Complaints Procedure

1. PURPOSE

Optivest Health Services (Pty) Ltd, a licensed Financial Services Provider (FSP No. 13475), is committed to resolving client complaints fairly, transparently, and timeously, in line with the Financial Advisory and Intermediary Services (FAIS) Act. This document explains how you can lodge a complaint and how it will be handled.

The policy is publicly available:

  • On our website: www.optivest.co.za
  • At our office: 9 Queen Street, Durbanville, 7550
  • By phone request: 021 975 2266

2. OVERVIEW OF COMPLAINTS RESOLUTION

We aim to resolve complaints promptly and fairly. Complaints may relate to:

  • Non-compliance with the FAIS Act causing financial harm;
  • Negligent or misleading financial advice;
  • Unfair treatment during service delivery.

We follow an escalation process to ensure your concerns are addressed at the appropriate level.

3. SUBMITTING A COMPLAINT

Please send your complaint in writing via any of the following:

Include:

  1. Full name and contact details
  2. Detailed description of the issue
  3. Name of consultant involved
  4. Date of incident
  5. Supporting documents
  6. Preferred communication method (email/phone)

4. HOW WE HANDLE YOUR COMPLAINT

  1. Once we receive your complaint, we will send you a written acknowledgment.
  2. We will investigate your complaint and aim to resolve it to your satisfaction within six (6) weeks from the date we receive it.
  3. If we are unable to resolve your complaint within six weeks, or if you are not satisfied with the outcome, you have the right to escalate your complaint to the FAIS Ombud, who has been appointed to assist with such matters.
FAIS Ombud Contact Details:
PO Box 74571, Lynwood Ridge, 0040
Tel: 012 470 9080
Fax: 012 348 3447
Email: info@faisombud.co.za
Website: www.faisombud.co.za

Important: You must refer your complaint to the FAIS Ombud within six (6) months from the date we notify you that we cannot resolve your complaint.

5. WHAT TO KNOW BEFORE APPROACHING THE FAIS OMBUD

5.1 Types of Complaints the Ombud Can Consider:

The Ombud is authorised to consider complaints that relate to financial advice and/or intermediary services. Your complaint must meet at least one of the following conditions:

  • The Financial Services Provider (FSP) breached the Financial Advisory and Intermediary Services (FAIS) Act, resulting in actual or potential financial loss to you.
  • The FSP or its representative acted negligently or deliberately, providing advice or services that caused (or could cause) financial harm.
  • You were treated unfairly during the interaction.

5.2 Important Limitations:

  • The Ombud will not consider complaints solely related to poor product performance, unless:
    • The product’s performance was explicitly guaranteed, or
    • The performance was so poor that it reasonably indicates misrepresentation, negligence, or mismanagement by the provider or representative.

6. CONDITIONS FOR SUBMITTING A COMPLAINT TO THE FAIS OMBUD

Before referring your complaint to the FAIS Ombud, the following conditions must be met:

  • The incident or conduct being complained about must have occurred on or after 30 September 2004.
  • The complaint must be received by the Ombud within 3 years of the date on which the act or omission took place.

If you were not aware of the issue at the time, the 3-year period starts from the date you became aware (or reasonably should have become aware) of the issue—whichever comes first.

  • If you have already taken legal action in a court of law on the same matter, the FAIS Ombud will not be able to consider your complaint.
  • The Financial Services Provider (FSP) must be given a fair opportunity to resolve the complaint.

You may only escalate the complaint to the FAIS Ombud if the FSP has not resolved the complaint to your satisfaction within 6 weeks of receiving it.

  • Once the FSP has issued a final response, you have 6 months to lodge your complaint with the Ombud.
  • All complaints must be submitted in writing, along with any relevant supporting documentation.
  • The Ombud may decline to investigate the complaint if it appears that the matter would be more appropriately handled through the courts.

7. RESPONSIBILITIES OF THE FSP WHEN A COMPLAINT IS RECEIVED

When a complaint is lodged against an FSP or its representative, the following steps must be taken:

  • Acknowledge Receipt:
    The FSP must acknowledge receiving the complaint in writing, without delay.
  • Attempt to Resolve:
    The FSP must assess and attempt to resolve the complaint within 6 weeks from the date of receipt.
  • Inform the Client if Unresolved:
    If the complaint cannot be resolved to the client’s satisfaction within 6 weeks, the FSP must:

    • Clearly notify the complainant that the matter remains unresolved, and
    • Inform the complainant of their right to escalate the complaint to the FAIS Ombud within 6 months from the date of this notice.

8. HOW THE FAIS OMBUD HANDLES A COMPLAINT

Once a complaint is referred to the FAIS Ombud, the following procedure is followed:

  • Official Receipt:
    The FAIS Ombud formally acknowledges receipt of the complaint.
  • Suspension of Prescription Period:
    The legal time limit (prescription period) is suspended from the date the complaint is officially received until:

    • The complaint is withdrawn, or
    • A determination is made by the FAIS Ombud or the Board of Appeal.
  • Administrative Fee:
    The FSP (person or entity complained against) may be required to pay an administration fee of up to R1,000 once the complaint is officially accepted.
  • Notification and Response Opportunity:
    The FAIS Ombud will not begin the investigation until:

    • All relevant parties have been informed of the complaint and its details, and
    • Each party has been given an opportunity to respond.
  • Court Proceedings Restriction:
    If the complainant starts legal action in court while the FAIS Ombud is investigating, the FAIS Ombud will discontinue their investigation.
  • Conciliation First:
    The FAIS Ombud will first attempt to resolve the matter through a mutually agreed conciliated settlement.
  • Recommendations:
    If no settlement is reached, the Ombud may issue recommendations to help resolve the matter.

