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Alternative Dispute Resolution SystemsRegarding Private Insurance
S!GORTA HUKUKU TÜRK DERNE"!TURKISH CHAPTER OF AIDA
TURKEY
Alternative Dispute Resolution SystemsRegarding Private Insurance
!stanbul, 4 M
ay 2012
S!GORTA HUKUKU TÜRK DERNE"!(AIDA TURKEY)
Alternative Dispute Resolution Systems Regarding Private Insurance
April 2014
Front Page Design: Ümran Arslan
Alternative Dispute Resolution SystemsRegarding Private Insurance
S!GORTA HUKUKU TÜRK DERNE"!TURKISH CHAPTER OF AIDA
Foreword
Samim ÜnanChairmanAIDA Consumer Protection and Dispute ResolutionWorking Party
Content
The German Insurance Ombudsman System
Maître en droit
Alternative Dispute Resolution Systemsfor Insurance Disputes - An Australian Perspective
B.Juris, LLB, Grad Dip Ins Law, ANZIIF (Fellow)
Resolving Consumer Insurance Complaintsin the UK - The Financial Ombudsman Service
Consultant, Norton Rose Fulbright LLP, London 66
La Mediation En Assurances En France
Professeur à l’Université Montpellier I (France)
Médiateur du groupe MMA
Alternative Dispute Resolution Sweden
Rose-Marie Lundström Advokat AB
The Function and Operationof the Insurance Ombudsmanin Greece through the Independent Authorityof the Consumer Ombudsman
The Finnish System for Dispute Resolutions
Legal Counsel
If P&C Insrurance Company Ltd, Finland
Member of the AIDA Presidential Council and the Executive Committee
Dispute Resolution in Insurance:The South African Ombud
University of Pretoria 100
Turkish Special Arbitration Scheme for Claims Against Insurers
AIDA Turkey 111
The German InsuranceOmbudsman System
Prof. Dr. Jens Gal, Maître en droitJens Gal is entrusted with a Chair for European Insurance Law with a main focus on
legal studies in Frankfurt and Lyon, France and passed the First and Second States Exam
in the state of Hesse. He has been a regular lecturer at the Institute for Law and Finance in
focus is largely on issues of insurance contract law and insurance supervisory law but also
on the law of civil procedure with a main interest on arbitration matters. Gal is, inter alia,
a member of the interdisciplinary International Center for Insurance Regulation (ICIR)
of Insurance Matters of the University of Frankfurt and he is the current secretary of the
IntroductionI.
1
2
1 i.a. HAAS
2 BRÖMMELMEYER
10
Versicherungsombudsmann
4
Versicherungsombudsmann
Historical DevelopmentII.
Versicherungsombudsmann e.V. 6 in
per annum OMBUDSMANN FÜR VERSICHERUNGEN
4
OMBUDSMANN DER PRIVATEN BANKEN
APEL
BÜCHNER
SURMINSKI
HOEREN
HOHLFELD et al.
6
BASEDOW VERSICHERUNGSOMBUDSMANN E.V.
REICHERT-FACILIDES, et al.
11
Ombudsman der Privatversicherung
10
11
movement on this point12 Ombudmann der privaten Banken
14
MAURER
HIPPEL
MICHAELS
LORENZ
HIPPEL 10 SCHERPE
RÖMER
et al.
BENKEL/HIRSCHBERG idem
11 COMMISSIONo
12 GUDE
HÖCHEth
SCHERPE
HOEREN
14 V. HIPPEL
12
German Insurance Association (GDV)
German Insurance Association (GDV)Versicherungsombudsmann e.V.
eingetragener Verein16
Wolfgang RömerBundesgerichtshof Versicherungsombudsmann
German Insurance Association (GDV) Association of [German] Private Healthcare Insurers (PKV)
Versicherungsombudsmann
PKV-Ombudsmann
Membership and Funding III. German Insurance
Association (GDV)
LABES
KNAUTH
MICHAELS
German Insurance Association (GDV)
MICHAELS, in: VERSICHERUNGSOMBUDSMANN E.V.16 BRÖMMELMEYER BULTMANN
BULTMANN Beirat
KALIS
V. RINTELEN
the Versicherungsombudsmann e.V.
