Client altering insurance form

Re: Client altering insurance form

Anthony Todd — Mon, 23 Jul 2012 16:33:19 GMT

[quote user="Anthony Todd"]If it is a windup he's a master.[/quote]

No it wasn't but why he didn't just say this in the first place....

Thank you for your email of 20 July 2012.

I am sorry if you found my response to your original email confusing. However, even though the question may appear simple it does not always follow that the answer will be. I would though like to emphasise two parts of my previous response to you.

"If you are undertaking the proposed changes to protect your own position rather than to assist the consumer, you are not completing the parts of the form on behalf of the consumer that the consumer should be completing, and you are not being paid by the consumer to complete the form, then I would be inclined to say that you are not undertaking the regulated activity in question."

And

"While the FSA can provide general guidance, we cannot tell you whether the proposals would or would not need to be authorised."

If you remain unsure of your regulatory position then you should seek compliance assistance. To this end you will note that I gave you a link to the Law Society in my previous response.

I hope that I have clarified the position.

Yours sincerely

All I wanted to do was just post the flipping form.....

Re: Client altering insurance form

J G Wray — Mon, 23 Jul 2012 14:32:39 GMT

How do claims forms submitted electronically, direct claims or otherwise, fit the FSA model?

These were driven by a desire on the ins cos part to reduce costs, the portal owner's to make some money, the designer of VetXML to find a use, er , for Vet XML and costs vets to use which may or may not be to their advantage?

JGW

Re: Client altering insurance form

Anthony Todd — Fri, 20 Jul 2012 19:36:58 GMT

[quote user="Evelyn Barbour-Hill"]Could it be that Mr. Mulholland spends his life answering b. stupid questions and is ingeniously taking the pixx ? [/quote]

Oh sh1t, never thought of that, Imean it's straight out of Monty Python and/or Private Eye.

Nah, I don't reckon, but you never know considering all the sh1t around the FSA at the moment....he might be the last sane person there!

If it is a windup he's a master.

Re: Client altering insurance form

Evelyn Barbour-Hill — Fri, 20 Jul 2012 19:00:55 GMT

Could it be that Mr. Mulholland spends his life answering b. stupid questions and is ingeniously taking the pixx ?

Re: Client altering insurance form

Anthony Todd — Fri, 20 Jul 2012 18:00:37 GMT

[quote user="Bob Russell"]from Directline[/quote]

If you read the FSA advice [I mean the common and garden, not the pages quoted], it implies that you must be authorised to post the form, but actually says "may need" not "must" and this advice would suit the insurance Co's very well indeed.

If you read some of the health and safety advice it seems to suggest that you must have an auxillary power supply for all the op. theatres and our sparky had got all ready to install it.

Some people always take "may" to mean "must" always; and they're often qualified....

Re: Client altering insurance form

Julian Earl — Fri, 20 Jul 2012 17:54:50 GMT

I have to sadly confess I read the whole thing as well and totally agree with Bob. If it's in your interest, you can do it,; if it's in the client's interest you cannot. So therefore, does that mean that if it is a direct payment to the practice you can post it, but if the client has already paid you then they have to post it? What if they've paid part of the bill, who posts it then?

Re: Client altering insurance form

Bob Russell — Fri, 20 Jul 2012 17:50:47 GMT

But this advice may have been based on the actions and written advice (we used to have it on our wall!) from Directline that was sent to practices soon after the new rules were introduced.

I still think they are masters of delay and have it down to a fine art!

I check every pearl of wisdom on this site with a magnifying glass so I don't miss a thing!!

Re: Client altering insurance form

Anthony Todd — Fri, 20 Jul 2012 17:03:44 GMT

[quote user="Bob Russell"]Hidden amongst the bull*hit seems to be a useful answer:[/quote]

Wow, there was an answer in there all the time....

bloody 'ell, you read the whole thing!!

[quote user="Bob Russell"]It seems to be Directline[/quote]

We got a direct NO NO from www.insureyourpet.com, which usually gives very sound advice, and is linked from our website.

Re: Client altering insurance form

Rob Davis — Fri, 20 Jul 2012 16:50:16 GMT

[quote user="Anthony Todd"]

I have had a reply from the FSA to my question regarding posting completed claim forms which I copy herein full [sorry Arlo, it's a bit long].

Comments invited, polite if conceivable....

Etc

For help to complete your regulatory return or for any other aspect of the FSA's rules and guidance please use the below link to the Industry Training section of our website. This details all of the training courses being run by FSA and includes forthcoming workshops, e-learning and events. http://www.fsa.gov.uk/Pages/Doing/Events/index.shtml

[/quote]

That is absolutely priceless! It should be framed and given pride of place on the wall for all to admire. I think you should reply with a single line: "So can I post the form?"

