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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 : PART1 Preliminary • 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 1 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. Organizational Structure 2 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 eradication. • 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 heard. • 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 decision. • The federal government may further prescribe rules for the 3 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 4 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 5
"AOA Fact Sheet Federal Insurance Ombudsman_ Pakistan Legal "