1 January - 31 December 2016
In 2016, the Insurance Claims Complaints Bureau (ICCB) handled altogether 770 cases, of which 659 were new cases (a 2% increase compared with 647 in 2015) and 111 cases were brought forward from 2015. Out of these 770 cases, 276 were dismissed because they did not fall within the terms of reference of the ICCB. Of the remaining 494 cases, 374 were closed while the balance of 120 cases were carried forward to 2017 (see Table 1).
For the 374 cases closed, the main categories of complaints included application of policy terms, non-disclosure, excluded items, amount of indemnity and breach of warranties or policy conditions (see Figures 1 and 2). And hospitalization/medical and travel insurance policies constituted the two largest groups of claim disputes (see Figures 3 and 4).
Amongst the 374 cases closed, 60 were mutually settled between the insurers and the complainants with the aid of the ICCB secretariat. These cases did not need to go to the Complaints Panel. No prima facie evidence was found in 220 cases and 49 cases were withdrawn by the claimants. The remaining 45 cases (12%) were referred to the Complaints Panel for deliberation (see Figure 5). The Complaints Panel ruled in favour of the complainants in seven cases and upheld the insurer's decision in 38 cases. Amongst these 38 cases, the Complaints Panel recommended ex-gratia payment in two cases and the recommendation was readily accepted by the insurers concerned (see Figure 6).
In dollar terms, 69 complainants received from insurers a total claims amount of HK$2.60 million comprising HK$2.41 million from mutual settlement and HK$190,000 from awards made by the Complaints Panel. The highest single case award was around HK$75,000.