INSURANCE OMBUDSMAN

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INSURANCE OMBUDSMAN
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DETAILS

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

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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

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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

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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.

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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

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THE B0ARD

• 9 Members all of whom are employed by insurers.

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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

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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

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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

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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.

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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

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CANNOT DEAL WITH

• Actuarial policy in setting surrender values,
  profits etc.
• Civil liability under the policy
• Underwriting other than material facts

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QUESTIONS???