The SSN reopened the DOAA's doors

In June 2011, the Superintendence of Insurance ("SSN", after its acronym in Spanish) issued Resolution SSN 35,680 which created the Department of Guidance and Assistance to the Insured ("DOAA”, after its acronym in Spanish), a specialized body whose purpose was to protect, promote and defend the rights of insureds, policyholders and/or beneficiaries. This Resolution also approved an "Operating and Procedures Manual for the Processing of Inquiries and Complaints."

As a complement to the DOAA, Resolution SSN 35,680 established that each insurance company must set up its own “Insured Customer Service” within its organization (Servicio de Atención al Asegurado, "SAA") and appoint a responsible to solve the cases raised by the clients and be the link between the SSN and the insurance company.

In 2018, by means of Resolution SSN 464, the current administration revoked the DOAA on the basis that it was "complex, inefficient and obsolete." The queries and complaints made were channeled directly to the Management of Coordination of Communication and Customer Service (Gerencia de Coordinación de Comunicación y Atención al Asegurado). It is worth mentioning that at that time the SSN had implemented the electronic file and had started the process of modernization of the State and digitalization of the proceedings, which resulted in a reduction in the processing times of the files and aimed at responding to the requirements of the insured and the insurance market, in a faster, more transparent, and more efficient way. Resolution 464/2018 maintained the SAA of the insurance companies.

Resolution SSN 464/2018 is now null and void, since according to the recitals of Resolution SSN 225/2022 ("Resolution 225") issued last March 31, "it is insufficient for the purposes of the process of strengthening the role of the SSN before the community." For that purpose, the new "Operating and Procedures Manual for the Processing of Inquiries and Complaints" was approved, reinstating the DOAA.

The reopening of the DOAA by means of new Resolution 225 seeks to reduce the time required to answer queries and process files, eliminate unnecessary burdens and costs for the insured party, complainant or querist and respond to the requirements received in a quick, transparent and efficient manner.

The main functions of the DOAA will be to receive and respond to queries and complaints from insureds, policyholders and/or beneficiaries. Complaints shall be related to specific facts referring to actions or omissions of the insurance companies and/or auxiliary insurance companies and/or unauthorized marketers that involve alleged breaches of the regulations in force in insurance matters or to their interests and/or legally recognized rights arising from insurance contracts.

The DOAA will also act ex officio, "when a pattern of conduct is observed and/or insurance market practices are verified whose operation involves an alleged breach of the regulations in force."

It is important to point out that, as clarified in Resolution 225, the DOAA will not be competent to settle conflicts between the claimant and the defendant, nor to fix indemnities or retributions and/or rule on claims for damages that may be filed by the claimants, its action being limited to the analysis of the practices and conducts denounced in relation to the regulations in force. The DOAA's decision in relation to the consultations and complaints submitted shall in no case be subject to the appeals provided for in Law 20,091 and in the Regulatory Decree of the Administrative Procedures Law.

Upon receipt of a complaint through the DOAA (which must meet certain minimum admissibility requirements), the officer in charge will forward the complaint to the insurance entity (or auxiliary) for a period of 10 working days so that it may provide its explanations, make the allegations it deems pertinent and submit the corresponding supporting documentation.

If deemed necessary, at any stage of the processing of the complaint, the DOAA may request the advice or intervention of the different areas or Managements of the agency, for its better operation.

If upon expiration of the deadline for the insurance company and/or auxiliaries of the insurance activity and/or unauthorized marketers to submit their explanations or, any of them had omitted to submit any presentation or consideration, the DOAA shall forward the proceedings directly to the Sub-Management of Summaries of the Management of Legal Affairs for the purpose of evaluating the possible initiation of the summary proceedings set forth in Law 20,091.

It is important to note that the initiation of the summary proceedings at any stage of the procedure before the DOAA will mean that the complainant ceases to be a party.

The DOAA shall analyze the case and may collect and process all the information related to the claims (and even request additional information or documentation). It may arrange and/or arbitrate instances of settlement between the claiming parties and the insurance companies and try to reach agreement amongst them. It may also intervene at any time through the Legal Department of the SSN to analyze and eventually initiate summary proceedings with respect to the alleged infringements, even if the parties have reached an agreement.

Resolution 225 also maintains the functioning of the SAA, which must be composed of at least one executive and one alternate. This position may never be vacant. They must have sufficient power of attorney granted by the entity to deal with claims, complaints and/or queries from policyholders, insured parties, beneficiaries and/or entitled parties, provide the pertinent explanations and resolve the issues raised within a reasonable term according to the complexity of the case, which may not exceed 10 working days.

The Resolution SSN 279 issued on April 28, 2022, which modifies article 4 of the Resolution 225, established that, as from May 16, insurance companies must include the following information in the Particular Conditions (front of the policy): "The insurance company has an Insured’s Customer Service. For those claims that have not been previously resolved through the entity's customer service channels, you may contact this service at the telephone number (telephone number shown on the entity's website). The SAA’s person contact information is available on the website (address of the entity's website). In case there is a claim before the insurance company and it has not been resolved or has been rejected, totally or partially, or its admission has been denied, you may contact the National Superintendence of Insurance by telephone at 0800-666-8400 or by e-mail at consultas@ssn.gob.ar".