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INSURANCE OMBUDSMAN

INSURANCE OMBUDSMAN. DETAILS. Ombudsman Is Caroline Gill M.Sc BL www.ombudsman-insurance.ie Situated in Merrion Square Dublin Appointed by insurance industry. HISTORY. Set up in 1992 First Ombudsman was Pauline Merrinan-Quinn B.L.

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INSURANCE OMBUDSMAN

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  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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