DEFINING RIGHTS AND RESPONSIBILITIES
Rights are defined in the legal dictionary as “the collection of entitlements which a person may have and which are protected by the government and the courts, or under an agreement (contract).” Responsibilities on the other hand are defined as “the obligation to answer for an act done, and to repair any injury it may have caused. This obligation arises without any contract, either on the part of the party bound to repair the injury, or of the party injured. The law gives to the person who has suffered loss, compensation in damages.” In other words, responsibilities do not always have to originate from a signed agreement or contract and can be seen as a general duty of a person.
It is important for all stakeholders, especially within the insurance industry, to be fully aware of their rights and responsibilities as well as those of others. This article provides a general overview of the rights and responsibilities of the insured, the insurers or reinsurers (including insurance intermediaries, hereinafter collectively referred to as “insurance entities”) and the Regulator. It is important to note that the rights and responsibilities are not conclusive, but more of a general guideline taking the relevant regulatory and legal framework into consideration.
It is important for all stakeholders, especially within the insurance industry, to be fully aware of their rights and responsibilities as well as those of others. This article provides a general overview of the rights and responsibilities of the insured, the insurers or reinsurers (including insurance intermediaries, hereinafter collectively referred to as “insurance entities”) and the Regulator. It is important to note that the rights and responsibilities are not conclusive, but more of a general guideline taking the relevant regulatory and legal framework into consideration.
THE INSURED (OR POLICYHOLDER)
As a consumer of insurance products, you, the policyholder/insured, have the following rights:
• The right to information of the insurance agent, broker or reinsurance broker (hereinafter collectively referred to as insurance intermediary);
• The right to information of the insurance or reinsurance company;
• The right to detailed and comprehensive information of the insurance products and insurance policy contract;
• This information should be clear and unambiguous;
• This information should include product benefits, exclusions, penalties, restrictions, waiting periods, excess, terms and conditions;
• Disclosure of total costs is imperative, including commission, fees and/or charges;
• Disclosure of claims and complaints procedures.
• The right to freedom of choice in respect of dealings with any insurance entity;
• The right to cancel your policy taking into consideration the requirement of any notification of cancellation periods as stipulated by the insurer;
• The right to an explanation of any questions in respect of policy contract wordings and terms and conditions;
• The right to obtain a policy which is a valid written short-term insurance contract (according to the Short-term Insurance Act No. 4 of 1998, the Act) from the insurer or reinsurer, which can usually be expected within 30 days depending on the agreement and rights and obligations of the parties involved;
• The right to hold your insurance intermediary accountable for the payment of premiums to the insurer;
• The right to privacy and confidentiality;
• The right to complain to NAMFISA and have these complaints dealt with in a timely and forthright manner;
• The right to obtain legal representation and to take an insurance entity to Court.
As a consumer of insurance products, you, the policyholder/insured, have the following responsibilities:
• To ensure you only deal with registered insurance entities;
• To fully and accurately disclose all information required for quotation purposes;
• To fully acquaint yourself with the policy contract and terms and conditions before signing the contract and accepting insurance cover;
• To not sign blank or partially completed application forms;
• To ensure safekeeping of your contract and supporting documents;
• To inform the insurance intermediary and insurer of any changes in contact details or life events;
• To ensure payment of premiums by the required date as per the agreed contract;
• To shop around for additional quotations in order to make a financially sound and well-informed decision.
• The right to information of the insurance agent, broker or reinsurance broker (hereinafter collectively referred to as insurance intermediary);
• The right to information of the insurance or reinsurance company;
• The right to detailed and comprehensive information of the insurance products and insurance policy contract;
• This information should be clear and unambiguous;
• This information should include product benefits, exclusions, penalties, restrictions, waiting periods, excess, terms and conditions;
• Disclosure of total costs is imperative, including commission, fees and/or charges;
• Disclosure of claims and complaints procedures.
• The right to freedom of choice in respect of dealings with any insurance entity;
• The right to cancel your policy taking into consideration the requirement of any notification of cancellation periods as stipulated by the insurer;
• The right to an explanation of any questions in respect of policy contract wordings and terms and conditions;
• The right to obtain a policy which is a valid written short-term insurance contract (according to the Short-term Insurance Act No. 4 of 1998, the Act) from the insurer or reinsurer, which can usually be expected within 30 days depending on the agreement and rights and obligations of the parties involved;
• The right to hold your insurance intermediary accountable for the payment of premiums to the insurer;
• The right to privacy and confidentiality;
• The right to complain to NAMFISA and have these complaints dealt with in a timely and forthright manner;
• The right to obtain legal representation and to take an insurance entity to Court.
As a consumer of insurance products, you, the policyholder/insured, have the following responsibilities:
• To ensure you only deal with registered insurance entities;
• To fully and accurately disclose all information required for quotation purposes;
• To fully acquaint yourself with the policy contract and terms and conditions before signing the contract and accepting insurance cover;
• To not sign blank or partially completed application forms;
• To ensure safekeeping of your contract and supporting documents;
• To inform the insurance intermediary and insurer of any changes in contact details or life events;
• To ensure payment of premiums by the required date as per the agreed contract;
• To shop around for additional quotations in order to make a financially sound and well-informed decision.
