Alternative Dispute Resolution Systems Regarding … Dispute Resolution...Alternative Dispute...

Alternative Dispute Resolution SystemsRegarding Private Insurance

S!GORTA HUKUKU TÜRK DERNE"!TURKISH CHAPTER OF AIDA

TURKEY


!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


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


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)


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.


Frank von Fürstenwerth German Insurance Association (GDV) Gutberlet

16

Horst Hiort

Supervisory Board3.


OMBUDSMANN FÜR VERSICHERUNGEN HIRSCH

See sec. 6 AOA

HIRSCH

TIFFE

Ombudsman4. Versicherungsombudsmann e.V.

its sole raison d’être



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.



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


HÖVEL

RÖMER

See HIRSCH BRÖMMELMEYER

ANONYMUS o

HIRSCH

V. HIPPEL


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


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


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


Model Case (Subsec. 4)d)

Other Dispute Resolution Mechanism Available (Subsec. 5)e)

Procedure VI.

HÖVEL

V. RINTELEN

HÖVEL

Entry Stage1.

Versicherungskaufmann

service centre


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



RÖMER


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



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

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

Mickovski:

th

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

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

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