CUSTOMER COMPLAINT
HANDLING
Manual
10/12/2014
Contents
I.
Document Distribution & Version Control ............................................................................................ 2
II.
Overview of this document................................................................................................................... 3
A.
Purpose ............................................................................................................................................. 3
B.
Scope ................................................................................................................................................. 3
III.
Definition of a complaint and its importance to ADNIC ................................................................... 4
IV.
Process, Roles & Responsibilities ...................................................................................................... 5
A.
Channels for submitting a complaint ................................................................................................ 5
B.
Acknowledging and Recording the Complaint .................................................................................. 5
C.
Target Resolution Times ................................................................................................................... 5
V.
Escalation Procedure ............................................................................................................................ 7
VI.
Complaints Analysis and Key Performance Indicators ...................................................................... 7
VII.
Process Flowchart ............................................................................................................................. 9
VIII.
Tips on Reacting to a Complaining Customer ................................................................................. 10
IX.
Glossary of Terms............................................................................................................................ 12
A.
X.
Feedback Type ................................................................................................................................ 12
Complaints TAT (Turn around Time) ................................................................................................... 13
A.
Line of Business Wise ...................................................................................................................... 13
B.
TAT for SAM Clients........................................................................................................................ 14
C.
Complaints – Priority types categorization ..................................................................................... 15
D.
Complaint Categories and Sub-Categories ..................................................................................... 16
ADNIC-RSK-04-01 Revision 2
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I.
Document Distribution & Version Control
Issue History:
Rev. #
Date
Preparer
Reviewer &
Approver
Status
Distribution
Group
1
30-04-14
Sethu
Benjamin Graham
Approved
All ADNIC Users
2
12-10-14
Sethu
Benjamin Graham
Approved
All ADNIC Users
Amendments to Document
Rev. #
Date
Page #
Description
2
12-10-2014
8
Updated CMP Process flow
ADNIC-RSK-04-01 Revision 2
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II.
Overview of this document
ADNIC serves corporate and retail customers not just directly, but through business partners as well
(e.g. brokers, medical providers, vehicle repair shops, surveyors & loss adjusters, etc.).
While complete care is taken to ensure high quality service delivery, there are occasions where a
customer will not feel satisfied with the services or product provided.
Due to the importance of commitment to customer service, this documented procedure, supported by
appropriate tools, has been established to define the handling / management of customer complaints
received by any individual, department, unit, branch in ADNIC.
A. Purpose
The purpose of this document is to define a process to manage customer complaints received at various
touch points and the roles and responsibility of the individuals with defined service level agreements
from complaint articulation by the customer to complaint resolution by ADNIC.
This document should help us achieve the below mentioned objective:

Enhancing the reputation of ADNIC, by improving customer confidence, loyalty and satisfaction.
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Creating a mechanism for ADNIC to hear and understand what our customers are thinking about
our products and services.
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Addressing reported customer dissatisfaction, quickly, effectively and fairly.
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Achieving a situation where our customer feels we have addressed their complaint. However, if
he/she remains unsatisfied with the outcome of our efforts, to ensure that he/she is notified of
their right to refer the matter to the appropriate authorities and regulators in the United Arab
Emirates, as the case may be.
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Utilizing the feedback from our customers as an opportunity to enhancing our procedures and
introducing corrective actions to avoid re-occurrences of any problems identified.
B. Scope
The scope of this document is to clearly define and outline the roles and responsibilities of individuals
and the service level of each stage of the complaint process from the time a service request or a
complaint is logged until resolution.
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In addition, it also covers how the data captured is used to draft corrective measures in operations to
eliminate or avoid repeat complaints.
III.
Definition of a complaint and its importance to ADNIC
A complaint is any expression of dissatisfaction by a customer, potential customer or other business
partner related to a service or product provided by ADNIC or on behalf of ADNIC by one of our business
partners; this expression of dissatisfaction will require a response from ADNIC.
Why do people complain?
The aim of complaining is to get compensation (financial and/or non-financial) for adverse effects, or to
change a criticized behavior.
However, 70% of dissatisfied customers don’t complain – they just leave and tell others about the bad
experience. Customers who have a positive experience when voicing a complaint, express more
satisfaction and have a greater tendency to remain loyal.
Common reasons for customers not complaining include:

They did not think they would be heard
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They did not know how to complain or where to go to complain
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They were not sure how to speak of the situation
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They previously complained, and no outcome resulted
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They were worried about repercussions on the employees responsible (i.e. job loss)
To prevent dissatisfied customers from leaving, ADNIC has established a complaint handling process and
various channels to help the customer voice their concerns.
Why are complaints important?
