Terms of Reference
- The complaint is of a monetary nature.
- The claim amount/monetary value of the complaints does not exceed HK$1,200,000 * .
- The insurer concerned is a Member of the ICB.
- The policy concerned is a personal insurance contract.
- The complaint is filed by a policyholder, a policy beneficiary, an insured person or a rightful claimant.
- The insurer concerned has made its final decision on the claim/dispute.
- The complaint is filed with the ICB within six months from the day of notification by the insurer of its final decision.
- The complaint in question does not arise from industrial, commercial or third party insurance.
- The complaint is not subject to legal proceedings or arbitration.
For Non-claim related complaints:
- The non-claim related complaint is not about quality of service or an underwriting decision of an insurer.
- The non-claim related complaint is not related to investment performance, level of a fee, premium, charge or interest rate unless the dispute concerns an alleged non-disclosure, misrepresentation, incorrect application, negligence, breach of any legal obligation or duty or maladministration on the part of an insurer.
* |
If an insured holds multiple policies, the aggregate amount of the individual claims involved should not exceed HK$1,200,000 should the causes of the claim rejection be identical or similar. As regards long-tail and periodic claims, the total claim amount, calculated up to a period of five years, should not exceed HK$1,200,000. |
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