20 21
22 membership at the Versicherungsombudsmann e.V. PKV-Ombudsmann
24
26
de iure German Insurance Association (GDV)
20
21 V. RINTELEN OMBUDSMANN FÜR VERSICHERUNGEN
ibidem22 RÜHL
24 HIRSCH
OMBUDSMANN FÜR VERSICHERUNGEN
HIRSCH 26 OMBUDSMANN FÜR VERSICHERUNGEN
14
Organisation IV.
General Meeting1. eingetragener Verein
Versicherungsombudsmann e.V.
For
BULTMANN
REUTERth
Executive Board and Management2.
Fremdorganschaft
catchall competence
TIFFE
Versicherungsombudsmann e.V.
OMBUDSMANN FÜR VERSICHERUNGEN
Frank von Fürstenwerth German Insurance Association (GDV) Gutberlet
16
Horst Hiort
Supervisory Board3.
OMBUDSMANN FÜR VERSICHERUNGEN
OMBUDSMANN FÜR VERSICHERUNGEN HIRSCH
See sec. 6 AOA
HIRSCH
TIFFE
Ombudsman4. Versicherungsombudsmann e.V.
its sole raison d’être
OMBUDSMANN FÜR VERSICHERUNGEN
Versicherungsombudsmann
40
41
42
Referendariat
44
The Versicherungsombudsmann e.V.
40
LORENZ
41 RÖMER
BRÖMMELMEYER
et al.
42 H.C. (King s Bench)
sollshall or ought muss
44
Wolfgang RömerBundesgerichtshof
46
the Versicherungsombudsmann e.V.
Bundesgerichtshof
46 BULTMANN
MICHAELS VERSICHERUNGSOMBUDSMANN E.V.
nach Gutsherrenart V. HIPPEL
20
contractual
Other Employees5.
BULTMANN
V. HIPPEL
VERSICHERUNGSOMBUDSMANN E.V.
21
Versicherungskaufmann
Volljuristen
JurisdictionV.
OMBUDSMANN FÜR VERSICHERUNGEN
OMBUDSMANN FÜR VERSICHERUNGEN
Argumentum e contrario
22
Person-Related Requirements1.
Complainanta)
natural persons60
61
Gesellschaft bürgerlichen Rechts GBR
GbRHÖVEL
th
60
61
62
64
may
Kleingewerbe
66
62 HÖVEL/LEISSNER
RÖMER
HÖVEL
64 HÖVEL
HIPPEL . 214; SCHERPE LORENZ RÖMER
66 HÖVEL
RÖMER
24
Respondentb)
Versicherungsombudsmann e.V
OMBUDSMANN FÜR VERSICHERUNGEN
HÖVEL
RÖMER
See HIRSCH BRÖMMELMEYER
ANONYMUS o
HIRSCH
V. HIPPEL
OMBUDSMANN FÜR VERSICHERUNGEN
Subject Matter within the Ombudsman’s Jurisdiction2.
such appears to be the practice
Prima facia
SCHERPE
KNAUTH
RÖMER
RÖMER
26
Compliance with Procedural Requirements3.
HÖVEL
RÖMER
RÖMER
Policendarlehen HÖVEL
RÖMER
See V. RINTELEN HÖVEL
Exclusions from Jurisdiction4.
Amount in Dispute (lit. a)a)
V. RINTELEN
SCHERPE
V. RINTELEN
VERSICHERUNGSOMBUDSMANN E.V.
PKV-Ombudsmannsee V. RINTELEN
In concreto
offengelegte Teilbeschwerde
Health, Long-Term Care and Credit Insurance Contracts (lit. b)b)
Association of [German] Private Healthcare Insurers (PKV) PKV-Ombudsman
HÖVEL
offengelegte TeilbeschwerdeHÖVEL
RÖMER
Versicherungsombudsmann e.V. RÖMER
OMBUDSMANN FÜR VERSICHERUNGEN insurers see LABES
Actuarial Methods or Formulae (lit. c)c)
the right venue
100
Third Party Claims (lit. d)d)
own 101
102
per se
HÖVEL
SCHERPE
HÖVEL
SCHERPE 100 HÖVEL
101
102 SCHERPE
LABES
104
an own
Lis pendens (lit. e)e)
pactum de non petendo106
Bundesanstalt für Finanzdienstleistungsaufsicht
Finanzdienstleistungsaufsichtsgesetz [FinDAG the customers inter alia
104
106 V. HIPPEL
Gesetz zur Stärkung der deutschen Finanzaufsicht
110
res iudicata
Mahnverfahrenlis pendens
111
112
Res Iudicata (lit. f)f)
res iudicata
Prozesskostenhilfe
LAARS
110 LAARS
111 res iudicata
112 HÖVEL
HÖVEL
Criminal Proceedings (lit. g)g)
this is not a lis pendens
114
Manifestly Unfounded Claim (lit. h)h)
Versicherungsombudsmann116
but
114 SCHERPE
V. RINTELEN
116
OMBUDSMANN FÜR VERSICHERUNGEN
RÖMER
Prescribed Claim (lit. i)i)
120 since prescription is not
Unsuitability5.
