Complaints Procedure

1. What is the purpose of this document?

Optivest Health Services (Pty) Ltd is a licensed Financial Services Provider, FSP No:13475, with the authority to provide financial advice and intermediary services in terms of the Financial Advisory and Intermediary Services Act on medical schemes and health cover-related products.  As such we have certain specific duties to you, our clients. One of these duties is to offer you a formal complaints resolution system, which will enable you to exercise your rights as provided for in the Financial Advisory and Intermediary Services Act.  The purpose of this document is to inform you of how you can make use of our complaints resolution system, to your advantage. This document can be found on our website (www.optivest.co.za); at our offices at 9 Queen Street, Durbanville, 7550 or it can be requested by phoning (021) 975-2266.

2. What is our complaints resolution procedure?

2.1.   Procedure when submitting a complaint to us:

If Optivest or any of its representatives provided you with health cover financial advice or any other intermediary service, and you feel that we or our representative-

• did not comply with the Financial Advisory and Intermediary Services Act and that you suffered financial prejudice as a result;
• intentionally or negligently gave financial advice or rendered an intermediary service to you which caused prejudice or damage or is likely to cause damage;
• treated you unfairly,

you must please write us a letter to Optivest Health Services (Pty) Ltd, send us an e-mail to complaints@optivest.co.za, send us a fax to 087 018 0005, with the following information:

1. Your name, surname and contact details;
2. A complete description of your complaint;
3. The name of the person who provided you with health cover financial advice or an intermediary service;
4. The date on which the matter complained about happened;
5. All documentation relating to your complaint;
6. How you would prefer to receive communication from us regarding your complaint i.e. by e-mail, fax, post and please provide us with the e-mail address, fax number or address where you would prefer to receive such communication.

2.2.   Our procedure when receiving your complaint:

1. As soon as we receive your complaint, we will send you an acknowledgement of receipt. Please take into consideration that the method of communication chosen by you will determine how quickly we will receive and respond to your complaint.
2. We will investigate and attempt to resolve your complaint to your satisfaction within 6 weeks of receipt of your complaint.
3. If we are unable to resolve your complaint within 6 weeks, or are unable to resolve the complaint to your satisfaction, you have the right to refer your complaint to the Ombud appointed specifically for this purpose. The contact details of the Ombud is as follows:

Please note: You must refer the complaint to the Ombud within 6 months from the date of the notice in which we inform you that we cannot resolve the complaint to your satisfaction.

3. What are the rules that you must keep in mind when you approach the Ombud?

What kind of complaints is considered by the Ombud?

• The complaint must relate to financial advice or intermediary service rendered and must have the following content:
  • that the financial services provider contravened the Financial Advisory and Intermediary Services Act which resulted / may result in the complainant suffering financial damage;
  • that the financial services provider negligently, or intentionally provided advice or an intermediary service that caused / may cause prejudice or damage to the complainant;
  • the complainant was treated unfairly.
• The complaint must not be about the performance of the financial product, unless-
  • financial performance was guaranteed; or
  • the financial performance was so deficient that it creates the presumption that there has been misrepresentation, negligence or mal-administration on the part of the person complained against.

Conditions applicable to complaints:

• The act or omission complained of must have been done on or after 30 September 2004.
• The complaint must be received by the Ombud within 3 years of the act or omission that resulted in the complaint – if the complainant was not aware of the act or omission, the 3 years starts running from the date on which the complainant became aware, or from the date on which the reasonable person in his circumstances would have become aware, whichever date is the earliest.
• If the complainant already instituted action in a court of law relating to the matter forming the subject of the complaint submitted to the Ombud, the Ombud will not consider the complaint.
• The financial services provider must have been given the opportunity to resolve the complaint first. Only if he or she failed to resolve the compliant to the satisfaction of the complainant within 6 weeks of receipt, may the complainant take the matter to the Ombud.
• The complainant has 6 months after he received a final response from the person complained against, to go to the Ombud.
• Complaints must be in writing and must be accompanied by relevant documentation.
• The Ombud may refuse to consider a complaint if he believes that the complaint should be dealt with in court.

What must the person complained against, do?

• Acknowledge receipt of complaint;
• If unable to resolve the complaint to the satisfaction of the complainant within 6 weeks, inform the complainant of his right to refer the complaint to the Ombud, and to do this within 6 months of receipt of the notice.

Procedure followed by Ombud:

• The Ombud officially receives the complaint.
• The running of prescription (under the Prescription Act) is suspended from the date on which the official receipt of complaint is received by the complainant until-
  • the complaint is withdrawn;
  • a determination is made by the Ombud or by the Board of Appeal.
• The person complained against may have to pay up to R1000 when the Ombud officially receives a complaint.
• The Ombud does not start the investigation of the complaint before-
  • He has informed all interested parties of the complaint, and of all particulars necessary to enable them to respond to the complaint;
  • Gave all parties opportunity to respond.
• The Ombud will discontinue an investigation of a complaint in respect of which the complainant instituted action in court while the Ombud was investigating the complaint.
• The Ombud will first attempt to resolve the complaint through conciliated settlement acceptable to all parties.
• The Ombud may make a recommendation to the parties to resolve the complaint.