Why do people seem to think bureaucracy is a bad thing?

Re: Client altering insurance form

Bob Russell — Fri, 20 Jul 2012 16:45:30 GMT

Hidden amongst the bull*hit seems to be a useful answer:

if you are undertaking the proposed changes to protect your own position rather than to assist the consumer, you are not completing the parts of the form on behalf of the consumer that the consumer should be completing, and you are not being paid by the consumer to complete the form, then I would be inclined to say that you are not undertaking the regulated activity in question.

Posting a form is not regulated unless you are being paid to do it. Completing your parts of the form without aiding the client to fill in theirs is also not regulated.

It seems to be Directline that are arguing we should not be posting the form. This seems to be in line with the very clever list of ways they delay processing the forms.

They do not allow downloaded forms to be used and wait days or weeks to send them out thereby keeping money in their account.

If an owner has to return to the practice to collect and post the form they are expecting at least a proportion to take some time to do so creating further delay.

Re: Client altering insurance form

Lorna McHardy — Fri, 20 Jul 2012 16:33:02 GMT

[quote user="Anthony Todd"]

Go on, I dare you, ask if you can sign the form in green ink...

[/quote]

I was thinking pink, actually....

Re: Client altering insurance form

Lorna McHardy — Fri, 20 Jul 2012 16:27:53 GMT

[quote user="Anthony Todd"]

[quote user="Lorna McHardy"]So, anyway... er.... um... can I post the forms, or not?[/quote]

I'll let you know in a max. of 12 days.

[/quote]

Re: Client altering insurance form

Anthony Todd — Fri, 20 Jul 2012 16:27:05 GMT

[quote user="Lorna McHardy"]So, anyway... er.... um... can I post the forms, or not?[/quote]

I'll let you know in a max. of 12 days.

Go on, I dare you, ask if you can sign the form in green ink...

Re: Client altering insurance form

Lorna McHardy — Fri, 20 Jul 2012 16:24:33 GMT

[quote user="Anthony Todd"]

I have had a reply from the FSA to my question regarding posting completed claim forms which I copy herein full [sorry Arlo, it's a bit long].

Comments invited, polite if conceivable....

<snip endless gobbledegook quoted by Anthony>

I hope this response is helpful to you and has explained to you where you can find more information on this issue that you have raised.

[/quote]

Er.... no.

[quote user="Anthony Todd"]

Let us know what you think of the service provided by the Customer Contact Centre by sending your comments to: FCCFeedback@fsa.gov.uk
[/quote]

It's tempting....

So, anyway... er.... um... can I post the forms, or not?

Re: Client altering insurance form

Anthony Todd — Fri, 20 Jul 2012 16:13:34 GMT

Incredible beyond belief, as Ned Sherrin used to quote...

Wynne obviously has worked it out.... I'm sure it was read thorougherlyably

This bit is worth quoting separately:

To reiterate, I recommend that you read the guidance that we have provided which will help you to decide if your proposed activities require prior authorisation from the FSA. However, should you remain in anyway uncertain as to your position I would strongly recommend that you seek expert legal advice from a lawyer familiar with the legislation. To this end I have below provided you with a link to the Law Society who will be able to supply you with a list of solicitors who are familiar with financial regulation.

This is to post a bloody form FFS!!!

Re: Client altering insurance form

Hannah Wynne Richards — Fri, 20 Jul 2012 16:04:57 GMT

??????????????????????????????????????????????????????

!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
********************************************************************************

Wynne

Re: Client altering insurance form

Anthony Todd — Fri, 20 Jul 2012 15:58:58 GMT

I have had a reply from the FSA to my question regarding posting completed claim forms which I copy herein full [sorry Arlo, it's a bit long].

Comments invited, polite if conceivable....

I understand from your correspondence that you are a veterinary surgeon. You wish to change your process when dealing with an insurance claim form. You ask if as a result of the proposed change you would be undertaking an activity that would require you to be authorised by the Financial Services Authority (FSA).

I appreciate that you have taken the time to write to us about this matter, I can understand why you have referred the matter to the FSA, as the legislation that we deal with here is the Financial Services and Markets Act 2000 (FSMA).

It may help if I give a brief outline of what is covered by FSMA before considering how this may affect your proposed activities. FSMA is concerned with the regulation of financial services and markets in the UK. Under Section 19 of FSMA, any person who carries on a regulated activity in the UK must be authorised or exempt. Section 22 of FSMA provides that an activity is a "regulated activity" if it is an activity of a specified kind carried on by way of business in relation to investments of a specified kind.