kann
soll
Scope of Proceedings (Subsec. 1)a)
121
RÖMER
120 V. RINTELEN RÖMER
121 HÖVEL
122
Controversial Legal Questions (Subsec. 2)b)
124
Bundesgerichtshof
126
Remote Fields of Law (Subsec. 3)c)
122 SCHERPE
SCHERPE 124 HIRSCH
126 HIRSCH
OMBUDSMANN FÜR VERSICHERUNGEN
Model Case (Subsec. 4)d)
Other Dispute Resolution Mechanism Available (Subsec. 5)e)
Procedure VI.
HÖVEL
V. RINTELEN
HÖVEL
Entry Stage1.
Versicherungskaufmann
service centre
OMBUDSMANN FÜR VERSICHERUNGEN
ibidem
Remedial Stage2.
140
141
HÖVEL
time limit
V. RINTELEN RÖMER
140 RÖMER
141 OMBUDSMANN FÜR VERSICHERUNGEN ibidem
Procedural Stage3.
Volljuristen 142 The
144
since the Beibringungsgrundsatz
146
142
see LORENZ
ibidem144 OMBUDSMANN FÜR VERSICHERUNGEN
OMBUDSMANN FÜR VERSICHERUNGEN RÖMER VERSICHERUNGSOMBUDSMANN E.V.
146 V. RINTELEN
V. HIPPEL
DecisionVII.
the
ex aequo et bono
V. RINTELEN RÖMER
RÖMER SCHERPE
HIRSCH
OMBUDSMANN FÜR VERSICHERUNGEN ibidem
See V. HIPPEL
40
Kullanzentscheidung
Wettbewerbsrichtlinien
Generalklauseln
Binding Decision1.
must contain reasons
RÖMER
NITSCHKE et al.
See V. HIPPEL
VERSICHERUNGSOMBUDSMANN E.V.
OMBUDSMANN FÜR VERSICHERUNGEN
RÖMER
VERSICHERUNGSOMBUDSMANN E.V.
41
160
161
162
164
per analogiam
OMBUDSMANN FÜR VERSICHERUNGEN 160 SCHLOSSER
JORDANS
et passim161 HOEREN idem V. HIPPEL
LORENZ V. RINTELEN PRÖLSS idem th
BERGER
162 i.a. V. HIPPEL
V. RINTELEN 164 V. HIPPEL
42
166
glass bead game167
non venire contra factum proprium
V. HIPPEL LORENZ 166 V. RINTELEN
Regina v. Insurance Ombudsman Bureau and the Insurance Ombudsmann ex parte Aegon Life Assurance Ltd.
SUMMER,
Glasperlenspiel
SCHLOSSER
V. RINTELEN
Non-Binding Recommendation2.
Publication3. closed-door the
V. HIPPEL
RÖMER
SCHERPE
SCHERPE
OMBUDSMANN FÜR VERSICHERUNGEN V. RINTELEN
44
ConclusionVIII. Versicherungsombudsmann
OMBUDSMANN FÜR VERSICHERUNGEN
OMBUDSMANN FÜR VERSICHERUNGEN
V. HIPPEL
in VERSICHERUNGSOMBUDSMANN E.V.
