;
- That the complainant has been prejudiced as a result of maladministration by the fund;
- That a dispute of fact or law has arisen in relation to a fund between the fund or any person and the complainant; or
- That an employer who participates in the fund has not fulfilled its duties in terms of the rules of the fund.
INSURANCE COMPLAINT: must relate to the application and interpretation of the terms and conditions of a policy; the conduct of any person in relation to insurance business. The person complaining must allege one or more of the following:
- That a decision of an insurer or any person purportedly taken in terms of the policy terms and conditions was in excess of his/its powers; results in improper exercise of powers;
- That the interest of the complainant has or will be prejudiced as a result of the decision, whether by act or omission;
- That a dispute of fact or law pertaining to insurance business has arisen between any person and the complainant;
- That the person against whom the complaint is made has not fulfilled their duties in terms of the policy terms and conditions.
A complaint must relate to any of the above specific complaints.
In making an allegation you must set out the facts supporting the allegation and the conclusions you have drawn from those facts. In other words, state what actually has happened and why you feel that such events amount to maladministration; excess of powers; a dispute of law or fact; dereliction of duty by employer etc.
You must complain in writing to the insurance company, broker, pension fund or employer concerned, at least 30 days before you can lodge your complaint with the Adjudicator.
NB* ESSENTIAL DOCUMENTS TO ATTACH TO YOUR COMPLAINT
Names; ID number; physical and postal addresses; phone & fax numbers; e-mail address.
State whether you are a member/ Policy holder or a Beneficiary or other.
If you are a beneficiary, state the name of the member whose beneficiary you are.
Full name & address of employer; phone & fax numbers; e-mail address.
When employed Date from…to…
Details of Insurance Co/Broker : Name and address (Postal and physical); fax & phone numbers; email address.
Retirement fund complaint
Details of Fund/Employer : Postal & physical address; phone & fax numbers; e-mail address;
Name of principal Officer (if known);Type of Fund (pension fund, provident fund, preservation fund, retirement annuity fund, or other).
Complaint must be submitted together with proof of the following:
Initial written complaint made to Insurance Co / Broker/ Fund/ Employer
Copy of any reply to the initial complaint made
Copies of relevant documents e. g fund membership certificate; benefit statement; policy document; payslip showing pension/insurance premium deductions; documents and correspondence concerning the complaint.
The complaint must be set out in full but concise details, also stating what you would like the Adjudicator to do to rectify the situation.
YOU MUST SEND AN IDENTICAL COPY OF THE COMPLAINT TO THE RESPONDENT(S).
Office of the Insurance and Retirement Funds Adjudicator
Suite 69B, 6th Floor, MBANDZENI HOUSE
P. O. BOX 8490
TEL: +268 2404 7653
FAX: +268 2404 0636