9. FAIS OMBUD DETERMINATIONS AND THEIR LEGAL EFFECT

If the complaint is not resolved through conciliation, the FAIS Ombud may issue a formal determination. The following applies:

  • Legal Status:
    A determination by the FAIS Ombud has the same legal standing as a civil court judgment and is enforceable as such.
  • Types of Orders:
    The Ombud may:

    • Award monetary compensation (up to R800,000, unless the FSP agrees to a higher amount), and/or
    • Issue any other type of order that a court of law would be empowered to make.
  • Costs Against the FSP:
    The FAIS Ombud may order the FSP (or person complained against) to pay the costs of the proceedings.
  • Costs Against the Complainant:
    If the complainant acted unreasonably, improperly, or caused undue delays, the FAIS Ombud may also award costs against the complainant.

10. APPEALS TO THE BOARD OF APPEAL

If you are dissatisfied with the FAIS Ombud’s determination, you may lodge an appeal — subject to the following conditions:

  • Permission to Appeal:
    You can only appeal if the FAIS Ombud grants leave to appeal.
    If the FAIS Ombud refuses, you may request permission directly from the Chairperson of the Board of Appeal.
  • Timeframe to Apply:
    • An application for leave to appeal must be submitted to the Ombud within 1 month of the date of the Ombud’s determination.
    • If leave is refused, you have 1 month from that refusal to apply to the Chairperson of the Board of Appeal. The FAIS Ombud must be informed of this application.
  • Legal Status of Appeal Outcome:
    A determination made by the Board of Appeal carries the same legal weight as a civil court judgment.

11. PROTECTION OF PERSONAL INFORMATION ACT (POPIA) COMPLAINTS

Optivest Health Services is committed to protecting your privacy and developing technology that gives you the most powerful and safe online experience. This Statement of Privacy applies to the Optivest Health Services, our website and governs data collection and usage. By using Optivest Health Services and our website, you consent to the data practices described in our Privacy Policy.

Ensuring that Optivest Health Services makes it convenient for data subjects who want to update their personal information or submit POPIA related complaints to Optivest Health Services. For instance, maintaining a “contact us” facility on Optivest Health Services’ website.

POPIA COMPLAINTS PROCEDURE

Data subjects have the right to complain in instances where any of their rights under POPIA have been infringed upon. Optivest Health Services takes all complaints very seriously and will address all POPIA related complaints in accordance with the following procedure.

  • Complaints need to be sent to: compliance@optivest.co.za
  • POPIA complaints must be submitted to Optivest Health Services in writing. Where so required, the Information Officer will provide the data subject with a POPIA Complaint Form.
  • Where the complaint has been received by any person other than the Information Officer, that person will ensure that the full details of the complaint reach the Information Officer within 1 working day.
  • The Information Officer will provide the complainant with a written acknowledgement of receipt of the complaint within 2 working days.
  • The Information Officer will carefully consider the complaint and address the complainant’s concerns in an amicable manner. In considering the complaint, the Information Officer will endeavour to resolve the complaint in a fair manner and in accordance with the principles outlined in POPIA.
  • The Information Officer must also determine whether the complaint relates to an error or breach of confidentiality that has occurred and which may have a wider impact on Optivest Health Services’ data subjects.
  • Where the Information Officer has reason to believe that the personal information of data subjects has been accessed or acquired by an unauthorised person, the Information Officer will consult with Optivest Health Services’s governing body where after the affected data subjects and the Information Regulator will be informed of this breach.
  • The Information Officer will revert to the complainant with a proposed solution with the option of escalating the complaint to Optivest Health Services’ governing body within 7 working days of receipt of the complaint. In all instances, Optivest Health Services will provide reasons for any decisions taken and communicate any anticipated deviation from the specified timelines.
  • The Information Officer’s response to the data subject may comprise any of the following:
    • A suggested remedy for the complaint,
    • A dismissal of the complaint and the reasons as to why it was dismissed,
    • An apology (if applicable) and any disciplinary action that has been taken against any employees involved.
  • Where the data subject is not satisfied with the Information Officer’s suggested remedies, the data subject has the right to complain to the Information Regulator.
  • The Information Officer will review the complaints process to assess the effectiveness of the procedure on a periodic basis and to improve the procedure where it is found wanting. The reason for any complaints will also be reviewed to ensure the avoidance of occurrences giving rise to POPI related complaints.

How to Contact Us

If you have questions about this policy or believe we have not adhered to it, or need further information about our privacy practices or wish to give or withdraw consent, exercise preferences or access or correct your personal information, please contact us at the following numbers/addresses:

The Right to Complain to the Information Regulator

If you believe that we have used your personal information contrary to this Privacy Policy, please first attempt to resolve any concerns with us directly using the information above. If you are not satisfied after this process, you have the right to lodge a complaint with the Information Regulator, under the Protection of Personal Information Act.

Their contact details are:

Street Address:
The Information Regulator (South Africa)
JD House, 27 Stiemens Street
Braamfontein
Johannesburg
2001

General enquiries:
Phone: 010 023 5200
Email: enquiries@inforeg.org.za

Complaint’s email:
PAIA: PAIAComplaints@inforegulator.org.za – should your PAIA request be denied or there is no response from a public or private body for access to records, you may use this email address to lodge a complaint. You may use and complete the prescribed PAIA form which is available on the Information Regulator’s website.
POPIA: POPIAComplaints@inforegulator.org.za – should you feel that your personal information has been violated, you may use this e-mail address to lodge a complaint. You may use and complete the prescribed POPIA form which is available on the Information Regulator’s website.

Website: https://inforegulator.org.za/

Our Vision

At Optivest, medical schemes and medical scheme related products are our speciality.
It is our vision to enable all South Africans to get medical cover, that suits their individual and family needs while saving them money.

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