Complaints should be considered as a second chance given to ADNIC by a customer, and not to be taken
as a “bad thing”. Here are some of the reasons why complaints are important:

Complaints can stimulate improvement
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Complaints can provide a window on systemic problems
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Good complaints handling can defuse a crisis and increase customer loyalty and brand value
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Most unhappy customers don’t complain; they just leave and tell on average 10 people about
the bad experience!
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IV.
We want to encourage customers to complain to help us improve.
Process, Roles & Responsibilities
A. Channels for submitting a complaint
There are multiple channels through which complaints can be received.
Channel
Phone Call
Email (customer
service/employee email)
Website
In Person
Fax
Mail
How to Handle
User receiving the call to register it in Lotus Notes CMP
User receiving the email to register it in Lotus Notes CMP
Contact center to register in Lotus Notes CMP
Customer service to provide complaint form to customer or register
complaint directly in Lotus Notes CMP
Fax to be sent to Contact Center for entry in Lotus Notes CMP
Mail to be sent to Contact Center for entry in Lotus Notes CMP
The client may not necessarily want to complain, but may want to provide suggestions, or even
compliments. In such cases, Feedback form would be provided to drop in suggestion box. Complaints
and Suggestions remain valuable to ADNIC and its efforts in improving customer service. For definitions
of “suggestions”, “complaints” and “compliment” please refer to glossary at the end of this document.
B. Acknowledging and Recording the Complaint
Customers’ dissatisfaction will be acknowledged, recorded in the complaints management system (Lotus
Notes Complaints Management Process “CMP”) and a reference number will be provided to the
customer. The complaint will be registered in English language, If in Arabic, it will be translated to
English and logged.
The complaint should be well documented with relevant details (on the person/entity complaining, their
contact information, the experience they had, the date it happened) in order to help ADNIC adequately
address the client’s complaint, and to ensure all information is gathered for legal & regulatory purposes.
Once the complaint is registered, notify the customer of the estimated time it will take for ADNIC to
resolve the complaint. Target Turnaround Time (TAT) are provided in the next section.
C. Target Resolution Times
The customer complaining is expressing a form of dissatisfaction. In order to avoid worsening the
situation, ADNIC has established target turnaround times for resolving the complaint. It is essential that
ADNIC-RSK-04-01 Revision 2
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Complaints are handled in a timely manner not only for the customer, but for regulators as well, who
scrutinize the complaints management process (i.e. Insurance Authority, Health Authority).
1
2
Activity Description
Customer can complain at various touch points and
method:
 Call Center,
 HQ and Branches Front Desk (FD).
 E-mail,
 Letter,
 Fax
 Website
Customer will be asked whether she/he would like to log a
complaint. If no, close the case as a normal customer
inquiry.
Target TAT
As and when
received
Customer
Contact Center/FD
Admin/Fax room
team
In case the complaint is received via fax it will be
transferred to Ops to log the complaint
3
Log the complaint in the system (LOTUS NOTES CMP) and
provide the complaint reference to the customer and
advise that we will revert back to him/her with an “update
at the earliest” and estimated time for resolution (within 10
working days)
4
Complaint will be sent to concerned department.
As and when
received
6
7
8
9
If the complaint is not ADNIC or ADNIC business partner
related then request will be closed and customer will be
informed
The concerned department / Branch shall study the
complaint and take steps to resolve the complaint. If more
facts/details are needed, System Should be Updated (Lotus
Notes CMP)
If the action needed to be taken is within the authority of
the concerned Department Head they would take the
action and Update the system (LOTUS NOTES CMP)
A proper reply explaining ADNIC’s view and resolution (if
required) would be communicated to Complaints
coordinator by updating LOTUS NOTES CMP.
Call Customer Back to communicate the complaint
outcome/resolution. Keep him posted on the status of
complaint in case its pending with relevant authorities
ADNIC-RSK-04-01 Revision 2
Any ADNIC staff
who received the
complaint from the
customer.
Complaints
Manager
Complaints related to branches will be sent to branch
manager and deputy.
5
Responsibility
At the earliest
Complaints
Manager
Department/Branch
Manager
As per defined TAT
Department/Branch
Manager
Department/Branch
Manager
Complaint Owner /
Contact Center
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10
11
Activity Description
(Insurance, HAAD)
Target TAT
Responsibility
All complaints on appropriate resolution by owner, will be
reviewed by the complaints manager (independent body
which is part of Risk Management Department) prior to
closure.
Monthly report to CRO on complaints by TAT/Category, Out
standing/Unresolved, validity.
On closure of
complaints
Complaints
Manager (RMD)
Monthly.
