1. The Customer Ombudsman is a natural person of recognised prestige, qualification, suitability and independence, to whom policyholders, insured parties, beneficiaries and injured third parties may present complaints concerning the acts or omissions of the company, provided that these have not been resolved within the scope of the company's complaints management CARAVELA - COMPANHIA DE SEGUROS, S.A. (CARAVELA)under the terms and for the purposes set out in Article 158, of Law 147/2015 of 9 September, as well as in the applicable regulatory standards approved by the Insurance and Pension Funds Supervisory Authority.
2. For the purpose of filing complaints, the contact details of the Customer Ombudsman of Insurance of CARAVELA are the following:
a) Endereço Profissional: Avenida Marquês de Tomar nº2- 3º Andar 1050-155, Lisboa
3. The Client's Ombudsman functions completely independently from CARAVELA and, unless there is an agreement between the claimant and the insurer, the documents, information and other elements belonging to the claim process, as well as the decisions or recommendations of the Client's Ombudsman cannot be invoked in the arbitration process, if there is one.
4. The Customer Ombudsman shall be bound to maintain secrecy in relation to facts coming to his or her knowledge in the exercise of his or her functions, subject to the exceptions provided for by law.
5. CARAVELA will create the necessary conditions for the smooth running of the Customer Ombudsman and shall ensure that it is provided with the appropriate support to guarantee the good level and efficiency of its functions.
ARTICLE 2º ATTRIBUTIONS
1.The Client's Ombudsman mission is to receive and examine complaints from policyholders,insured persons, beneficiaries or third parties injured by acts or omissions of CARAVELA.
2. The Customer Ombudsman has no power to revoke, reform or convert, or in any way
alter the decisions of CARAVELA. It is responsible, within the scope of its functions, for formulating
non-binding recommendations.
3. Claims filed by policyholders, insured parties, beneficiaries or injured third parties with the Customer Ombudsman does not entail any costs or burdens for the claimant, as well as any charges which are not effectively indispensable for the fulfilment of that function.
ARTICLE 3º SCOPE
1. The performance of the Customer Ombudsman extends to all classes of insurance, covering disputes
relating to insurance contracts concluded with the CARAVELA, it will be responsible for examining
complaints against decisions taken under such contracts and which may be submitted by policyholders, insured
policyholders, insured persons, insured persons or beneficiaries of the same, as well as third parties
2. The intervention of Customer Ombudsman can only be raised after all the internal channels for dispute resolution
dispute resolution methods made available to the complainant by the CARAVELA..
ARTICLE 4º FUNCTIONS
1. The Customer Ombudsman has a purely advisory role and may make recommendations to the CARAVELA as a result of the consideration of complaints.
2. Compete ao Provedor do Cliente:
a) receber e verificar o cumprimento dos pressupostos de apresentação de reclamações ao Customer Ombudsmanand in particular those provided for in Articles 6º and 7º;
b) to instruct the process of claim;
c) analyse the complaints submitted.
d) request to CARAVELA the information it deems necessary, as well as the exhibition of documents it deems convenient;
e) carry out all investigations it considers necessary or advisable, and may adopt all reasonable procedures regarding the collection and production of evidence;
f) to make the communications it is obliged to make under the terms of the law;
g) formulate, when it deems appropriate, recommendations, taking into account the content of the respective complaints;
h) to prepare the annual reports provided for by law and regulations.
ARTICLE 5º ELIGIBLE CLAIMS
1. The following shall be considered eligible for consideration by the Customer Ombudsman complaints against the CARAVELA, by policyholders, insured persons, beneficiaries or injured third parties in respect of whom:
(a) no reply has been received from CARAVELA within a maximum period of 20 days, or 30 days in particularly complex cases, counting from the date of receipt, or;
b) having been given an answer within that time limit, the complainant disagrees with the meaning of the answer.
2. The statements regarding the contractual negotiation process, the communications inherent to the claims settlement process and eventual requests for information or clarification shall not integrate the concept of claim.
ARTICLE 6º COMPLAINTS REQUIREMENTS
1. Complaints to be heard by the Customer Ombudsman should be submitted directly to it using the contact details set out in Article 1, nº 2.
2. Complaints must be formulated in writing, preferably using the form specifically provided for this purpose, and must contain the following elements:
a) Full name of the complainant and, if applicable, of the person representing him/her;
b) Quality of the claimant, namely of policyholder, insured person, beneficiary or injured third party or the person representing him/her;
c) Contact details of the complainant and, if applicable, the person representing him/her;
d) Identification document number of the claimant;
e) Description of the facts that motivated the complaint, identifying the intervenient and the date when the facts occurred, except if it is manifestly impossible;
f) Date of the claim.
3. The complaints that are eventually delivered directly to the CARAVELA should be immediately forwarded to the CustomerOmbudsman.
4. The Customer Ombudsman and CARAVELA make available on their own electronic portal on the Internet the form referred to in paragraph 2.
ARTICLE 7º REFUSAL TO ADMIT A CLAIM AND TERMINATION OF THE CLAIM
1. The Customer Ombudsman should refuse the complaint whenever:
a) Essential information is omitted that makes the respective management unviable and has not been corrected in spite of the complainant having been invited to fill it in;
b) If he/she intends to present a claim regarding a matter within the competence of arbitral or judicial organs or when the matter object of the claim has already been solved by those instances;
c) It reiterates complaints that are presented by the same complainant in relation to the same subject and that have already been replied to by the Client's Ombudsman;
d) The complaint was not made in good faith or its content is qualified as vexatious.
