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INSURANCE OMBUDSMAN

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First Ombudsman was Pauline Merrinan-Quinn B.L. ... Adjustment of policy moneys from the surrender or cancellation of policies. PRE-C0NDITIONS ... – PowerPoint PPT presentation

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Title: INSURANCE OMBUDSMAN


1
INSURANCE OMBUDSMAN
2
DETAILS
  • Ombudsman Is Caroline Gill M.Sc BL
  • www.ombudsman-insurance.ie
  • Situated in Merrion Square Dublin
  • Appointed by insurance industry

3
HISTORY
  • Set up in 1992
  • First Ombudsman was Pauline Merrinan-Quinn B.L.
  • No. of complaints in 15 months from Oct 92 to Dec
    1993 was 473
  • Report for 2001 reveals 1285.
  • In first 15 months 26 adjudications compared with
    476 in 2001

4
DEVELOPMENTS
  • Within the idea of a financial services regulator
    the government has considered the use of a
    statutory ombudsman
  • The initial scheme only referred to insurers,
    brokers are now being admitted to the scheme

5
LEGAL STRUCTURE
  • Limited company called insurance ombudsman of
    Ireland Ltd
  • There is a Board of Directors and a council
  • Ombudsman reports to council
  • 47 Irish insurance companies have subjected
    themselves to the ombudsmans powers.

6
THE COUNCIL
  • Consists of 6 people of which
  • 2 representative of insurers
  • Chair is independent of insurance
  • 1 past member of conumers association
  • 1 Accountant
  • 1 member of ESRI

7
THE B0ARD
  • 9 Members all of whom are employed by insurers.

8
TERMS OF REFERENCE
  • Must have complete autonomy
  • Reports to The Council
  • Deals with complaints about insurance policies
    issued by member companies
  • Has to make awards based on the terms of the
    insurance contract, the terms of reference, rules
    of law and good insurance practice
  • Ombudsman acts a counsellor, conciliator or
    adjudicator

9
AWARDS
  • Monetary and binding on member
  • Limits of awards to
  • PHI Policies benefits less than 26,000 pa
  • The amount of benefit less than 160,000

10
AWARDS IN RESPECT OF
  • Payment of a claim
  • Payment of interest from 14th day after award is
    made
  • Adjustment of policy moneys from the surrender or
    cancellation of policies

11
PRE-C0NDITIONS
  • The complaint must have been considered by senior
    managemnt or has not been considered within two
    months of submission.
  • No formal proceedings in a court of law have been
    commenced
  • It must not refer to matter which formed part of
    previous complaint
  • Must be submitted within six months of offer or
    observations made by senior management.

12
DEALS WITH
  • Policies on behalf natural persons in their
    private and personal capacity
  • Insured or person who has legal title to policy
  • Risks outside Ireland if policy issued in Ireland

13
CANNOT DEAL WITH
  • Actuarial policy in setting surrender values,
    profits etc.
  • Civil liability under the policy
  • Underwriting other than material facts

14
QUESTIONS???
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