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Following is a question by the Hon Cheung Man-kwong and a written reply by the Secretary for Financial Services, Mr Rafael Hui, in the Legislative Council today (Wednesday):
Question:
It is learnt that upon receipt of a complaint from an insurance policyholder relating to the refusal of his insurer to settle the claim, the Insurance Claims Complaints Bureau will refer the case to the insurer concerned for a reply. If the insurer maintains its position, the Bureau will refer the case to its Honorary Secretary for an objective assessment. If the Honorary Secretary is not in favour of the insurer's position, the Bureau will refer the case to the insurer for reconsideration. If the insurer still maintains its position, the case will be referred to the Insurance Claims Complaints Board ("the Board") under the Bureau for deliberation and adjudication. In this connection, will the Government inform this Council whether it knows:
(a) the number of complaints received by the Bureau in the past three years, with a breakdown of such cases by different types of insurance policies;
(b) of these complaints,
(i) the respective numbers of cases in which insurers settled the claims upon the first and the second referrals; and the number of cases in which insurers settled the claims after the Board's adjudication;
(ii) the average amount of compensation adjudicated by the Board and how this amount compares to the average amount claimed by the policyholders concerned;
(iii) a breakdown of these cases by the types of disputes, including coverage of the insurance policies, information required to be disclosed by policyholders in taking out insurance, determination of the amount of compensation to be awarded and interpretation of other terms in the policies; and
(iv) the number of cases which were rendered invalid by the Bureau without making the above-mentioned referrals or seeking adjudication by its Board; and the rationale for the Bureau making such decisions?
Reply:
Madam President,
(a) The Insurance Claims Complaints Bureau ("ICCB") received a total of 406 complaints between 1997 and October 1999. A breakdown of the cases by types of insurance policies is as follows-
Jan to
1997 1998 Oct 1999
---- ---- --------
(1) Fire/ Home 6 7 11
(2) Life 37 35 52
(3) Hospitalisation/
Medical treatment 6 39 36
(4) Motor vehicle
Liability 23 24 23
(5) Accident/Disability 5 26 33
(6) Travel 11 7 9
(7) Others 3 7 6
----- ----- -----
91 145 170
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(b) Given the time required for the processing of complaints by the Bureau, not all cases could be closed within the same year. Between 1997 and October 1999, a total of 409 cases were closed. The details are set out below:-
(i) Number of cases in which insurers settled the claims:
Jan to
1997 1998 Oct 1999
---- ---- --------
Upon the first referral 14 17 16
Upon the second referral 6 7 13
After the Board's
Deliberation 10 11 10
----- ----- -----
30 35 39
===== ===== =====
(ii) Average amount of compensation adjudicated by the Board:
Jan to
1997 1998 Oct 1999
---- ---- --------
(Hong Kong Dollars)
Average amount of
compensation paid by
insurers per case 86,667 94,286 48,974
Average amount claimed (No breakdown is available
by policyholders per case since some policyholders
did not specify the amount
claimed)
(iii) Breakdown of cases by the types of disputes:
Jan to
1997 1998 Oct 1999
---- ---- --------
(1) Non-disclosure of
material fact by the
policyholder 28 27 26
(2) Insufficient quantum
of indemnity 11 9 11
(3) Breach of warranty/
policy conditions 9 19 21
(4) Interpretation of
policy conditions 33 54 65
(5) Others 25 29 42
----- ----- -----
Total 106 138 165
===== ===== =====
(iv) Number of cases which ICCB had considered as not substantiated, hence for which no referrals were made:
Jan to
1997 1998 Oct 1999
---- ---- --------
27 68 83
The ICCB considered that the above cases are not substantiated on the following grounds:
(1) The complainant obviously held back important insuring information;
(2) The claim was not within the coverage of the policy;
(3) Payment had been made by the insurer; and
(4) The complaint was outside the ICCB's terms of reference.
End/Wednesday, December 15, 1999
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