The activities and investments are specified in The Financial Services and Markets Act 2000 (Regulated Activities) Order 2001 ("the RAO"), which is secondary legislation under FSMA. Specified activities are defined in Part II of the RAO and include arranging deals in investments. Specified investments are defined in Part III of the RAO and include various investments. Therefore, if a company is conducting a specified activity, for example arranging deals in investments, they will need to be authorised, or exempt.

To see if you may need to be authorised under FSMA please refer to the section of our website entitled "Do I need to be authorised". This can be found by accessing the following link

www.fsa.gov.uk/Pages/Doing/Do/index.shtml

You will see from this page that you may need to be authorised if you are undertaking a regulated activity in respect of a specified investment and will receive 'remuneration' for doing so. We refer to this last element as "by way of business" and it covers both monetary and non-monetary rewards.

The page contains a full list of specified investments and regulated activities together with information on "by way of business". It also discusses exemptions and exclusions which, if they can be relied upon on a continuing basis, would mean that you would not need to be authorised. Exclusions are provisions that turn activities that would otherwise be regulated activities into unregulated activities. An exempt person is a person who is exempt from authorisation.

For more detailed guidance about the circumstances in which authorisation is required, including guidance on the activities which are regulated under FSMA and the exclusions which are available, you should refer to our Perimeter Guidance Manual (PERG). I have below attached a link for your attention:
www.fsahandbook.info/FSA/html/handbook/PERG

I have also provided you with a link to chapter 2.6 of PERG which gives detailed guidance on specified investments regulated by the FSA:
www.fsahandbook.info/FSA/html/handbook/PERG/2/6

In addition I have provided you with a link to chapter 2.7 of PERG, where you will find detailed guidance on activities regulated by the FSA:
www.fsahandbook.info/FSA/html/handbook/PERG/2/7

As I mentioned above, for an activity to be a regulated activity it must be carried out "by way of business". There is a test to see if you undertake an activity "by way of business". It is referred to as "the business test". If you do not meet "the business test" then authorisation under FSMA would not be required. I have provided a link below to chapter 2.3 of PERG, which contains guidance on the business test:
www.fsahandbook.info/FSA/html/handbook/PERG/2/3

I now turn to your specific query. The regulated activity you might be carrying out that would require prior authorisation is assisting in the administration and performance of a contract of insurance.

Under article 39A of the RAO there is a regulated activity of assisting in the administration and performance of a contract of insurance. Further guidance on this activity is given at paragraph 5.7.1 of PERG:
www.fsahandbook.info/FSA/html/handbook/PERG/5/7
the activity relates, in broad terms, to activities carried on by intermediaries after the conclusion of a contract of insurance for and on behalf of policyholders in the event of a claim;

*loss assessors acting on behalf of policyholders in the event of a claim are, therefore likely to be carrying on this activity;

*where a person assists a claimant in filling in a claims form, this amounts to administering a contract of insurance;

*where a person completes the form on a policyholders behalf, this amounts to assisting in the performance of a contract of insurance;

*notifying a claim under a policy, providing evidence in support of the claim and/ or helping negotiate its settlement on the policyholders behalf, are examples of where both "assisting in the administration" and "assisting in the performance" of a contract of insurance are taking place.

From the information you have provided it appears that you might be assisting in the administration and performance of a contract of insurance under article 39A RAO. You should refer to chapter 5 of PERG and apply the exclusions against your own particular circumstances. You will note that you would be need to be undertaking both parts of the activity i.e. both administration and performance to be seen to be undertaking the activity.

However, if you are undertaking the proposed changes to protect your own position rather than to assist the consumer, you are not completing the parts of the form on behalf of the consumer that the consumer should be completing, and you are not being paid by the consumer to complete the form, then I would be inclined to say that you are not undertaking the regulated activity in question.

I suggest that you read this information, and, taking into consideration any exclusions that may apply, you should be able to determine whether or not your proposals would require authorisation. Please be aware that while the FSA can provide general guidance, we cannot tell you whether the proposals would or would not need to be authorised.

Any person wishing to carry on one or more regulated activities must apply to the FSA for authorisation (unless they can abide by the terms of an exclusion or are exempt). I have provided a link to the page of our website where you will find the relevant application form together with explanatory notes on the completion of the form. It also has information on the authorisation fee which is a one-off fee to enable us to process the application. The application process is between three and six months.
www.fsa.gov.uk/Pages/Doing/how/index.shtml

To reiterate, I recommend that you read the guidance that we have provided which will help you to decide if your proposed activities require prior authorisation from the FSA. However, should you remain in anyway uncertain as to your position I would strongly recommend that you seek expert legal advice from a lawyer familiar with the legislation. To this end I have below provided you with a link to the Law Society who will be able to supply you with a list of solicitors who are familiar with financial regulation.

www.lawsociety.org.uk/choosingandusing/findasolicitor.law

I hope this response is helpful to you and has explained to you where you can find more information on this issue that you have raised.