Alternative DisputeResolution Systems for Insurance
Disputes - An Australian Perspective
Christopher RoddB.Juris, LLB, Grad Dip Ins Law, ANZIIF (Fellow)
lectures in insurance law part time. He has been both a state and national president of
involvement in insurance law education, and has written numerous articles on insurance
1
1
46
Practice
2
2
4
4
6
There is no
6
10
11
10
11
12
14
basis that the case involves:
12
14
There are
16
16
that total amount is less than the amount
motor vehicle
20
21
22
20
21
22
24
26
24
26
Critique of FOS System
in
Mickovski:
th
th
60
61
Conclusions in Relation to the Financial Ombudsman Scheme
62
Litigation, Mediation and Arbitration
40
41
40
41
64
42
42
Conclusions
44
th
44
66
Resolving Consumer Insurance Complaints in the UK - The Financial
Ombudsman Service
Michael MendelowitzConsultant, Norton Rose Fulbright LLP, London*
reinsurance practice. His experience covers a wide spectrum of classes of business,
including international casualty and property catastrophe, marine, aerospace, professional
indemnity and products liability. He specialises in disputes over contract interpretation,
materiality of underwriting information, environmental and other long tail liability issues,
and insurer insolvency. He is also regularly involved in non-contentious work, such as
alternative risk transfer transactions and contract negotiation and drafting. Michael is an
and editor of a major loose-leaf textbook on reinsurance practice and the law and has
written numerous articles for legal and trade journals. Michael is a frequent speaker at
individual in insurance and reinsurance by the major legal directories. He has consistently
Guide to the World’s Leading Insurance and Reinsurance Lawyers, and every edition of
The International Who’s Who of Business Lawyers since 2005 has put him in the world’s
top ten insurance and reinsurance lawyers.
Historical introduction1
*
1
Journal of Insurance Research and Practice
m
2
Overview
4
2
4 See h l
h k
6
Ombudsman News
Jurisdiction
6
Ombudsman News
Funding
th
Procedure
Effect of FOS decision
10
10
11
Pan Atlantic Insurance Co Ltd v Pine Top Reinsurance Co Ltd,12
11
12
Selected “war stories”Ombudsman News
Travel insurance – policy construction
Health insurance – non-disclosure
Property insurance – warranties
Property insurance – non-disclosure
FOS and proposed insurance contract law reform with regard to warranties
The future of FOS
Nineteen Eighty-Four
La Mediation En Assurances En France1
Anne PélissierProfesseur à l’Université Montpellier I (France)
Médiateur du groupe MMA
in insurance disputes and has a large practical experience in the alternative dispute
1
Anne Pélissier
« modalités d’examen des réclamations qu’il peut formuler au sujet du contrat, y compris, le cas échéant, l’existence d’une instance chargée en particulier de cet examen, sans préjudice pour lui d’intenter une action en justice »
1) Quel est le périmètre de la médiation?
2) Qui est le médiateur?
Anne Pélissier
3) Comment saisit-on le médiateur?
harmonisée pour classer les réclamations est on ne peut plus large : « une déclaration actant le mécontentement exprimé par un consommateur envers un professionnel »
a) Conditions de saisine
Au 1er niveau
Au 2 niveau
b) Effet de la saisine
4) Quel est la mission du médiateur?
5) Quelle est l’autorité des avis du médiateur?
Anne Pélissier
Alternative Dispute ResolutionSweden
Rose-Marie LundströmRose-Marie Lundström Advokat AB
Rose-Marie Lundström has a broad and strong insurance and reinsurance legal experience,
including a deep understanding of the insurance industry, as inhouse lawyer of Skandia
Rose-Marie has arbitrated and litigated a range of substantial insurance and reinsurance
disputes. She also acts as an arbitrator in insurance and reinsurance matters. Her practice
and experience includes a variety of legal areas such as casualty, professional liability,
product liability, environmental liability, personal injuries, accident and health, property
and regulatory matters. In addition she has experience advising on insurance/reinsurance
wordings, on coverage and construction issues. She is a lecturer of insurance and
reinsurance law at the Universities of Uppsala and Stockholm. She is Vice Chairman of
Insurance Law at Stockholm Centre for Commercial Law and a member of the Swedish
insurance). She serves in the ICC Reference Group on Financial Services and Insurance.
Introduction
1. The National Board for Consumer Complaints (Sw.: Allmänna Reklamationsnämnden)General background
Cross-border disputes
Konsument Europa
The Procedure
Contracts entered into in Sweden
Types of matters that ARN does not try
How a dispute is settled
General background
Sw
Sw
Sw
The Commission’s structure
Chairman
Sw
Deputy chair persons
Representatives of insurance companies
Sw
Sw
Lay representatives
Sw
When the Commission’s recommendation must be obtained
The procedureSw
Statistics 2012
Level of indemnity
3. Insurance Sweden (Sw. Svensk Försäkring)Sw
3.1 Personförsäkringsnämnden (PFN)
concerning:
PFN’s structure
A Chairman or a vice chairman lawyers
Sw
Two members with extensive claims handling experience
Two members representing the consumerSw
One advisory doctor
The procedure
3.2 Ansvarsförsäkringens Personskadenämnd (APN)
Sw
Sw
Sw
3.3 The Swedish Bar Association Establishesa Consumer Dispute Board
4. The Patient Injury Board
Sw
Sw
What is covered by the insurance?
