The number of complaints received by the insurance industry's self-regulator climbed 12 per cent last year, but the watchdog said it was simply because more people were buying insurance.
"More people have bought insurance over the years, and I think this is why the number of complaints rose," said Michael Tsui Fuk-sun, chairman of the Insurance Claims Complaints Bureau's complaints panel. "I don't see the increase as an indication that insurance companies aren't doing their jobs well."
The city's Federation of Insurers said that each year, 200,000 more people purchase medical insurance, and about three million people are covered.
The 12 per cent rise saw the panel receive 535 complaints last year, up from 479 in 2012. The number is the highest in at least five years. Of the 343 cases it has processed so far, 52 per cent were rejected for lack of evidence and 12.5 per cent were withdrawn.
Only 2.5 per cent of complainants won their cases and the panel upheld insurers' decisions in 12.5 per cent of cases. A settlement was reached in 20.5 per cent of cases.
In one case, a complainant who suffered chest pains was admitted to hospital where she had to undergo several tests. Her insurer refused to foot her medical bill of HK$10,800, saying the tests could have been taken without her being admitted overnight.
But the complaints panel found that the woman had suffered acute chest pain and shortness of breath, and did indeed require hospitalisation. The insurer was then ordered to pay up.
In another case, the panel ruled an insurer did not have to pay a man's HK$7,000 personal accident claim as he had consulted a Chinese medical practitioner. "Medical practitioner" - the term stated in the insurance contract - is legally different from "Chinese medicine practitioner".