2. Whenever the complaint submitted does not include the necessary elements for the purposes of the respective management, the Customer Ombudsman will inform the complainant of this fact, inviting him to correct the omission.
3. Of claims preliminarily rejected by the Customer Ombudsman or that are forwarded to the complaint management services of the CARAVELA the complainants will be informed.
4.Without prejudice to the information and communications provided for in Article 11, the closure of a complaint may only be ordered when:
(a) does not fall within the competence of the Customer Ombudsman, namely because it is alien to the insurance business;
b) After the preliminary assessment phase, the Customer Ombudsman concludes that there are not sufficient elements for any procedure to be adopted;
(c) the conditions for non-admission are met.
ARTICLE 8º IMPEDIMENTS
The Customer Ombudsman cannot assess claims in respect of which:
a) Directly or indirectly has an interest that would allow it to be a claimant;
b) The claimant is his or her spouse or a relative or kinsman, in a direct line or in the second degree of the collateral line, or when any of these persons has an interest in the claim that allows him or her to be included as a claimant;
(c) is a claimant by himself or as a representative of another person;
(d) has intervened in the situation that is the object of the complaint in any other capacity.
ARTICLE 9º PROCESS
1. The Customer Ombudsman should have in mind, when assessing the complaints received, the principle of celerity, seeking to find fair or equitable consensual solutions.
2.The Client's Ombudsman is not bound by any formalities regarding the organisation of the proceedings or the production of evidence, and may adopt any procedures appropriate to the circumstances it considers appropriate for the conduct of the proceedings, provided that they do not conflict with the rights or legitimate interests of the parties involved.
3. The complaint will only be considered received for the purposes of counting time limits after it has been correctly instructed.
4. In the context of evidentiary diligence, the Customer Ombudsman may consult elements contained in the files and documentation existing in the CARAVELA, directly related to the complaints presented, as well as any other relevant documentation for the assessment of the same, with respect for the principles of personal data protection and always in close articulation with the interlocutor designated by CARAVELA.
5. The Customer Ombudsman may request the collaboration of experts from CARAVELA or external experts and to take the steps it deems appropriate with a view to gaining a better understanding of the cases.
6.The intervention of Customer Ombudsman shall not suspend the running of any time-limits, including those for contentious appeals.
7.The assessment made by the Customer Ombudsman in specific cases may not be invoked in court, except with the prior agreement of the parties.
ARTICLE 10º MAXIMUM TIME LIMITS FOR INFORMATION AND COMMUNICATION
1. The Customer Ombudsman communicates to CARAVELA any complaint that meets the requirements set out in Article 7 and that has been directly addressed to it within a maximum period of 5 days.
2.Upon receipt of the aforementioned communication, the CARAVELA shall, within a maximum period of 5 days, reply to the Customer Ombudsman, this reply shall be accompanied by a statement of reasons for the complaint in question.
3.The Customer Ombudsman communicates to the claimant, in writing or through another mean of communication that is registered in a durable support, within a maximum period of 30 days, the results of the assessment of the claim and respective grounds. 45 days.
4.The Customer Ombudsman also communicates to CARAVELA within the period referred to in the previous number, the results of the assessment of the complaint.
5.In cases where the assessment of the complaint made by the Customer Ombudsman is totally or partially favourable to the complainant, the CARAVELA communicates it, within a maximum period of 10 days if it agrees to accept the outcome of the assessment made.
6. The Customer Ombudsman informs the complainant, within a maximum of 5 days in writing or by other means of communication on a durable medium, of the position of the CARAVELA transmitted under the terms of the preceding paragraph.
ARTICLE 11º RECOMMENDATIONS
1. Compete ao Customer Ombudsman make recommendations to CARAVELA that may be considered necessary.
2. Recommendations should be addressed to the Board of Directors or equivalent senior body of the CARAVELA concerned and are not binding.
3. A CARAVELA it will inform the Customer Ombudsman of the acceptance or otherwise of the recommendations made by it, within a maximum period of 20 days from the date of receipt.
4. The recommendations of the Customer Ombudsman will be publicised in the electronic portal made available for this purpose, accompanied by information on whether or not it is accepted by the CARAVELA.
5.The Client's Ombudsman shall, within the scope of the report provided for in Article 14, report annually to the Insurance and Pension Funds Supervisory Authority by the 31 January, the recommendations it has made in the year prior to the CARAVELA or, if this is the case, inform them that you have not made any recommendation.
ARTICLE 12º RELATIONSHIP WITH CARAVELA
1. A CARAVELA should appoint a single interlocutor, and his substitute, who will be responsible for liaising with the Customer Ombudsmanwithout prejudice to Article 12.
2. The single interlocutor must provide the Customer Ombudsman all information and documents relating to the complaint submitted that is requested and to facilitate contacts with other services or employees of the CARAVELA, if necessary.
3. Communications between the Customer Ombudsman and CARAVELA are preferably done through the computer application made available for this purpose.
ARTICLE 13º ANNUAL REPORT
1. The Customer Ombudsman will annually disclose its activities, through a report containing an indication of the complaints received, the steps taken and the recommendations made, as well as mentioning their adoption by the recipient companies.
2. This report will be sent by 31 January of each year to CARAVELA and the Insurance and Pension Funds Supervisory Authority.
