Insurance Regulation: New Mechanism for Receiving and Adjudicating Complaints

- A maximum of 3 working days for the final resolution of complaints

- Escalation to the Unit is permitted after 7 days, with a maximum duration of 30 days

- 15 escalated complaints within a year require holding the company accountable

- Appeals against the Decisions Committee’s rulings must be filed within 30 working days

- Companies are mandated to appoint a responsible officer and a deputy to follow up on complaints

The Insurance Regulation Unit issued a new decision regarding the regulation of the mechanism for receiving and resolving complaints. This decision introduces a new framework for managing complaints, repeals previous regulations on the matter, and sets a maximum of 3 working days for the final resolution of a complaint from the date of its submission. It allows for escalation to the Unit after 7 days, with the escalation period not exceeding 30 days from the date of submission. Furthermore, it stipulates that companies against which 15 escalated complaints have been filed will be held accountable.

The decision mandates the establishment of an electronic system within the Unit to manage complaints filed by stakeholders against licensed companies, track them, exchange information regarding them, and resolve them. Each complaint will have a dedicated record and a reference number.

The decision requires that complaints and supporting documents be submitted through the electronic system, utilizing the authentication feature provided by the Public Authority for Civil Information via the "Huwiyati" application or other government websites and applications. This applies whether the complainant submits the complaint personally or through an agent, guardian, custodian, or legal representative, accompanied by documents proving their status and the subject of the complaint. Complaints or documents submitted outside this channel will not be accepted.

If a complaint is filed by a company, ministry, or government entity responsible for managing its legal representation, prior written consent must be obtained, and a letter of authorization and consent must be attached. This letter must confirm that no ongoing litigation exists regarding the subject of the complaint.

The decision obligates the entity against which a complaint is filed to periodically follow up on complaints submitted against it, verify the existence of an insurance relationship with the complainant, request necessary documents for resolution, and provide a complete claim file upon receipt of a new complaint. This file must include the documents relied upon to accept or reject the claim, with clear explanations for the reasoning behind each document.

The decision emphasizes the necessity of submitting documents clearly and legibly, ensuring all pages are included without omission, and providing certified translations if the documents are in a foreign language. Documents must be clearly classified and sorted.

The decision sets a maximum deadline of 3 working days for the final resolution of a complaint from the date of submission. The resolution must include a statement of facts, reasons for acceptance or rejection, insurance and legal justifications, supporting documents, and the basis for calculating compensation, if applicable.

The decision allows the complainant, if dissatisfied with the actions of the entity against which the complaint was filed, to escalate the complaint to the Insurance Regulation Unit via the electronic system after 7 days from the date of submission, with a maximum escalation period of 30 days. The complaint will be automatically closed if this deadline is exceeded.

The decision authorizes the Decisions Committee to issue rulings on complaints, including resolving, archiving, or closing them. These rulings are binding and must be published via the electronic system. The Committee is also empowered to request the complainant to provide additional documents and information deemed necessary within a specified timeframe.

Regarding the invoices and measurement reports submitted as part of the complaints, the decision stipulated compliance with the provisions of Law No. (39) of 2014, requiring that they be drafted in Arabic, with the option to use another language, and that they include the service or goods provider’s details and contact information, details of the service or goods and their value, the invoice or report number and its issue date, and that they be free from erasures, scrapings, or alterations.

The decision specified several cases in which a complaint may be closed, including when it is filed against entities not subject to the Unit’s supervision, when it lacks specific content or an insurance relationship, or when its malicious intent is proven. It also covers complaints regarding disputed refund amounts between entities under the Unit’s supervision for which no final judicial rulings have been issued.

Other cases include complaints filed by employees of regulated entities against their superiors, repeated complaints that do not contain new facts, or those that do not meet the requirements for documents and attachments proving the complainant’s legal standing. Additionally, it covers complaints related to a company subject to the procedures of the Bankruptcy Law No. (71) of 2020.

The decision permitted licensed individuals and companies to file complaints against other licensed companies due to their refusal or unjustified delay in executing a final judicial ruling issued in favor of the complainant.

In such cases, the role of the Complaints Committee is limited to referring the non-compliant company to the competent authority to take legal measures in accordance with Articles (52) and (55) of the Insurance Regulation Law.

To accept this type of complaint, the decision required that the ruling be final and issued against one of the companies, that no order to suspend its execution has been issued, that an execution file has been opened with the competent authority and at least one month has passed since the announcement of the executable form, while the company continues to refuse execution, and that no previous complaint has been filed regarding the same ruling unless new facts have emerged.

The decision allowed any interested party to appeal before the Appeals Committee against the Complaints Committee’s decisions within 30 working days from the date of their issuance. Interested parties are to be notified electronically via the system, and such notification is considered received and effective upon its attachment to the system.

The decision also obliged licensed companies to prepare and update a written procedure manual for handling customer complaints and publish it on their websites. This manual must include mechanisms for submitting, receiving, archiving, and numbering complaints, notifying customers of receipt, processing and settling complaints, and informing them of investigation results.

Furthermore, the decision required companies to appoint a complaints follow-up officer and a deputy, both of whom must reside in Kuwait. The Unit must be provided with their names and have their data updated whenever requested.

Regarding violations, the decision stipulated legal liability for non-compliant companies, including failing to submit a complete claim file within the specified period, submitting an incomplete, partial, or unclear file, failing to complete documents within deadlines set by the Committee, or the company’s refusal to execute the Committee’s decisions.

It also considered reaching 15 escalated complaints against a complained-against entity within a calendar year, with decisions issued in favor of the complainants, as a ground for accountability.

The Unit was authorized to impose an administrative fine on the complained-against entity for each escalated complaint where negligence or non-compliance with prescribed responsibilities was proven. The fine is to be issued by the Disciplinary Board, and its value must be deposited with the Unit within 15 days from the date the company is notified of it.

The new decision annuls Decision No. (1/2022) concerning the regulation of the mechanism for receiving and adjudicating complaints, Decision No. (6/2023) concerning the addition and amendment of certain provisions thereof, and any provision that conflicts with the new decision. It shall take effect from the date of its issuance and be published in the Official Gazette.