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Insurance Ombudsman


The Insurance Ombudsman Service has been active in the Republic of Croatia as from the beginning of the year 2007. It has been established according to Article 272 of the Insurance Act, by which the scope of business of the Croatian Insurance Bureau has been considerably broadened in the sense that apart from the existing responsibilities related to the operation of the national Green Card Bureau, the Guarantee Fund, competences regarding the adoption of common insurance conditions and tariffs in compulsory traffic insurance ..., it has assumed further functions related to the out-of-court settlement of disputes of insured i.e. damaged persons. The Insurance Ombudsman Service was established by the Decision on the Establishment and Operation of the Insurance Ombudsman at the Insurance Association – the Croatian Insurance Bureau, as an independent and autonomous body to facilitate the settlement of disputes between consumers and insurance companies.

Competences of the Insurance Ombudsman
• according to the quoted Decision the Ombudsman decides over disputes which arise from disregard of the Code of Insurance and Reinsurance Business Ethics and Other Fair Business Practices and Basic Professional Insurance Standards
• the Ombudsman is not competent for the settlement of property lawsuits since these fall under the authority of the courts
• the Ombudsman is not competent for the resolution of disputes which cases are already in process at the competent court
Head of the Insurance Ombudsman Service is the Ombudsman whose work is focused on the detection of disregard of fair business practices and basic professional insurance standards. The Ombudsman thus decides in cases related to insurance companies failing to act in compliance with the provisions of the Code of Insurance and Reinsurance Business Ethics – the basic Act which insurance companies adopted and to which they committed themselves to compliance. The Ombudsman is not authorised to decide on property claims of insured i.e. damaged persons, such as damaged persons’ complaints relating to the height of the offered indemnification for personal injury, or to disregard of their repair bill to its full amount etc. Decisions on the party’s claims arising out of property relations fall under the jurisdiction of the courts which guarantee the plaintiff the conduct of judicial proceedings, their rights to appeal and the like. In addition to that, the Ombudsman is not empowered to justify his position in Court cases.

How to make a complaint to the Ombudsman
• a complaint is submitted in writing, including any relevant documents and signed
• a complaint is made within a period of 6 weeks
• a complaint may be submitted only if the insurance company has already brought a final decision in its own internal procedure

The written complaints may be taken to the Ombudsman to the following address:

Croatian Insurance Bureau
To the attn. of the Ombudsman
HR - 10000 ZAGREB – Martićeva 71
Tel. +385 1 46 96 600
Fax. +385 1 46 96 660
e-mail: pravobranitelj@huo.hr

 

Complaints taken to the Ombudsman must include the information on the insurance company the complaint is being made about (name, address and file number), the information on the claim and facts the complaint is based on as well as provide any evidence which substantiate it – also it must be signed. The complaint must be made to the Ombudsman within a period of 6 months from the date of the action of the insurance company which the party considers as breach of the Insurance Code. However, ordinarily before the party takes his/her complaint to the Insurance Ombudsman, he/she has to complain to the liable insurance company first – the decisions brought by a company in its internal complaints procedure represent a procedural presumption, and the Ombudsman shall not take into consideration any complaint if the internal complaints procedure has not finished.

The procedure of investigating a complaint
• the Ombudsman fully investigates the complaint
• the Ombudsman forwards the complaint to the insurance company to comment on
• the insurance company is obliged to send its reply within a time limit of 15 days
• if the recommendations are not fulfilled the Ombudsman shall report it to the Supervisory Authority
If the Ombudsman establishes that a particular insurance company has disregarded the Insurance Code, that it has acted against the Fair Business Practices and Basic Professional Insurance Standards, he will then send his recommendation to the insurance company to put this action right.
The insurance company is obliged to inform the Ombudsman on its actions taken in compliance with the recommendation. Should the insurance company not comply with the recommendations the Ombudsman shall submit a report to the Supervisory Authority.
The insurance company is expected to comply with the Insurance Code and to act fair towards the consumer – relating to insurance purchase as well as to claims settlement. For instance, on signing an insurance contract the insurance company is obliged to supply the future insured with precise information on the insurance conditions and tariffs, the terms of the contract must be written in a clear and comprehensible language in order not to misinform the party. Similar provisions relate to the claims handling and settlement procedure of the insurance company – insurance companies are obligated to settle the claims without any delays, to indemnify the insured i.e. damaged person for the undisputed part of the claim, to give in the insurance terms instructions on out-of-court settlement procedures, insurance companies are obliged to bring their internal regulations on procedures in case of complaints made by the parties etc.

Council of the Insurance Ombudsman Service
The Ombudsman submits his annual report to the Council of the Insurance Ombudsman Service which supervises his activities. The Council consists of three members, namely, a consumer representative, an independent professional in the fields of insurance, finance or economic law and an insurance i.e. reinsurance company representative.


Code of Insurance and Reinsurance Business Ethics