Yours sincerely

Tim Mulholland (Mr)
Customer Contact Centre
Financial Services Authority
Firm Helpline: 0845 606 9966
www.fsa.gov.uk

Let us know what you think of the service provided by the Customer Contact Centre by sending your comments to: FCCFeedback@fsa.gov.uk

The Financial Services Authority will shortly be carrying out a customer satisfaction survey which is being conducted by an independent research company. You may be asked to provide feedback on the handling of your query and the response you received.

For help to complete your regulatory return or for any other aspect of the FSA's rules and guidance please use the below link to the Industry Training section of our website. This details all of the training courses being run by FSA and includes forthcoming workshops, e-learning and events. http://www.fsa.gov.uk/Pages/Doing/Events/index.shtml

Re: Client altering insurance form

Stephen Courtney — Wed, 11 Jul 2012 22:11:20 GMT

I think you are right Anthony. I always post the forms myself, half the time the clients seem unable to address an envelope correctly or legibly, and until the form is in the post I feel it is vulnerable to creative amendments that might leave my ass hanging in the breeze a bit. we always scan insurance forms into the patients clinical record so if anything goes astray it is easy to reprint and resubmit.

Re: Client altering insurance form

Anthony Todd — Wed, 11 Jul 2012 20:24:46 GMT

[quote user="Stephen Courtney"]I also send the forms off for clients routinely - I gather we are not supposed to[/quote]

What is this based on, or is it from the too rigid reading of the FSA regs, or even someone else's interpretation?

I suspect "may" has been extrapolated to "must" .

Only 11 days to wait for the FSA response.....

Re: Client altering insurance form

Rachael Winder — Wed, 11 Jul 2012 20:23:59 GMT

We had a similar case in my last job, I think it was tesco insurance. Client changed form to pay herself and never paid us. Tesco were very unimpressed when informed and I think they took her to court in the end. Don't think they involved the police but pursued it via civil court? I could be wrong, it was while ago.

Re: Client altering insurance form

Stephen Courtney — Wed, 11 Jul 2012 17:51:16 GMT

I also send the forms off for clients routinely - i gather we are not supposed to - but there is no way I release an official veterinary certificate, with attendant legal implications, as E&L so nicely put it, back to the client - and especially for a direct claim. but as i said before, it is relatively easy for a determined fraudster to rip you off if they want to. it is just fortunate that almost everyone is decent at heart. It is the few rotten folk in the world that are unfortunately the more memorable.

Re: Client altering insurance form

Hannah Wynne Richards — Wed, 11 Jul 2012 09:22:15 GMT

I'm with Stephen I really really push insurence to my clients-and 1 of my selling points is that they won't have to find the money up front I can only remember 1 case like this in 16 years of practice ownership-police no use at all I'm afraid

Wynne

Re: Client altering insurance form

Stephen Courtney — Tue, 10 Jul 2012 22:35:51 GMT

99.99% of my clients are trustworthy people. we try to avoid direct claims but my branch is in a fairly deprived area, and i will always try to help a client who has tried to help themselves by taking advice over having decent insurance.

I despair over some of the crap that people buy over the internet however, and unless i know a client and know their insurance policy, i make a point of checking their policy paperwork before accepting a direct claim. but sometimes these things slip through the cracks. you can only live and learn, I only get cheated by a client once, and the few that do this are outweighed by the many that we can help, and that are grateful for that help. The sad thing is that the police have no interest in dealing with fraud at this level. far easier to go catch someone driving at 33 miles an hour somewhere, isn't it?

The main problem i have with direct claims are for the few occasions when it goes wrong, it queers the pitch for genuine cases.

Re: Client altering insurance form

Anthony Todd — Tue, 10 Jul 2012 20:35:12 GMT

[quote user="Anthony Todd"]registered with the FSA[/quote]

Sorry, it's actually "authorised by the FSA" which sort of means the same but I'm trying to develop accuracy in the face of non sensible interpretations.

Re: Client altering insurance form

Anthony Todd — Tue, 10 Jul 2012 20:31:16 GMT

[quote user="Mark Hedberg"]The practice i worked at in kent always posted the insurance forms, never had a problem. Never did direct claims either, took too long to be reimbursed.

[/quote]

We neither, but the RVN is right, depending on what you read. Common sense and expediency tells me that it's easier and cheaper for the client for us to post the form but if there's a reason not to do something sensible......