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AOA Fact Sheet Federal Insurance Ombudsman_ Pakistan Legal


									                                    AOA Fact Sheet
                Federal Insurance Ombudsman, Pakistan

APRIL 8, 2010                      INSTITUTIONAL OVERVIEW NUMBER 1

                     ORDINANCE No. XXXIX OF 2000 AN ORDINANCE to regulate the
                     business of the insurance industry to ensure the protection of the interests
Legal Framework      of the insurance policy holders and to promote sound development of the
                     insurance industry and for matters connected therewith and incident
                     thereto. Now, therefore in pursuance of the proclamation of the
                     emergency of the fourteen day of October,1999 and provisional
                     constitution order no 1 of 1999,as well as order no 9 of 1999 and in
                     exercise of all powers enabling him on that behalf ,the president of the
                     Islamic republic of Pakistan is pleased to make and promulgate the
                     following ordinance :

                        • Short title, extent and commencement. this ordinance may be
                           called the insurance ordinance 2000
                        • It extends to whole of Pakistan
                        • it should come in to force at once

                     Hence consequent upon the promulgation of the insurance ordinance
                     2000,the federal insurance ombudsman secretariat came in to being on
                     15/5/2006 as provided there in u/s 125(1) : as soon as may be after the
                     commencement of this ordinance ,the federal government shall appoint
                     an insurance ombudsman:

                     The insurance ombudsman may on a complaint by an aggrieved person
Jurisdiction/        undertake any investigation in to any allegation of mal administration on
Functions            the part of any insurance company.

                        •   The insurance ombudsman shall have the power for purposes of
                            disposing a case, to require an insurance company to disclose to
                            him any information subject to the following conditions, namely.
                        •   The insurance ombudsman shall make every endeavor to ensure
Legal Powers                that insurance confidentiality is maintained as required by

                     insurance law and procedure and shall take no action which is
                     volatile thereof.
                 •   The insurance ombudsman may call for any or all such
                     documents which are relevant or pertinent for purpose of deciding
                     a complaint;
                 •   Provided that he shall not be entitled to call for unrelated
                     documents which may compromise the insurance company
                     position in relation to other customers.
                 •   Provided further that in cases where the insurance ombudsman is
                     investigating cases of corruption, he shall have a greater latitude
                     in relation to the inspection of documents and
                 •   In the event of an insurance company refusing to furnish
                     information, or copies of relevant documents, the insurance
                     ombudsman may draw an adverse inference and comment on the
                     same in his findings.


                  Under section133 (3) any order passed by the insurance ombudsman
Implementation    which has not been appealed against, or any order passed by the
Arrangements      commission in appeal, as the case may be, shall become final and
                  operative and if not implemented shall render the insurance company
                  concerned liable to such action including the imposition of a fine or
                  penalty as the commission may deem fit, and in relation to the insurance
                  company officer, to the appropriate disciplinary or other proceedings.

                  Under section 127 (5) for carrying of the objectives of this ordinance
Addressing        and, in paricular for ascertaning the root causes of corrupt practices and
Systemic Issues   injustice,the insurance ombudsman may arrange for studies to be made or
                  research to be conducted and may recommend appropriate steps for their

                     •   Under section 129(1) a complaint shall be made on solemn
                         affirmation or oath in writing addressed to the insurance
Investigative            ombudsman. The complaint shall set out the full particulars of the
                         transaction complained of and the name and address of the
Techniques               complainant.
                     •   Prior to making a complaint the complainant shall intimate in
                         writing to the concerned insurance company his intension of
                         filing a complaint and if the insurance company either fails to
                         responds, or makes a reply which is unsatisfactory to the
                         complaint with in a period of one month, the complainant may
                         file a complaint at any time thereafter, with in a further period of
                         three months.
                     •   Provided that the insurance ombudsman may , if satisfied that
                         there were reasonable grounds for the delay in filing the
                         complaint, Condon the delay and entertain the complaint.
                     •   The insurance ombudsman may adopt any procedure as he
                         consider appropriate for investigating a complaint:
                     •   Provided that he shall not pass any order against a insurance
                         company with out first giving it a notice and an opportunity to be
                     •   Subject to section 128, the insurance ombudsman shall not have
                         any power to issue an order in the nature of stay order or to
                         entertain any complaint if the matter is pending before court,
                         tribunal or other legal forum.
                     •   The insurance ombudsman may reject a complaint summarily or
                         he may accept the same or pass any other order he deems fit:
                     •   Provided that in each case he shall pass a reasoned order for his
                     •   The federal government may further prescribe rules for the

                           conduct of proceedings in relation to complaints brought before
                           the insurance ombudsman.

                    The Insurance Ordinance lays down u/ S. 125 (6), “The Federal
Public Grievances   Government may further prescribe rules for the conduct of proceedings
& Redress (PGR)     in relation to complaints brought before the Insurance Ombudsman.”
Rules &             Following that one this office has formulated the rules in conformity with
Standards           the rules being followed by other the Ombudsman institutions in the
                    country and to a great extent being observed universally. However the
                    draft rules will shortly be forwarded to the legal department for vetting
                    and subsequent approval.

                    Nonetheless currently the practice pertaining to PGR being followed by
                    this office since its inception have been standardized. The streamlining of
                    the procedure for lodging the claim and the mechanism to deal with it has
                    smoothed the progress of the redress of the complaints for the officials
                    and the general public as well.

Freedom of
                    As for the Ordinance there is no specific stipulation relating to the
Information         accessibility of information to the public or an applicant. However no
(FOI) Standards     complainant is denied of any information which he has the right to obtain
                    from this office.

                    Currently this office is in the advance stage of developing/launching its
Use of              own web site in order to meet the changing nature of the public
Technology          requirement via communication, information and awareness. A
                    committee will shortly take decision on the bids tendered by various IT
                    firms. The web site will be interactive, user friendly and informative.

                    The federal insurance ombudsman publishes annual report (enclosed)
Public Awareness    available in printed foam, which is being distributed to the stakeholders,
& Outreach          besides this secretariat organize various seminars and conferences for the
                    facilitation and education of the masses so that our message could get
                    across various communities and they become fully aware of the working,
                    purpose, scope of this Office and assistance that could be provided to
                    them and to draw the attention of the insurers towards the fair treatment
                    to the policyholders.

                    In addition, for effective communication and awareness FIO is also
                    launching a website which will allow easy accessibility to the office. The

                  purpose would be to facilitate the public by disseminating information,
                  provide an understanding of the office of FIO, its functioning and
                  jurisdiction, procedure of filing complaints.

                  The Ombudsman as being an ex H C Justice and practicing lawyer
Linkages with     already has been active in social and literary circles and engaged in
Civil Society     educational activities especially for the children of the poor. Frequent
                  social interactions render him fully mindful of ever changing demands of
                  the civil society.

                  In a formal way this office since its founding has been the full member of
                  AOA and IOI. Needless to say both the august institutions have afforded
                  a great opportunity of improvement owing to exposure to the regional
                  and global movements in the subject of complaint redressing.

                  An institution which comes closer to this office in respect of sphere and
Parallel          nature of working is the Insurance Tribunal which came into existence on
Complaint         1st May, 2006 in pursuance of the Insurance Ordinance S. 121.
Redress Systems   The other institutions in this regard may be counted as follows:

                     1. Wafaqi Mohtasib (Ombudsman) Pakistan
                     2. Securities & Exchange Commission of Pakistan


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