Authorized Insurers or Licensed Insurance Intermediaries
(1) What is the Insurance Authority’s (“IA”) role in handling insurance-related complaints?
The IA is a statutory body established under the Insurance Ordinance (Cap. 41) (“Insurance Ordinance”) to regulate and supervise the insurance industry.
In line with its regulatory functions and powers, the IA may handle complaints regarding the conduct of authorized insurers and licensed insurance intermediaries (being licensed insurance agents and licensed insurance brokers) in the insurance market in Hong Kong.
“Conduct” broadly covers matters such as sales and marketing practices in relation to insurance policies, the negotiation or arrangement of insurance policies, the giving of advice and making of recommendations on insurance policies, and the handling of premium or other insurance monies on behalf of policyholders or potential policyholders.
Examples of complaints about conduct in the insurance market (i.e. potential “misconduct”) which the IA may handle are as follows:
- unethical sales practices (e.g. using unauthorized sales materials which contain false or misleading information to influence policyholders to enter into insurance policies);
- mis-selling of an insurance policy by misrepresenting the benefits, coverage or terms and conditions of an insurance policy;
- giving wrong or unsuitable advice on insurance matters;
- failing to explain the cooling-off period to policyholders or failing to deliver the cooling-off notice or insurance policy to the policyholder within the required timeframe or cooling-off period;
- failing to conduct a proper financial needs analysis in relation to a life insurance policy to identify the policyholder’s insurance needs;
- mishandling of premium or other insurance monies;
- inducing policyholders to replace their existing life insurance policy with another life insurance policy by misrepresentation, fraud or unethical means;
- wrongful conduct in signing or completing insurance related documents;
- improper conduct in the carrying on of insurance business or regulated activities (e.g. failing to comply with the requirements in the Insurance Ordinance or the codes and guidelines issued by the IA causing actual or potential prejudice to policyholders or harming the public interest; and
- carrying on regulated activities or insurance business without the requisite licence or authorization.
As the IA’s remit focuses on conduct in the insurance market, it generally cannot handle complaints that do not involve matters of conduct (see in particular, question 6 on claims-related disputes and question 7 of commercial disputes).
(2) How does the IA handle and make decisions on complaints regarding conduct in the insurance market?
Upon receipt of the first submission of your complaint (see question 5), we will issue an acknowledgement to you within 10 working days. As part of our acknowledgement (depending on the nature of your complaint) we may indicate how your complaint is to be handled and next steps. Please note, however, that if you submit an incomplete or unsigned complaint form or do not provide your identity and contact details (e.g. if the complaint is anonymous), we may not be able to respond or provide any findings to you and the handling of your complaint may be impaired or potentially delayed.
We will carefully examine the information you provide and make general enquiries about your complaint with other relevant parties (if appropriate). If you have provided your consent for the IA to refer your complaint to the relevant party(ies), we may disclose your complaint and (where applicable) any of your personal data to the relevant party(ies) (including the relevant authorized insurer or licensed insurance intermediary) if we consider this will assist us in the handling of your complaint. Depending on the nature of your complaint, we may also refer it to other regulators or authorities for handling, as appropriate (see also questions 8 and 9).
After assessing all the relevant information, we have gathered in a fair and objective manner, we will provide you with a written conclusion of our assessment results. If we consider your complaint unsubstantiated, we will inform you why this is so and conclude the handling of your complaint. If, however, we consider any aspect of your complaint is substantiated, we will take appropriate and proportionate action to conclude your complaint. Such action may include:
- addressing the issues in your complaint directly with the authorized insurer or licensed insurance intermediary through supervision, by requiring them to take remedial actions (through, for example, rectification of its controls and procedures);
- issuing a compliance advice letter or warning letter to the authorized insurer or licensed insurance intermediary; and/or
- referring the matter to the IA’s Enforcement Team for handling, for example, through formal statutory investigation and (depending on the results of the investigation) disciplinary or other appropriate follow-up action.
PLEASE NOTE: The IA is subject to secrecy provisions under the Insurance Ordinance. This means, depending on the circumstances, we may not be able to inform you of information that comes to our knowledge during handling your complaint, or the specific details of any actions we have taken in relation to the insurer or insurance intermediary as a result of your complaint.
(3) What is the IA’s policy on providing updates on the progress of handling complaint matters on conduct issues?
