The Insurance Claims Complaints Panel (Complaints Panel) has released the claims complaints statistics and case review for the year 2017.
In 2017, the then Insurance Claims Complaints Bureau (ICCB) handled altogether 782 cases, of which 662 were new cases (representing a 0.5% increase over the previous year) and 120 cases were brought forward from 2016. Out of these 782 cases, 223 were dismissed because they did not fall within the terms of reference of the ICCB. Of the remaining 559 cases, 411 cases were closed while the balance of 148 cases were carried forward to 2018.
The main categories of these 411 complaint cases were related to the application of policy terms, non-disclosure, excluded items, amount of indemnity and breach of warranties or policy conditions. And hospitalisation/medical and travel insurance policies constituted the two largest groups of claim disputes.
Amongst the 411 cases closed, 89 were mutually settled between the insurers and the complainants with the aid of the ICCB secretariat. These cases did not need to go to the Insurance Claims Complaints Panel (Complaints Panel). No prima facie evidence was found in 217 cases and 69 cases were withdrawn by the claimants.
The remaining 36 cases (8.8%) were referred to the Complaints Panel for deliberation. The Complaints Panel ruled in favour of the complainants in 12 cases and upheld the insurer’s decision in 24 cases.
In dollar terms, 101 complainants received from insurance companies a total claims compensation of HK$10.25 million (US$1.31 million), of which HK8.45 million was from mutual settlement.
Mr Michael F S Tsui, Chairman of the Complaints Panel, said, “The Complaints Panel ruled in favour of the complainants in twelve cases and the amounts involved was HK$1.8 million. The highest single case award was around HK$650,000.”
The Insurance Complaints Bureau (ICB), which superseded the ICCB on 16 January 2018, aims at providing an alternative dispute resolution mechanism to all insurance disputes arising from personal insurance contracts. The Complaints Panel is appointed by the ICB. Same as before, its objective is to provide independent and impartial adjudication of claims complaints between insurers and policyholders or their beneficiaries. Its decisions are binding on all the ICB Members. However, if the complainants find the decision of the Complaints Panel unacceptable, they are free to seek legal redress and their legal rights are not affected by the decision of the Complaints Panel.
The Complaints Panel is made up of five members. The majority of members come from the non-insurance industry. This ensures the independence and credibility of this alternate dispute resolution mechanism.
Members of the Complaints Panel acted on a voluntary basis and consisted of:
- Mr Michael F S Tsui, Chairman, Barrister-at-law
- Ms Chairty C S Au, Representative of the Life Insurance Council of the Hong Kong Federation of Insurers (HKFI)
- Ms Constance H M Choy, Nominee of the Consumer Council
- Mr Lars Nielsen, Nominee of the Hong Kong Institute of Certified Public Accountants
- Mr Jonathan C H Yau, Representative of the General Insurance Council of the HKFI
Picture: Chairman of The Insurance Claims Complaints Panel Mr Michael Tsui (second from left), together with his fellow members (from left) Mr Lars Nielsen, Ms Charity Au and Mr Jonathan Yau, announced the annual claims complaints statistics for 2017. (Credit: ICB)
Download your complimentary copy of 50 social media tips for insurance practitioners