Complaints
Manager (RMD)
D. Training
The CMP (Complaints Management Process) application is a lotus notes based application which
is accessible by all ADNIC staff. An overview of the CMP is provided in Induction training. A self
explanatory document on how to register a complaint is circulated to all ADNIC staff and
available in the Lotus Notes.
V.
Escalation Procedure
On delay in response from the complaint owner/handler to whom it is assigned, it will be escalated
to the Head of the function for taking action as per the agreed Turn around Time (TAT).
VI.
Complaints Analysis and Key Performance Indicators
Complaint metrics will be measured on a monthly basis and communicated to Management via the Risk
Management Dashboards. Any deviations from targets will be investigated and, as required, action plans
will be developed to minimize recurrence.
Performance Indicators to be monitored will be as follows:
Key Performance Indicator
Turnaround Time (TAT)
# of Open Complaints at month
end
# of repeat complaint
Satisfaction with complaint
resolution
ADNIC-RSK-04-01 Revision 2
Definition
Number of days between
complaint registration and
closing dates
# complaints still open at the
end of a given month
# of complaints
about/dissatisfaction with a
specific complaint that was
already registered
Level of satisfaction of the
complaining party with the
resolution of complaint. To be
gathered after the complaint is
flagged as “closed” by someone
other than the individual
Target
As per defined TAT, 80% of the
time (subject to a large enough
population size)
Prioritize Closure
1 week from closure of
complaint
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Complaint Validity (Medical
Complaints)
ADNIC-RSK-04-01 Revision 2
resolving the issue. Satisfaction
will be categorized as Fully
Satisfied-1, Largely satisfied-2,
Largely unsatisfied-3 &
Completely dissatisfied.
For Medical complaints, the
validity of the complaints will be
classified as Validity-Denied,
Validity - Fully Upheld , Validity –
NA & Validity – Partially Upheld
1 week from closure of
complaint
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VII.
Process Flowchart
VIII.
Tips on Reacting to a Complaining Customer
1. Understand complaints as a normal part of your job and as a change to reduce
customer dissatisfaction and to ensure customer retention.
2. If the complaint is in person, look for a quiet location for the complaint
conversation. Do not let other customers listen to the conversation. Offer the
customer a seat. Address the customer by name.
3. Signal willingness to talk (“let us talk about this calmly”). Over the phone, keep a
calm, composed and sympathetic tone. In person, use your gestures, eye
contact, and body language to convey that you are paying close attention.
4. Offer an apology or at least regret that the customer has had a bad experience.
Use the first-person form when formulating your responses. (“I am really sorry
that you had this inconvenience” or “I apologize for the trouble caused”)
5. Listen carefully. Do not interrupt the complainant. Let her/him speak first
without interruption even though she/he may bring up incorrect statements.
6. Conduct the conversation in a calm and courteous manner. Respond calmly to
exaggerations and personal accusations. Respond to insults calmly and bring the
conversation back to the factual level. Do not argue with the customer and do
not engage in a power struggle. An argument with the customer is always won
by the customer.
7. Take notes. The activity of writing down what she/he says demonstrates to the
customer that you are taking the complaint seriously and encourages her/him to
explain the circumstances more accurately. Furthermore, the notes are valuable
in complaint handling and analysis. If over the phone, mention that you are
making note of all the information they are giving.
8. Avoid immediate diagnoses and listen to all the information without confessing
that you were at fault.
9. Ask questions regarding the complaint until the situation becomes completely
clear. Pose questions in a courteous manner. (“Thanks for the information. One
more thing I would like to know is …..”)
10. Put yourself in the customer’s place. (“I can easily imagine that you are
annoyed”). Avoid wordings that increase the level of annoyance (“You are
wrong!” or “But this is your fault!”).
11. If a mistake actually happened, do not blame a colleague, other departments, or
the firm in general.
12. Initiate the handling of the complaint immediately, if within your scope of work
and authority.
13. If a prompt solution is not possible, promise the customer that the case will be
thoroughly reviewed and indicate how long it will take before she/he received a
notice. Observe this deadline. If this is despite your best efforts not possible,
inform the complainant in a timely manner and explain the reasons.
14. If you are not responsible or you cannot do anything, forward the complaint and
see to it that the receipt and handling process is continued according to the
customer’s wishes.
15. Conclude the conversation positively. (“I appreciate that you have brought this
matter to our attention”).
16. Document the details of the complaint and escalate to the complaint manager.
A well-documented complaint is critical for ADNIC to understand the situation
and to ensure adequate documentation if the regulators (i.e. HAAD, Insurance
Authority) request information.
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IX.
