SHORT-TERM insurance RIGHTS AND RESPONSIBILITIES

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.

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 unam-biguous;
• This information should include product bene-fits, exclusions, penalties, restrictions, waiting periods, excess, terms and conditions;
• Disclosure of total costs is imperative, includ-ing commission, fees and/or charges;

• Disclosure of claims and complaints proce-dures.
• The right to freedom of choice in respect of deal-ings with any insurance entity;
• The right to cancel your policy taking into con-sideration 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 writ-

ten short-term insurance contract (according to the Short-term Insurance Act No. 4 of 1998, the Act) from the insurer or reinsurer, which can usu-ally be expected within 30 days depending on the agreement and rights and obligations of the par-ties 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 forth-right 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 con-tract and accepting insurance cover;
• To not sign blank or partially completed applica-tion forms;
• To ensure safekeeping of your contract and sup-porting 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 noti-fication of cancellation as per the policy contract;
• The right to asses, 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 en-tities dealt with are registered;
• The responsibility to correctly allocate premiums

received by policyholders;

• For intermediaries this means the responsibil-ity to pay the premiums received by policy-holders to the insurer within 45 days as per the Regulations;

• For insurers/reinsurers this means the correct allocation to the relevant policyholder’s ac-count as well as under the correct insurance class;
• The responsibility to notify NAMFISA should the insurer/reinsurer become aware of misappropria-tion 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 Regula-tions to the Act;

• The responsibility to train employees and/or in-surance intermediaries on the products and pro-viding of fair and sound advice;

• The responsibility to ensure the fair treatment of policyholders;

• The responsibility to safeguard client’s informa-tion 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 (per-sons dealing with policyholders, i.e. broker or agents) are experienced, ethical, qualified and registered.

THE REGULATOR

As the Regulator, the following rights are appli-cable:

• The right to supervise and regulate the insurance industry and industry players in terms of the leg-islation;

• 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 enti-ties;

• The right to impose penalties and cancellation of licences upon proving misconduct and non-com-pliance 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 val-ues 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 miscon-duct, unethical conduct and crime;

• To ensure the promotion of public awareness and understanding of financial institutions and mar-kets;

• To ensure the highest standards of conduct of business by industry players/stakeholders

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