LCQ2: Complaints about insurance claims (16.6.2004)
Wednesday, June 16, 2004
Following is a question by the Hon Michael Mak and a reply by the Secretary for
Financial Services and the Treasury, Mr Frederick Ma, in the Legislative Cou ncil today
It has been reported that while the total number of complaints about insurance claims
received by the Insurance Claims Complaints Bureau ("ICCB") decreased by 12% over the
previous year, the number of complaints in respect of claims on medical insurance and
personal accident insurance increased by about 30% respectively. In this connection, will
the Government inform this Council whether:
(a) it has assessed the cause of the rise in the number of complaints about the above two
types of insurance claims;
(b) it knows the number of complaints, broken down by the cause of complaints, about
medical insurance claims received by ICCB in each of the past three years and, among them,
the number of cases in which the insurance companies were ordered to pay compensation to
the complainants; and
(c) the Office of the Commissioner of Insurance has discussed with trade organizations of
the insurance industry ways to reduce complaints about the two types of insurance claims?
Before replying to the Hon Mak's questions, I would like to introduce the operation
of the Insurance Claims Complaints Bureau (the Bureau). The Bureau was established by
the insurance industry in 1990. Its objective is to handle/arbitrate claims complaints lodged
by policyholders against insurance companies, so as to offer an alternative avenue other
than courts to resolve the relevant dispute and thereby protect the interests of policyholders.
An independent Complaints Panel with five members was established by the Bureau to
handle complaints. The incumbent Chairman is a barrister. Two of the other four members
come from the insurance industry, and the remaining two are non-insurance professionals
who represent the Consumer Council and the Hong Kong Society of Accountants
I will now reply to the Hon Mak's questions one by one:
1. The Bureau received a total of 256 complaints in 2003, which was 12% less than that in
2002. On the other hand, it handled a total of 222 cases in 2003, which was 9% more than
that in 2002. The number of cases relating to medical and personal accident insurance
claims had increased by about 30%, compared with 2002.
It is believed that the reasons for the increase in complaints handled by the Bureau
relating to medical and personal accident insurance claims are that the public is now more
receptive to insurance products and more assertive in protecting their interests. Moreover,
through the education and publicity campaigns of the Office of the Commissioner of
Insurance (OCI) and industry bodies, there has been greater awareness among members of
the public of their right in lodging complaints.
2. According to the information provided by the Bureau, there were 220 handled
complaints on medical insurance claims in the past three years (2001: 74, 2002: 63, 2003:
83). After arbitration and adjudication of the cases, the number of cases with claims
successfully settled was 21 in 2001; 19 in 2002; and 23 in 2003.
The main causes of complaints were the different interpretations of policy terms by
the policyholders and the insurance companies; dispute over "excluded items"; and the
rejection of claims due to non-disclosure of material facts by the policyholders.
The complaints on medical insurance claims handled by the Bureau in 2003 were
classified as below:
Interpretations of policy terms 25
Excluded items 19
Amount of indemnity 11
Others (e.g. delay in claim settlement) 9
The Bureau does not have the relevant information for 2001 and 2002, but it is
believed that the situation then was similar to that in 2003.
3. Over the years, the OCI has maintained close liaison with the insurance industry
(including the Hong Kong Federation of Insurers (HKFI)), held regular meetings, and
explored ways to promote good insurance practice, code of business and self-regulation of
the insurance industry. To help minimise complaints involving medical and personal
accident insurance, the HKFI has launched a section of "Insurance Tips" on its website,
which aims to facilitate policyholders in choosing insurance products and highlight issues
they need to know when taking out insurance. The HKFI is now deliberating on whether
to issue guidelines to medical insurers on the exclusion clauses in medical insurance
policies, with a view to further enhancing the protection of policyholders.
To protect their own interests and reduce arguments with insurance companies over
claims, may I also draw consumers' attention to the following three points:
(a) Disclose fully and accurately all information in the insurance proposal forms. If in
doubt, ask an agent to explain fully the implications of the clauses;
(b) Understand the scope of coverage of the insurance policy; and
(c) Read the policy terms comprehensively, in particular all the exclusion clauses.