Glossary of Terms
A. Feedback Type
Term
Complaint
Suggestion
Compliment
ADNIC-RSK-04-01 Revision 2
Definition
Expression of dissatisfaction, usually involving a request for immediate action
from ADNIC to address the complaining party’s concern. It helps us
understand where attention is needed to better function as a business and
better serve our customers.
Information provided on areas in which we can improve. It may not require an
immediate action but needs to be analyzed to identify areas of improvement.
Expression of satisfaction with an ADNIC product, service or how staff has
dealt with a customer. It helps us understand what we do well and leverage it
across other areas of the business.
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X.
Complaints TAT (Turn around Time)
A. Line of Business Wise
Line of Business
Priority / Category
P1
P2
P3
P4
Resolution TAT in working days
Life & Medical
3
5
5
7
Motor
3
5
7
10
Property & Energy
5
10
Marine Hull & Cargo,
Aviation & Aerospace
5
10
Engineering &
Construction
5
10
Liabilities & Financial
Lines
5
10
Operations
3
5
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B. TAT for SAM Clients
Line of Business
Priority / Category
Resolution TAT in working days
Life & Medical
Motor
3
3 (IMC)
5 (Garage)
Property & Energy
5
Marine Hull & Cargo, Aviation &
Aerospace
5
Engineering & Construction
5
Liabilities & Financial Lines
5
Operations
3
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C. Complaints – Priority types categorization
Category
Priority
Platinum/VIP
P1
Gold
P2
Silver
P3
Bronze
P4
Note:
1. Color coding applicable for Motor & Medical only.
2
TAT starts on registering of complaint in lotus notes. TAT calculated on working days (8 AM4 PM)
3. TAT applicable for complaints within scope of ADNIC/Partners
4. Complaints requiring inputs from HAAD, Insurance Authorities and Brokers are not in
control of ADNIC. However regular updates on the status of the complaint will be given to
the client.
5. TAT (P1 & P2) of 3 and 5 days is applicable for:
- Life & Medical (Medical Authorization & PBM approvals) complaints
- Complaints from high priority clients /SAM clients
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D. Complaint Categories and Sub-Categories
Category
Medical PBM Related
Medical
Authorization/Card
Rejection
Communication
Definition
Dissatisfaction with a business partner with which a
client has interacted. Examples of business partners
include medical providers (hospitals,
pharmacies).Approval of PBM
Dissatisfaction related to rejection/delays incurred in
medical authorization. Rejection of ADNIC insurance
card by Hospital/Pharmacy
Dissatisfaction with any communication channel used
by the client in an attempt to reach ADNIC, or
dissatisfaction with the frequency/nature of ADNIC
communications with the client.
Motor IMC / Garage
related
Dissatisfaction related to Motor (IMC) or Garage
related.
Quality of
products/services
offered
Dissatisfaction with the accuracy of information or
documentation provided to a customer/business
throughout any ADNIC process.



Sub-Categories
Quality of service & products
Professionalism
Refusal to serve ADNIC client

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Office condition & environment
Office location & accessibility
Office hours & timings
Call quality
Ease of accessing / reaching ADNIC
Website - Ease of use
Website - Content
Website - Online payment
Unwanted calls / messages / mailings
Response to queries / requests / complaints
Quotation (renewal or new business)
Issuance of policy & related documents
Issuance of invoice
Endorsements
Delay in vehicle release
Claim acknowledgment
Claim processing / settlement
Issuance of refund / cheque from ADNIC
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
Response to queries / requests / complaints
Quotation (renewal or new business)
Policy & related documents
Invoice
Endorsements
Medical authorizations
Claim acknowledgment
Claim processing / settlement
Pharmacy approval (PBM)
Knowledge of ADNIC
products and process
Dissatisfaction with other process/documentation
related issues that are not due to errors/delays.
Behavior and
Professionalism
Dissatisfaction with the level of service provided by
ADNIC staff either due to the level of professionalism
when interacting with the complaining party or level of
knowledge of ADNIC products, services and processes.
Dissatisfaction with various aspect of the products
offered by ADNIC (including price, variety, benefits) or
dissatisfaction with how a product was advertised.
Products
Timely Communication
Dissatisfaction related to communication
Claims Rejection
Staff Availability
Dissatisfaction due to rejection of claims
Dissatisfaction in availability of ADNIC staff
ADNIC-RSK-04-01 Revision 2
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Refund / cheque from ADNIC
Methods of payment
Pre-requisite / requirements for insurance eligibility
Documentation requirements from customer
Documentation requirements from providers
Behavior & Professionalism
Knowledge of ADNIC products & processes
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Pricing
Product Variety and/or Benefits
Inaccurate product advertising
Product Knowledge
Channel of communication
Language/Tone
Response time
Valid Reason for rejection
Availability during office hours
Timely response
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