It may take time to gather the necessary information from the relevant parties to consider your complaint in a fair and objective manner. To enable full focus to be given to reviewing and gathering information on your complaint, we generally do not respond to enquiries or requests for updates within the three-month period immediately following the date of receipt of your completed complaint form and supporting documents (if any). After this three-month period (assuming the complaint is still ongoing), we will at your request provide you with an update on progress and give you an indication of when a further update may be sought, if the complaint has not been completed by that point.
(4) What is the IA’s policy on arranging meetings with complainants?
We ask that communications on complaints be mainly in writing for record purposes and clarity. If we consider that there is a need to meet with a complainant in order to better understand the conduct issues involved in a complaint, or to gather information on the complaint, we will seek to arrange such meeting.
(5) How do I lodge a complaint with the IA?
In order to enable us to handle your complaint effectively, we ask that your complaint be made in writing to the IA using our Complaint Form. The Complaint Form can be downloaded from our website. Your complaint should include:
- The name of the authorized insurer / licensed insurance intermediary or other person you are complaining against;
- Your name and contact details (including email address and telephone number);
- Full details of your complaint and copies of any supporting documents; and
- Your written consent for the IA to handle your complaint and to refer your complaint to the relevant party(ies), if the IA considers it appropriate to do so for the purposes of handling your complaint.
It is important that you sign the Complaint Form (or that it is signed by you and your authorized representative if you are a company or you have appointed a representative to act on your behalf), otherwise the IA may not be able to process your complaint. Once you have completed the Complaint Form, you may send it to us:
Insurance Authority - North Point Office
23rd Floor, FOYER, 625 King’s Road, North Point, Hong Kong
|By Fax:||(852) 3753 3812|
|By Email:||[email protected]|
If you have any questions concerning on how to complete the Complaint Form, you can contact the IA’s hotline for assistance on 3899 9983 from Monday to Friday (excluding public holidays) between 8:45am and 12:45pm, and 1:45pm to 6:00pm.
(6) What if I want to complain about my claim not being paid?
The IA can only handle complaints in accordance with its statutory functions and powers. This means the IA can handle complaints about conduct of insurers or insurance intermediaries in the insurance market (see question 1). The IA does not, however, have the power to adjudicate disputes on claims between authorized insurers/ licensed insurance intermediaries and policyholders, or to order an authorized insurer/ licensed insurance intermediary to pay a claim or make compensation under an insurance policy/complaint.
As such, where a complaint does not involve the conduct of the insurer or intermediary, but is merely a dispute regarding the non-payment of a claim under an insurance policy, the IA’s powers to handle the complaint are limited.
The Insurance Complaints Bureau (“ICB”) provides a cost-effective and efficient alternative dispute resolution mechanism to help resolve all insurance disputes of a monetary nature (not exceeding HK$1,200,000) arising from personal insurance policies with authorized insurers which are members of the ICB. For this purpose, the ICB defines “a personal insurance policy” as an insurance contract effected in the name of an individual person or persons for his own benefit and/or the benefit of his dependents, and insured in a private capacity only. In accordance with its terms of reference, the ICB may handle certain disputes on claims under such personal insurance policies by way of adjudication.
To facilitate the handling of claims-related complaints, the IA has entered into a Memorandum of Understanding (“MoU”) with the ICB since 1 November 2021. Under the terms of the MoU, if the IA receives a complaint which disputes the non-payment of a claim that is within the ICB’s remit to adjudicate, upon obtaining the complainant’s consent, the IA will refer the dispute on the claim to the ICB for adjudication. Alternatively, you can refer your claims-related dispute directly to the ICB for adjudication (without going through the IA).
Disputes that may be referred to the ICB include, for instance, where the insurer has rejected payment of the claim, either in part or in whole, on the basis that the claim is not covered according to the terms, conditions and exclusions of a personal insurance policy, or the insurer has avoided the personal insurance policy on grounds of material non-disclosure or misrepresentation. The contact details of ICB are:
Insurance Complaints Bureau
29/F, Sunshine Plaza, 353 Lockhart Road , Wanchai, Hong Kong
|Hotline:||(852) 2520 2728|
|Fax:||(852) 2520 1967|
(7) What if I want to complain about the way the terms and conditions under my insurance policy or about the level of premium I have to pay?As indicated, the IA can only handle complaints in accordance with its statutory functions and powers. Whilst the IA can handle complaints about conduct by insurers or insurance intermediaries in the insurance market (see question 1), it has no statutory power to intervene or decide a pure commercial dispute between a policyholder and an authorized insurer or licensed insurance intermediary and which involves no issues of conduct. For example, we would unlikely be able to intervene in a dispute about the level of premium charged by an insurer or on the interpretation of the terms and conditions of an insurance policy.
If your complaint is a pure commercial dispute, you should raise it with the authorized insurer or licensed insurance intermediary concerned directly. Please note that authorized insurers, licensed insurance agencies and licensed insurance broker companies are required to handle complaints in accordance with standards set out in the guidelines and codes of conduct issued by the IA.
If you are still dissatisfied with the outcome of the complaint and the dispute is monetary in nature, the ICB offers a mediation service which you may consider using (if your complaint falls within the ICB’s jurisdiction).
For monetary disputes related to insurance products purchased from authorized institutions under the Banking Ordinance (Cap. 155) (e.g. banks) or licensees of the Securities and Futures Commission (“SFC”) which also act in the capacity of authorized insurers or licensed insurance intermediaries, you can also consider approaching the Financial Dispute Resolution Centre (“FDRC”) for mediation and/or arbitration (if your complaint falls within the FDRC’s jurisdiction). The contact details of FDRC are:
Financial Dispute Resolution Centre
Room 408-409, 4/F, West Wing, Justice Place, 11 Ice House Street, Central, Hong Kong
|Hotline:||(852) 3199 5199|
|Fax:||(852) 2565 8662|
Alternatively, you may consider seeking independent legal advice regarding the appropriate avenues (if any) and your rights and obligations arising from the complaint.
(8) What if my complaint requires involvement of other regulators?
In general, the IA is the front-line regulator for authorized insurers and licensed insurance intermediaries. However, authorized insurers or licensed insurance intermediaries may also be subject to regulatory oversight by other regulators in Hong Kong. For example, a bank, which is regulated by the Hong Kong Monetary Authority (“HKMA”), may also be a licensed insurance agency.
The IA has entered into MoUs with various other regulators including the HKMA, the SFC and the Mandatory Provident Fund Schemes Authority which detail their respective roles, responsibilities and collaborative arrangements in handling complaints, investigation and disciplinary actions. In accordance with these arrangements, if you lodge a complaint with the IA concerning a person who is also a regulatee / licensee of another regulator, the IA may refer your complaint (or certain aspects of your complaint) to the relevant regulator for handling.
For complaints against banks which act in the capacity of licensed insurance agencies, or their technical representatives (agent), the IA will refer such complaints to the HKMA for handling. The contact details of the HKMA are:
Hong Kong Monetary Authority
55th Floor, Two International Finance Centre, 8 Finance Street, Central, Hong Kong
|Hotline:||(852) 2878 1378|
|Fax:||(852) 2509 3990|
(9) What if my complaint relates to an insurance policy under the Voluntary Health Insurance Scheme ("VHIS")?
If your complaint relates to issues specific to the VHIS including product availability, features of Certified Plans and compliance with the scheme documents issued by the Health Bureau (e.g. Code of Practice for Insurance Companies under the Ambit of the Voluntary Health Insurance Scheme), you should lodge your complaint with the Voluntary Health Insurance Scheme Office of the Health Bureau. The contact details of its office are:
Voluntary Health Insurance Scheme Office
Unit 2902, Millennium City 6, 392 Kwun Tong Road, Kowloon, Hong Kong
|Hotline:||(852) 2529 8900|
|Fax:||(852) 2529 8982|
(10) What is the IA’s policy on Persistent Complainants?
If a complainant persists in pursuing his or her complaint for a long period of time but fails to provide the necessary information or requested evidence to support the allegation(s) raised in the complaint, the IA may refrain from entering into any further discussion or correspondence with the complainant about his or her complaint. Before ceasing to enter into any further discussion or correspondence, the complainant will be notified of this arrangement and the reasons for this arrangement in writing.
(11) What is the IA’s Call Termination Policy?
In the event a complainant uses foul or abusive language with any IA staff, the complainant will be informed once that, if the use of such language continues, the discussion will be terminated, and the complainant will be advised to put the matter in writing
For answers to other questions on our complaints handling procedures, please click here.