Complaints and dispute resolution process
Emergence Insurance Pty Ltd (Emergence) is committed to meeting and exceeding our clients’ expectations whenever possible and would like to know if your expectations haven’t been met.
What is a complaint: A complaint is an expression of dissatisfaction relating to our products or services or our complaints handling process itself, where a response or resolution is explicitly or implicitly expected. You are entitled to make a complaint about any aspect of your relationship with Emergence including the conduct of its agents and authorised representatives. Emergence will attempt in good faith to resolve any complaint/dispute in a fair, transparent and timely manner.
The complaints process described below does not apply to your complaint if Emergence resolves it to your satisfaction by the end of the 5th business day after your complaint was received by Emergence, and you have not requested a response in writing. The exemption to the complaints process does not apply to complaints regarding a declined claim, the value of a claim or financial hardship.
This policy complies with the General Insurance Code of Practice.
We will review any financial hardship application in accordance with Section 8 of the General Insurance Code of Practice and any applicable guidelines.
1.COMPLAINTS PROCESS (STAGE 1)
1.1 What to do if you have a complaint
To allow Emergence to consider your complaint the following information needs to be provided (where available):
- Name, address, email and telephone number of the policyholder;
- Policy number, claim number and product type;
- Name and address of the insurance intermediary through whom the policy was obtained;
- An explanation of the situation that led to the complaint; and
- Copies of any supporting documentation you believe may assist Emergence in addressing your complaint appropriately.
1.2 How Steadfast UW Agencies will initially handle your complaint
Emergence aims to acknowledge receipt of your complaint by either telephone, email or letter within two business days and advise the name and contact details of the employee assigned to liaise with you.
Emergence will respond to your complaint in writing within 15 business days of first being notified of the complaint, provided Emergence has all the necessary information and have completed any necessary investigations.
If Emergence cannot respond within 15 business days, Emergence will seek to agree a reasonable alternative timetable with you. Emergence will keep you informed of the progress no less than every 10 business days, unless an alternate timetable is agreed. If we cannot reach a reasonable alternative timetable, Emergence will advise you of your right to escalate the complaint to Stage 2 of the complaints process.
2.REFERRAL TO LLOYD’S AUSTRALIA (STAGE 2)
If Emergence’s Stage 1 decision does not resolve your complaint to your satisfaction, you may advise Emergence that you wish to escalate your complaint to Stage 2. You should then contact Lloyd’s Australia Ltd (Lloyd’s Australia). Contact details are:
Following receipt of your complaint, you will be advised whether your dispute will be handled by either Lloyd’s Australia or the Lloyd’s Complaints Team in the UK, or what other avenues are available to you:
- Where your complaint is eligible for referral to the Australian Financial Complaints Authority (AFCA) your complaint will generally be reviewed by a person at Lloyd’s Australia with appropriate authority to deal with your dispute;
- Where your complaint is not eligible for referral to AFCA, Lloyd’s Australia will refer your complaint to the Lloyd’s Complaints team in the UK if it falls within the jurisdiction of the Financial Ombudsman Service Ltd (UK), which will review your complaint and liaise directly with you; or
- For all other matters, you will be advised of what other avenues may be available to you.
Your complaint will be acknowledged in writing within five business days of receipt. You will be kept informed of the progress of the review at least every 10 business days. Generally, you will receive a full written response to your complaint within 15 business days of requesting an escalation of the complaint to Stage 2, provided all necessary information is received and investigations have been completed.
3.EXTERNAL DISPUTE RESOLUTION (STAGE 3)
Stages 1 and 2 will not exceed 45 calendar days in total. If a final decision cannot be provided within 45 calendar days, Lloyd’s Australia will advise you of the reasons for such delay and your right to escalate the matter to AFCA.
If your complaint is not resolved in a manner satisfactory to you, you may refer the matter to either AFCA, where applicable, or the Financial Ombudsman Service Ltd (UK) depending on eligibility related to your policy. AFCA is an independent national scheme for consumers in Australia, free of charge and aimed at resolving disputes between the insured and their insurance intermediary/insurer. AFCA can advise you if your dispute falls within their rules.
If the matter is referred to AFCA, Lloyd’s Australia will receive a further 21 days to resolve the complaint. If the complaint is not resolved during this additional period, Lloyd’s Australia will be required to provide a detailed submission to AFCA.
Determinations made by AFCA are binding on the insurer/intermediary, where relevant. If you would like to refer your dispute to AFCA, you must do so within two years of the final decision from Stage 2. AFCA may consider a dispute lodged after this time if AFCA considers that exceptional circumstances apply.
Australian Financial Complaints Authority contact details are:
Before AFCA can consider your dispute, Emergence and/or Lloyd’s must be given an opportunity to resolve the dispute with you directly. After your dispute is lodged with AFCA (where applicable), they will contact Emergence and/or Lloyd’s and ask for a response from both parties. Response times requested by AFCA vary depending on the situation.
If AFCA advises you that their rules do not extend to you or your dispute, you can seek independent legal advice or access any other external dispute resolution options that may be available to you. If your complaint is not eligible for AFCA, it may be eligible for referral to the Financial Ombudsman Service Ltd (UK). Any referral must occur within six months of the final decision from Stage 2.
The Financial Ombudsman Service Ltd (UK) contact details are: