Insurance Consumer Complaint Handling Management

Original Language Title: 保险消费投诉处理管理办法

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Read the untranslated law here: http://www.chinalaw.gov.cn/article/fgkd/xfg/gwybmgz/201311/20131100393578.shtml

Insurance consumer complaint handling management

    (July 1, 2013, China insurance regulatory Commission [2013] 8th release come into force November 1, 2013) Chapter I General provisions

    First in order to standardize the insurance consumer complaint-handling work, protecting the rights and interests of consumers, in accordance with the People's Republic of China insurance law and other laws and administrative regulations, these measures are formulated.

    Article insurance consumer complaints in these measures, including insurers insurance consumers and insurance intermediaries insurance consumer complaints and insurance consumers to the China insurance regulatory Commission (hereinafter "CIRC") and the insurance consumer complaints Agency.

    Insurance consumers to insurance agencies, insurance agencies make the insurance consumer complaints, consumer activity refers to insurance consumers in insurance with insurance companies, insurance intermediaries, insurance disputes, insurance agencies, insurance agencies reflect the situation, to sort out the dispute.

    Insurance consumers to CIRC and its local bodies for the insurance consumer complaints, consumers believe in consumer activity in the insurance refers to insurance, because insurance companies, insurance intermediaries, insurance practitioners in breach of the insurance supervision law, administrative regulations and the State stipulated by the CIRC, damage to their legitimate rights and interests, to the China insurance regulatory Commission and its agencies reflect the situation, apply for the fulfilment of their statutory and regulatory responsibilities.

    Article insurance consumer complaint handling should be done according to law, the principle of fair, impartial, accessible, efficient, effectively protecting the legitimate rights and interests of consumers.

    Article fourth Circ insurance consumer protection board is the work of the national insurance consumer complaint handling management, supervision and management of the national insurance consumer complaint handling work.

    Agency of the China insurance regulatory Commission should clarify the insurance consumer complaint handling management departments, to conduct supervision and management area insurance consumer complaint handling.

    Article fifth insurance agency, an insurance intermediary shall set up or designate the insurance consumer complaint-handling work of administrations and jobs, staff, this unit is responsible for the insurance consumer complaint handling, statistics, analysis, and management.

    And its provincial branches of insurance companies, insurance agents, insurance brokers, insurance assessment institutions should specify the units in charge of insurance consumer complaint-handling work of senior management people working for the insurance consumer complaint handling responsibilities.

    Sixth insurance company, insurance agent, insurance broker, insurance assessment institutions should strengthen the branches of insurance consumer complaint handling management, guidance and assessment, coordination and support to branches and properly handle all types of insurance consumer complaints.

    Article seventh Insurance Association of insurance consumer complaint handling mechanism should be established, actively coordinating and supervising member insurance companies and insurance intermediaries dealing with insurance consumer complaints in a timely manner.

    Eighth Agency of the China insurance regulatory Commission shall establish provisional guide insurance dispute mechanisms and monitor its regular operation.

    Insurance industry associations shall strengthen self-discipline, coordination, supervision member insurance companies and insurance intermediaries through consultations and mediation to solve the insurance consumer complaints, do the insurance dispute resolution institution construction and management work, insurance dispute mediation mechanisms function properly.

    Insurance companies, insurance agents, insurance brokers, insurance assessment institutions should be guided and supported affiliates participating in insurance disputes settlement mechanism, consultation and insurance consumers resolve disputes with insurance consumer.

    Insurance dispute mediation mechanism and the specific measures formulated by the China insurance regulatory Commission separately.

    Chapter II responsibilities

    Nineth insurance agency is responsible for the following insurance consumer complaint:

    (A) the insurance contract provisions relating to this dispute;

    (B) for insurance sales, insurance, surrender, preservation, payment and other business with the employer disputes;

    (C) an insurance consumer activities of other disputes with the employer.

    Article tenth insurance intermediary body responsible for handling insurance consumers ' insurance intermediary services dispute with the units of the complaint.

    Consumer complaints to the insurance agency insurance insurance consumers, to provide insurance intermediary services of insurance intermediaries can help reflect the situation or to provide the relevant facilities and promoting consumer complaints successfully resolved.

    11th China insurance regulatory Commission is responsible for the following insurance consumer complaint:

    (A) the insurance regulation in the insurance companies in breach of the provisions of laws and administrative rules and regulations and CIRC, prejudice the legitimate interests of insurance consumers, the law should be dealt with by the China insurance regulatory Commission;

    (B) the related insurance insurance violates the legal provisions, administrative regulations, and the China insurance regulatory Commission, prejudice the legitimate interests of insurance consumers, the law should be dealt with by the China insurance regulatory Commission;

    (C) other circumstances that by law should be dealt with by the China insurance regulatory Commission.

    12th Agency of the China insurance regulatory Commission is responsible for the following insurance consumer complaint:

    (A) the area within the branches of insurance companies, insurance intermediaries in breach of the insurance supervision law provisions, administrative regulations, and the China insurance regulatory Commission, prejudice the legitimate interests of insurance consumers, the law should be dealt with by the local Office of the China insurance regulatory Commission;

    (B) the insurance regulation in the area of insurance practitioners in breach of the laws, administrative rules and regulations stipulated by the CIRC, prejudice the legitimate interests of insurance consumers, the law should be dealt with by the local Office of the China insurance regulatory Commission;

    (Iii) other law should be dealt with by the local Office of the China insurance regulatory Commission.

    Chapter insurance consumer complaint handling

    First insurance consumer complaints made

    13th insurance consumers insurance consumer complaints can be taken by mail, fax, e-mail or any other means, or take phone calls, interviews or any other means.

    Insurance consumer complaints by mail, fax, e-mail messages, and insurance consumer complaint material should be sent to the specified by the complaints unit mailing address, fax number, email address.

    Take telephone insurance consumer complaints, consumers should call the phone number specified by the complaints unit. Take interview of insurance consumer complaints, consumers should be raised in the complaints handling unit designated reception sites.

    5 or more common insurance insurance consumers to be taken face-to-face consumer complaints, 1 to 2 should be elected representatives.

    14th insurance consumer complaints should be presented by the insurance consumers, and should provide the following materials:

    (A) the basic situation of the complainant, including: citizen's name, ID number, contact phone number, contact address, zip code, legal person or other organization names, addresses, postal code and name of the legal representative or principal responsible person, position;

    (B) the respondent's basic situation, including: insurance agencies or insurance intermediaries were the subject name of complaints related to insurance and insurance agencies or insurance intermediary's name to which it belongs;

    (C) the request, the main facts and reasons, as well as relevant facts and documentation. 15th insurance consumer insurance consumer complaints I do have difficulties, may appoint a person on whose behalf, it should be submitted to the complaints unit the complaint provided for in article 14th material, the original power of Attorney, as well as the identity of the trustee.

    Power of attorney shall set forth the matters entrusted, permissions, and the term, and should be made by insurance consumers autographs.

    Article 16th e-mail to make the insurance consumer complaint, may submit written materials; complaint handling staff can also request the complainant to provide evidence, as appropriate. Take interview of insurance consumer complaint, you can also submit written materials provided in this article 14th, material or fill in the complaint form. There is difficulty in writing the complainant, complaints can be dealt with by the complaints of staff records and requests for basic information, complaint, complaints principal facts and reasons, and signed by the complainant.

    Complaint handling staff can also request the complainant to provide evidence, as appropriate.

    Take telephone insurance consumer complaints, complaint handling staff should document complaints and requests for basic information, complaint, complaints principal facts and reasons, and where appropriate, request the complainant to provide related proof materials. Written materials submitted by the complainant should be signed by the complainants.

    Insurance consumer complaints submitted by legal persons and other organizations, and complaints materials should be stamped with the seals of the unit.

    Article 17th insurance consumer complaint handling Management Division shall register the insurance consumer complaints received, incomplete complaint material shall within 5 working days from the date of receipt of materials to inform the complainant supplement provides.

    Insurance consumers to insurance institutions of insurance consumer complaints, insurance intermediaries, insurance agencies, insurance intermediaries have been master or material which can be obtained through the information about files and no further additional requirement the complainants.

    18th insurance consumers insurance consumer complaints should be objective, responsible for the material that it provides content authenticity, shall not provide false information or false, distorted, or falsely accuse or frame other persons.

    Insurance insurance consumer complaint process, consumers should abide by the laws, administrative regulations and the relevant provisions of the State, maintain social order and complaint handling unit order in the workplace.

    Section II-insurance consumer complaints

    Article 19th insurance consumer complaints Management Division is the unit accepts insurance consumer complaint bodies.

    Article 20th insurance consumer complaint handling management upon receipt of the complete complaint material, it should be reviewed in a timely manner, and are made according to the following process:

    (A) in accordance with this regulation, this unit is responsible for the insurance consumer complaint, is admissible;

    (B) belong to the insurance consumer complaints as provided herein, but do not belong to this unit is responsible for the inadmissible and can transfer the relevant units to deal with;
(C) does not belong to the insurance consumer complaints as provided herein, but it should be dealt with by other parts of the unit, and transferred to related departments in accordance with the relevant regulations;

    (D) do not belong to the insurance consumer complaints as provided herein, and does not belong to other parts of the unit is responsible for the inadmissible;

    (E) one of the circumstances prescribed in the first paragraph of the article 21st, inadmissible.

    21st insurance consumer complaint has any of the following circumstances, inadmissible complaints handling Management Department:

    (A) the complaint is not the trustee of insurance consumers and insurance consumers;

    (B) the unit has accepted a complaint, insurance consumers within the processing period no new facts and reasons made the same complaint again;

    (C) the complaint handling decisions have been made, no new facts and reasons for insurance consumers again made the same complaints.

    Insurance consumers within the processing period again raised the same complaint, but new facts and reasons for checking, complaint management consolidation, processing period from the date of receiving complaints from new materials to recalculate.

    22nd insurance consumer complaint handling Management Division shall, on receipt of the completed complaints within 10 working days from the date of the material, inform people whether to accept the complaint inadmissible, it shall explain the reasons.

    Section III insurance consumer complaint handling decisions

    Article 23rd insurance institutions of insurance, insurance intermediaries to receive consumer complaints should be timely investigation and verification, depending on the complaints request situation, respectively, made the following decision:

    (A) in line with laws, administrative regulations, relevant State provisions, and the insurance contract shall be contractual obligations according to law;

    (B) does not comply with the laws and administrative regulations, as well as the relevant provisions stipulated in the insurance contract, it should be explained to the complainant;

    (C) the laws, administrative regulations, relevant State provisions are not expressly provided for and unclear insurance contract shall, in accordance with the principle of fair and reasonable consultation with the complainant;

    (D) consumer complaints are not covered by the insurance consumers proposed by the trustees or the insurance consumer, termination of insurance consumer complaint and inform the complainant;

    (E) before the decision was made, the complainant withdrew insurance consumer complaints and termination of insurance consumer complaint and inform the complainant.

    Article 24th insurance agency, insurance intermediaries after accepting the insurance consumer complaints should be different and make a decision within the following periods:

    (A) the clear facts and disputed simple insurance consumer complaints should be made within 10 working days from the date of the acceptance decision; (B) for paragraph (a) provides insurance consumer complaints other than the State, shall make a decision within the accepted date of 30th.

    Complex, insurance consumer complaint-handling work of the units responsible for approval, you can extend the deadline, but extended periods of not more than 30th, and notify the complainant of extension on the grounds. 25th dealt with within 5 working days from the date of the decision, insurers and insurance intermediaries shall inform the complainant.

    Inform content should include:

    (A) the complaints request conforms to laws, administrative regulations, relevant State regulations and insurance contract;

    (B) opinions;

    (C) if the complainant disagrees with the decision, may apply in accordance with the provisions of the present article 26th verification or through insurance or litigation, arbitration and other means to resolve the dispute mechanism.

    26th complainants to insurance company branches, insurance agency affiliates, insurance broker company branches, insurance assessment institutions branch of insurance consumer complaint handling decisions taken by objections, from the date of receipt of the decision in the 30th to the level on the written application of the Agency's verification. Verification body should the insurance consumer complaint handling process, processing time, and to verify the results, and it should be since the date of the verification request is received within 30th verification decision.