5. The Pharmaceutical Injury Board
The Pharmaceutical Insurance (Sw. Läkemedelsförsäkringen)
The Pharmaceutical Injury BoardSw
The Function and Operationof the Insurance Ombudsman
in Greece throughthe Independent Authority
of the Consumer Ombudsman
Dr. Kyriaki Noussia
and is licensed to appear before the Supreme Court and the Conseil d’Etat. She specialises
in arbitration and in international commercial law. She has an extensive and wide-
ranging experience inter alia in insurance, reinsurance, marine insurance, arbitration and
the above areas of law both in a stand-alone and in a transactional context as well as
on the contentious side. Prior to that she has held numerous academic positions abroad,
such as at the University of Hamburg, Faculty of Law and the Max Planck Institute for
Comparative and international Private Law in Hamburg, Germany, where she was an
of international commercial law, arbitration, international procedural law, insurance and
reinsurance law, transportation law and private international law.
Introduction
The Function of the Independent Authority of the Consumer Ombudsman as far as Consumer Insurances are concerned.
inter alia
Mediation, Conciliation and Arbitration as Opposed to the recourse to the Consumer Ombudsman
pro bono
The Way Forward
The Finnish Systemfor Dispute Resolutions
Taisto Hujala, Legal CounselIf P&C Insrurance Company Ltd, FinlandMember of the AIDA Presidential Council
and the Executive Committee
number of areas involving insurance. He has been a member of several claims boards
Helsinki University.
categories:
all consumer issues
concerning
insurance
insurance companies
1 The Claims board for all consumer issues
2 The Claims board which handle claims and give recommendations concerning mandatory insurance
3 The Claims boards which handle claims concerning only voluntary insurance
4 The Appeal organs in Insurance companies
Panel
5 Organs for Social Insurance matters
general Courts
100
Dispute Resolution in Insurance:The South African Ombud1
Prof. Birgit KuschkeUniversity of Pretoria
1. Overview of South African Insurance legislation
1.1 General
insurance business:2
4
1.2 The Long-term Insurance Act
1
2
4
101
6
1.3 The Short-term Insurance Act
1.4 Policyholder Protection Rules
6
102
1.5 The Financial Advisory and Intermediary Services Act
Section 1
2. Dispute Resolution Procedures
2.1 General
10
2.2 Regulation of Ombud Schemes11
12
10 Modern Insurance Law in South Africa
11
12
104
2.3 Internal dispute resolution schemes:
14
14
106
3. Voluntary Ombud schemes
3.1 Voluntary Schemes for insurance disputes
3.2 The Short-term Ombud
3.2.1 Structure of the Ombud
3.2.2 Procedure and determination
3.3 The Long-term Ombud
3.3.1 Structure of the Ombud
3.3.2 Procedure and determination
3.3.3 Appeals
4. Statutory Schemes
Services Ombud
16
16
20
4.2 Special adjudicators
21
22
5. The FAIS Ombud claims procedure and determination
5.1 Procedure and determination
24
20
21
22
24
110
5.2 Appeals
6. Conclusion
111
Turkish Special Arbitration Schemefor Claims Against Insurers
Dr. Samim Ünan AIDA Turkey
law at the University of Galatasaray. He works as legal consultant for insurance companies.
Chairman.
Dispute resolution methods
Complaints
Insurance Intermediary
112
Insurance Undertaking
Regulator
Courts
Commercial Courts
1
1
2
Other Courts of First Instance
Consumer Courts
Arbitration
According to Turkish International Arbitration Act
2
114
According to Turkish Civil Proceedings Act
According to Insurance Activities (Control) Act Article 30 (= Special Arbitration Scheme for Insurance)
Administration
Claims eligible
Claimants- Defendant Insurer
116
Arbitrators
Costs
th
Conditions of application
Rapporteur
Procedural Rules
particular
Pros and Cons
Advantages of the special arbitration scheme
Disadvantages
120
Reliability
Conclusion