Speaking up when you feel let down
As South Africans, we are certainly accustomed to seeing people expressing their discontent – sometimes effectively, often not. In this month’s Xpress comment, our Healthcare Consultant, Paramesh Dayaram, explains the channels that we should be using to voice our legitimate Employee Benefits complaints.
April saw two tidal waves of mass protests hit the streets of major cities nationwide to signal the demand for an end to government corruption. The notion of the country’s leaders and leading party being captured for the financial advantage of others is what has galvanised ordinary citizens into action.
While not all concerns have a national impact, we all hate being exploited. Our sense of outrage is magnified when there appears to be no clear way to express concerns or have our dissatisfaction heard. So, what does a consumer do with a valid complaint regarding poor service?
An increasing number of bodies have been established to consider legitimate complaints – various industry Ombudsmen, the National Consumer Tribunal, the National Credit Regulator, for example. In recent years, South Africa has created regulations in consumer protection, including, the Consumer Protection Act, Treating Customers Fairly (TCF), the National Credit Act, FAIS, FICA.
In this month’s newsletter, we focus on the regulatory bodies you can consult regarding your employee benefits, specifically in respect of the Medical Industry and Pension Funds.
Valid complaints and complaint processes:
Medical Schemes
You have received an outcome from a medical scheme that you feel is unfair. You have escalated this through the scheme complaint resolution system, but are still aggrieved. The Council for Medical Schemes has a dedicated division that aims to resolve complaints to ensure that beneficiaries of medical schemes are treated fairly. For more information on the complaints process log on to www.medicalschemes.com
Healthcare Practitioners
You have received a level of service from a healthcare practitioner not in line with the high standards, professionalism or ethical standards of behaviour outlined by the Health Professions Council of South Africa. Should you wish to lodge a complaint, HPCSA allows the public to file and request an investigation into practitioners whom they believe have acted unethically or caused harm. For more information on the complaints process log on to www.hpcsa.co.za
Nurses
You would like to report an incident of professional misconduct against you by a nurse. The South African Nursing Council has a complaints division that investigates any complaint of conduct that violates the high standards of care to which a patient is entitled. For more information on the complaints process log on to www.sanc.co.za.
Pension Funds
Once you have raised your complaint with the fund of your employer and have received a reply with which you are still not happy, you may lodge a complaint with the Pension Fund Adjudicator. Your complaint must relate to the administration of a pension fund, the investment of its assets, or the application of its rules. For more information on the complaints procedure log on to www.pfa.org.za.
Financial Services
The FAIS Ombud’s role is to resolve disputes between financial services providers and their clients. The complaint will be considered if it is alleged that the provider or representative has acted in contravention of the FAIS Act and has negatively impacted the complainant. For more information on the complaints procedure log on to www.faisombud.co.za.
Tips for a successful complaint submission:
- Your complaint should have a sound basis and merit; the above bodies have clear guidelines on what constitutes a valid claim.
- Ensure that you have clear records of documents.
- Clear timelines of all communication, names, dates and reference numbers.
- Stick to the facts and avoid emotion-fuelled correspondence in your complaint.
- Whilst you may not always win in a complaint process, it is important to know that you have exhausted all avenues to express your dissatisfaction and your complaint was given due consideration.