Insurers offering basic coverage for private passenger vehicles must set up and maintain a complaint process, name a complaint contact, respond in writing within 30 days unless extended, report complaint statistics to the Superintendent on request, and give policyholders information on how complaints are handled.
(Consolidated up to 179/2017) ALBERTA REGULATION 259/2004 Insurance Act COMPLAINT RESOLUTION REGULATION Table of Contents 1 Definitions 2 Duties of insurers 2.1 Complaint to insurer 3 Responding to complaints 4 Complaints resolution process 5 Reports 6 Publication Definitions 1 In this Regulation, (a) “basic coverage” means basic coverage as defined in the Premiums Regulation; (b) “complaint” means a complaint made under section 2.1; (c) “insurer” means an insurer that provides basic coverage for private passenger vehicles; (d) “policyholder” means the person who holds a policy for basic coverage in respect of a private passenger vehicle and includes an applicant for basic coverage or for renewal of basic coverage; (e) “Premiums Regulation” means the Automobile Insurance Premiums Regulation (AR 117/2014); (f) “private passenger vehicle” means a private passenger vehicle as defined in the Premiums Regulation. AR 259/2004 s1;206/2014 Duties of insurers 2 Every insurer must (a) appoint one or more persons to be responsible for receiving and dealing with complaints from policyholders and notify the Superintendent of the name of the person or persons, and (b) establish a complaint resolution process in accordance with this Regulation. AR 259/2004 s2;206/2014 Complaint to insurer 2.1 A policyholder may make a complaint to an insurer, with respect to a calculation, a determination, an action or an incident, if the policyholder (a) is not satisfied with respect to the basis on which a premium for basic coverage for a private passenger vehicle was determined under the Premiums Regulation, or (b) considers that an insurer, directly or indirectly, has with respect to insurance for basic coverage for a private passenger vehicle taken an adverse contractual action contrary to section 555 of the Act. AR 206/2014 s4 Responding to complaints 3 The person appointed by an insurer to receive and to deal with complaints by policyholders must (a) be reasonably available to respond to policyholder’s complaints, (b) facilitate the timely, expeditious and efficient management of complaints, and (c) keep the complaints resolution process of the insurer up‑to‑date, including notifying the Superintendent of any changes to the person or persons responsible for receiving and dealing with complaints. Complaints resolution process 4 (1) An insurer must establish and maintain a complaints resolution process, including the following: (a) a written process describing the means by which complaints are received, processed, considered and responded to within the time referred to in subsection (2); (b) the means by which and the times at which policyholders will be notified of the management of their complaint; (c) the opportunity that will be provided to policyholders to explain their complaint and the manner in which the insurer will respond to the policyholder; (d) a written code of ethical conduct for the manner in which complaints are processed, managed and decided; (e) a fair and efficient process for managing complaints that will allow the insurer to make an attempt in good faith to resolve the policyholder’s complaint. (2) Unless the insurer and policyholder agree to extend the time period, the insurer must notify the policyholder in writing of the insurer’s decision about the policyholder’s complaint within 30 days of the date the insurer receives the complaint. AR 259/2004 s4;206/2014 Reports 5 An insurer must, on the request of the Superintendent, file a written report with the Superintendent covering all the following matters: (a) stating the number of complaints received; (b) stating the number of complaints resolved; (c) categorizing the general nature of the complaints received and the number in each category; (d) providing any other information the Superintendent requests. AR 259/2004 s5;206/2014 Publication 6 An insurer must provide to its policyholders information about the complaint resolution process established in accordance with this Regulation and the person to whom and how complaints may be made. 7 Repealed AR 179/2017 s1.