Determinations by Ombud and its legal status:

• If the complaint was not resolved through conciliated settlement, the Ombud will make a determination which has the legal status of a civil judgement of court.
• The determination can be a monetary award (not exceeding R800 000, unless the person complained against agrees to it), or any other order that can be made by a court.
• An award of costs may be made against the person complained against.
• An award of costs may be made against a complainant if the conduct of the complainant was improper or unreasonable, or if the complainant caused an unreasonable delay in the finalisation of the investigation.

Appeals to Board of appeal:

• It is possible to appeal to the Board of Appeal, only if the Ombud gives leave to appeal. If the Ombud refuses, the chairperson of the Board of Appeal can be requested for permission to appeal.
• Application for leave to appeal must be made to the Ombud within 1 month of the Ombud’s determination.
• If the Ombud refuses leave to appeal, application for leave to appeal may be made to the Chairperson of the Board of Appeal, within 1 month of the Ombud’s refusal – the applicant must inform the Ombud of his application.
• A determination by the Board of Appeal has the same status as a judgement of a civil court.

4. Internal Complaints resolution procedure

The following table describes the internal complaints resolution procedure and what process OPTIVEST follows to resolve the complaint:

1. If the client is not satisfied with the outcome and requests proof of the call recordings, this can only be done in a form of a transcript. The request needs to be sent to the Quality Assurance Team whom will transcribe the relevant call(s) and provide feedback to the Responsible Person within 3 – 5 working days.
2. If the outcome of the complaint is not in the client’s favour, reasons must be provided and the Incident Report
3. Should a client not be satisfied with the details pertaining to the transcript and wants to escalate the matter further, the client may be directed to the FAIS Ombud at https://faisombud.co.za/ whom will investigate the complaint and request all relevant details from OPTIVEST.

5. Protection of Personal Information Act (POPIA) Complaints

Optivest Health Services is committed to protecting your privacy and developing technology that gives you the most powerful and safe online experience. This Statement of Privacy applies to the Optivest Health Services, our website and governs data collection and usage. By using Optivest Health Services and our website, you consent to the data practices described in our Privacy Policy.

Ensuring that Optivest Health Services makes it convenient for data subjects who want to update their personal information or submit POPIA related complaints to Optivest Health Services. For instance, maintaining a “contact us” facility on Optivest Health Services’s website.

POPIA COMPLAINTS PROCEDURE

Data subjects have the right to complain in instances where any of their rights under POPIA have been infringed upon. Optivest Health Services takes all complaints very seriously and will address all POPI related complaints in accordance with the following procedure.

Complaints need to be sent to compliance@optivest.co.za

• POPI complaints must be submitted to Optivest Health Services in writing. Where so required, the Information Officer will provide the data subject with a “POPI Complaint Form”.
• Where the complaint has been received by any person other than the Information Officer, that person will ensure that the full details of the complaint reach the Information Officer within 1 working day.
• The Information Officer will provide the complainant with a written acknowledgement of receipt of the complaint within 2 working days.
• The Information Officer will carefully consider the complaint and address the complainant’s concerns in an amicable manner. In considering the complaint, the Information Officer will endeavour to resolve the complaint in a fair manner and in accordance with the principles outlined in POPIA.
• The Information Officer must also determine whether the complaint relates to an error or breach of confidentiality that has occurred and which may have a wider impact on Optivest Health Services’s data subjects.
• Where the Information Officer has reason to believe that the personal information of data subjects has been accessed or acquired by an unauthorised person, the Information Officer will consult with Optivest Health Services’s governing body where after the affected data subjects and the Information Regulator will be informed of this breach.
• The Information Officer will revert to the complainant with a proposed solution with the option of escalating the complaint to Optivest Health Services’s governing body within 7 working days of receipt of the complaint. In all instances, Optivest Health Services will provide reasons for any decisions taken and communicate any anticipated deviation from the specified timelines.
• The Information Officer’s response to the data subject may comprise any of the following:
  • A suggested remedy for the complaint,
  • A dismissal of the complaint and the reasons as to why it was dismissed,
  • An apology (if applicable) and any disciplinary action that has been taken against any employees involved.
• Where the data subject is not satisfied with the Information Officer’s suggested remedies, the data subject has the right to complain to the Information Regulator.
• The Information Officer will review the complaints process to assess the effectiveness of the procedure on a periodic basis and to improve the procedure where it is found wanting. The reason for any complaints will also be reviewed to ensure the avoidance of occurrences giving rise to POPI related complaints.

The Right to Complain to the Information Regulator

If you believe that we have used your personal information contrary to this Privacy Policy, please first attempt to resolve any concerns with us directly using the information above. If you are not satisfied after this process, you have the right to lodge a complaint with the Information Regulator, under the Protection of Personal Information Act.

Their contact details are:

Street Address: 

The Information Regulator (South Africa)

JD House, 27 Stiemens Street

Braamfontein

Johannesburg

2001

General enquiries

Phone: 010 023 5200

Email: enquiries@inforeg.org.za

Complaint’s email:

PAIAComplaints@inforegulator.org.za – should your PAIA request be denied or there is no response from a public or private bodies for access to records you may use this email address to lodge a complaint. You may use and complete the prescribed PAIA form which is available on the Information Regulator’s website.

POPIAComplaints@inforegulator.org.za – should you feel that your personal information has been violated, you may use this e-mail address to lodge a complaint. You may use and complete the prescribed POPIA form which is available on the Information Regulator’s website.

Website: https://inforegulator.org.za/