    Decision within 5 working days from the date of verification, the verification agency shall inform the complainant. 27th CIRC and its local agencies to accept the insurance consumer complaint shall organize investigation and verification, and make a decision within 60 days from the date of complaint; complex, approved by the head of the unit, you can extend the deadline, but the extension period shall not later than 30th and notify the complainant of extension on the grounds.

    Otherwise stipulated by laws, administrative regulations and rules, in accordance with its provisions. Complainants in the process before the decision was made to withdraw the insurance consumer complaints, or CIRC and its local agencies in the survey found that consumer complaints are not covered by the insurance consumers proposed by the trustees or the insurance consumer, termination of insurance consumer complaint and inform the complainant.

    In accordance with the relevant provisions should be dealt with by other parts of the unit, and transferred to related departments. 28th dealt with within 5 working days from the date of the decision, the CIRC and its local agencies shall inform the complainant.

    Inform content should include:

    (A) the complainants of violations or suspected violations of the relevant insurance regulatory laws, administrative rules and regulations stipulated by the Circ;

    (B) opinions;

    (C) if the complainant disagrees with the decision, may apply in accordance with the provisions of article 29th of this approach for verification.

    Article 29th complainants insurance consumer complaints to the Agency of the China insurance regulatory Commission disagrees with the decision, starting from the day of receipt of the decision in the 30th to the CIRC written application for verification. Circ shall insurance consumer complaint handling process, processing time, and to verify the results, and it should be since the date of the verification request is received within 30th verification decision.

    Verification within 5 working days from the date of the decision, shall inform the complainant of the Circ.

    Fourth section insurance consumer complaint handling system

    Article 30th insurance agency, insurance intermediaries shall announce insurance consumer complaint phone number, fax number, letters, mailing address, reception site address and email information, and on the official show Web site and place of insurance consumer complaint handling procedures.

    CIRC and its local agencies should establish and improve the insurance consumer complaint rights hotline, publishing the company's insurance consumer complaint phone number, fax number, letters, reception site address mailing address and email information and the official show website and office space insurance consumer complaint handling procedures.

    31st insurance companies, insurance intermediaries, CIRC and its local agencies shall establish a insurance consumer complaints registration and insurance consumer complaint management system, and aggregated complaint data on a regular basis, are analyzed.

    Article 32nd insurance agency, insurance agency, China insurance regulatory Commission and its agencies should improve the insurance consumer complaint handling system, the evaluation system and the responsibility system of complaints.

    Article 33rd insurance companies, insurance intermediaries, the CIRC and its local agencies shall, in accordance with relevant regulations of the State major emergency response plan for dealing with consumer complaints and group insurance, group insurance and major consumer complaints prevention, reporting and emergency response work.

    Insurance companies, insurance intermediaries, the local Office of the China insurance regulatory Commission of China for more than 5 people group significant insurance consumer complaint or information shall be reported in accordance with relevant regulations of the China insurance regulatory Commission.

    34th article deals with insurance consumer complaints of staff shall comply with the following requirements:

    (A) the facts and legal compliance, without prevarication, perfunctory, delay;

    (B) comprehensive, listened carefully to the complainant's statement of facts and reasons, deal not to intensify the contradiction;

    (C) the insurance consumer complaints or complaints people have a direct interest, should be avoided;

    (D) comply with the provisions on confidentiality.

    Supervision and administration of the fourth chapter

    35th insurance agency, insurance intermediaries Circ or its agency turned the insurance consumer complaints, should be in accordance with the transferred units asking for a written report the following:

    (A) the admissibility of the complaint shall state the reason of the inadmissible;

    (B) the time limit for processing, handling complaints and opinions;

    (C) the complainant whether to accept the results.

    Article 36th insurance agency, insurance intermediaries in the insurance of consumer complaints in the following circumstances, the CIRC and its local agencies can be improved in a timely manner and the requirements and supervision and rectification of complaints handling units:

    (A) in accordance with this regulation inadmissible;

    (B) failure to inform the complainant whether it accepts as provided herein;

    (C) does not make a decision as provided herein;

    (D) in accordance with this regulation to the complainants informed treatment decisions;

    (E) in accordance with this regulation to inform the complainant disagrees with the decision to apply for verification;

    (Vi) other violations of these rules, prejudice the legitimate interests of insurance consumers in complaint handling, needs improvement.