THE INSURER (INCLUDING THE INTERMEDIARY)
As an insurer and/or insurance intermediary, you have the following rights:
• The right to provide insurance products and cover as per your registration and licence per class of insurance business;
• The right to premiums based on your risk profile;
• The right to cancel a policy as per the agreed notification of cancellation as per the policy contract;
• The right to assess, approve and/or repudiate claims providing valid reasons thereof as per the policy contract and terms and conditions;
• The right to full disclosure of information by the consumer;
• The right to accept or reject the insurance cover of a client based on valid reasons;
As an insurer and/or insurance intermediary, you have the following responsibilities:
• The responsibility to ensure that the insurance entities dealt with are registered;
• The responsibility to correctly allocate premiums received by policyholders;
• For intermediaries this means the responsibility to pay the premiums received by policyholders to the insurer within 45 days as per the Regulations;
• For insurers/reinsurers this means the correct allocation to the relevant policyholder’s account as well as under the correct insurance class;
• The responsibility to notify NAMFISA should the insurer/reinsurer become aware of misappropriation of premiums by the insurance intermediary within 30 days;
• The responsibility to ensure compliance with the relevant Regulatory framework, i.e. Short-term Insurance Act (No. 4 of 1998) and the Regulations to the Act;
• The responsibility to train employees and/or insurance intermediaries on the products and providing of fair and sound advice;
• The responsibility to ensure the fair treatment of policyholders;
• The responsibility to safeguard client’s information and use it only for what it is intended;
• The responsibility to ensure the financial well-being of the insurance entity;
• The responsibility to ensure all employees (persons dealing with policyholders, i.e. broker or agents) are experienced, ethical, qualified and registered.
• The right to provide insurance products and cover as per your registration and licence per class of insurance business;
• The right to premiums based on your risk profile;
• The right to cancel a policy as per the agreed notification of cancellation as per the policy contract;
• The right to assess, approve and/or repudiate claims providing valid reasons thereof as per the policy contract and terms and conditions;
• The right to full disclosure of information by the consumer;
• The right to accept or reject the insurance cover of a client based on valid reasons;
As an insurer and/or insurance intermediary, you have the following responsibilities:
• The responsibility to ensure that the insurance entities dealt with are registered;
• The responsibility to correctly allocate premiums received by policyholders;
• For intermediaries this means the responsibility to pay the premiums received by policyholders to the insurer within 45 days as per the Regulations;
• For insurers/reinsurers this means the correct allocation to the relevant policyholder’s account as well as under the correct insurance class;
• The responsibility to notify NAMFISA should the insurer/reinsurer become aware of misappropriation of premiums by the insurance intermediary within 30 days;
• The responsibility to ensure compliance with the relevant Regulatory framework, i.e. Short-term Insurance Act (No. 4 of 1998) and the Regulations to the Act;
• The responsibility to train employees and/or insurance intermediaries on the products and providing of fair and sound advice;
• The responsibility to ensure the fair treatment of policyholders;
• The responsibility to safeguard client’s information and use it only for what it is intended;
• The responsibility to ensure the financial well-being of the insurance entity;
• The responsibility to ensure all employees (persons dealing with policyholders, i.e. broker or agents) are experienced, ethical, qualified and registered.
THE REGULATOR
As the Regulator, the following rights are applicable:
• The right to supervise and regulate the insurance industry and industry players in terms of the legislation;
• The right to inspect registered insurance entities;
• The right to request information;
• The right to ensure compliance with the Act;
• The right to register and deregister insurance entities;
• The right to impose penalties and cancellation of licences upon proving misconduct and non-compliance to the Act.
The Regulator has the following responsibilities:
• To ensure the wellbeing and fair treatment of the insured at large;
• To ensure employment of staff with similar values and vision as the Regulator;
• To ensure the financial soundness of insurance entities;
• To ensure the protection of consumers of non-banking financial services;
• To ensure the reduction and deterrence of misconduct, unethical conduct and crime;
• To ensure the promotion of public awareness and understanding of financial institutions and markets;
• To ensure the highest standards of conduct of business by industry players/stakeholders.
• The right to supervise and regulate the insurance industry and industry players in terms of the legislation;
• The right to inspect registered insurance entities;
• The right to request information;
• The right to ensure compliance with the Act;
• The right to register and deregister insurance entities;
• The right to impose penalties and cancellation of licences upon proving misconduct and non-compliance to the Act.
The Regulator has the following responsibilities:
• To ensure the wellbeing and fair treatment of the insured at large;
• To ensure employment of staff with similar values and vision as the Regulator;
• To ensure the financial soundness of insurance entities;
• To ensure the protection of consumers of non-banking financial services;
• To ensure the reduction and deterrence of misconduct, unethical conduct and crime;
• To ensure the promotion of public awareness and understanding of financial institutions and markets;
• To ensure the highest standards of conduct of business by industry players/stakeholders.