    Receive car complaint handling should be written report the rectification in the 30th.

    37th CIRC and its local agencies in accordance with work requirements, insurance agencies, insurance intermediaries to process insurance consumer complaint was a return visit, heard the complainant's comments on the decision.

    Article 38th of the insurance company shall, according to the China insurance regulatory Commission requirements, report unit insurance complaints consumer complaint handling system, evaluation system, the accountability system, list of insurance consumer complaint handling responsibilities, and changes in these matters.

    Insurance company provincial branch, insurance intermediaries shall be requested by the local agency of the China insurance regulatory Commission, report unit insurance complaints consumer complaint handling system, evaluation system, the accountability system, list of insurance consumer complaint handling responsibilities, and changes in these matters.

    39th insurance company shall, within 10 working days after the end of each quarter to the China insurance regulatory Commission a written report for the first quarter of the insurance institutions of insurance consumer complaint handling work.
Insurance company branches, insurance intermediaries shall, within 7 working days of the end of each quarter where local Office of the China insurance regulatory Commission a written report for the first quarter of the insurance consumer complaint-handling work.

    40th insurance agency, insurance intermediaries shall annually on work presided over the insurance consumer complaint handling, and on March 1 of the following year to the CIRC report or the local agency submit a written self.

    Self-examination report shall indicate the unit of insurance consumer complaint handling system and the implementation of existing problems and improvement measures.

    41st CIRC to establish insurance companies, insurance intermediaries, insurance consumer complaint handling system of job evaluation, selecting appropriate indicators, comprehensive scientific evaluation of insurance agencies, insurance intermediaries complaint-handling work.

    42nd insurance agency, insurance agency violates these rules, any of the following circumstances, the China insurance regulatory Commission and its agencies can be tailored to specific situations, as its key regulatory objects with their senior management staff to monitor the conversation, or to take other regulatory measures:

    (A) in accordance with this approach provides for the establishment of insurance related to consumer complaints handling system;

    (B) in accordance with this approach required insurance consumer complaint-related information;

    (C) in accordance with this regulation the term of insurance consumer complaint-handling work-related reporting;

    (D) in violation of these regulations 36th article without the required corrective actions, if the circumstances are serious;

    (E) other violations of these rules, resulting in serious consequences.

    The fifth chapter by-laws

    Article 43rd insurance consumer activities mentioned in these measures refers to purchase of People's Republic of China territory of insurance products, as well as access to insurance services.

    Insurance consumers in these measures, including policyholders, insured persons and beneficiaries.

    The insurance mentioned in these measures refers to insurance agencies, insurance intermediaries in China, sales of insurance products, insurance and other insurance institutions in China sales.

    44th insurance agencies in these measures refers to the insurance company and its affiliates.

    Insurance intermediaries in these measures, refers to the insurance company and its affiliates, insurance brokers and their branch offices, insurance assessment institutions and their branches.

    Article 45th insurance consumers believe in insurance and consumer activities, for concurrent-business insurance agencies and their employees in breach of the insurance supervision law provisions, administrative regulations, and the China insurance regulatory Commission, the expense of their legitimate rights and interests, to the China insurance regulatory Commission and its agencies reflect the situation, apply for the fulfilment of their statutory and regulatory responsibilities, reference to the application of this approach.

    Article 46th insurance consumer complaint handling management departments shall, in accordance with the regulations to the complainant to inform related matters, but except for the complainants could not be contacted.

    In accordance with this regulation to inform the complainant not to accept insurance consumer complaints or inform the insurance consumer complaint handling decisions, writing should be taken; the consent of the complainant, can also take other means such as telephone, e-mail, and to retain the informed text or audio.

    Writing, should be informed of these measures send a written document within the time limit; inform taken by telephone, should be informed as provided herein within the period called the complainant telephone e-mail informed shall be informed within the period stipulated in this way relevant electronic files.

    Mentioned in the 47th article of the measures within this figure.

    48th article of the approach by the China insurance regulatory Commission is responsible for the interpretation. 49th article of the rules take effect on November 1, 2013.