Complaints to Hong Kong insurance industry self-regulator rise by 7pc
Of 333 cases closed last year, industry body ruled in favour of just two policy holders
The number of new complaints received by the insurance industry’s self-regulator increased by 7 per cent to 647 cases last year.
Among the 333 cases the Insurance Claims Complaints Bureau closed last year, nearly 60 per cent were found to have no prima facie evidence.
The bureau only ruled in favour of complainants in two cases and around 16 per cent of the 333 cases were resolved through mutual settlement between the insurers and the aggrieved parties.
Half of the closed cases were related to medical insurance while 20 per cent were related to travel policies.
Chairman of the bureau’s complaints panel, Michael Tsui Fuk-sun , said the rise in complaints reflected an increase in the number of insurance policies being issued in Hong Kong,
“The number of policies in Hong Kong has been steadily increasing for many years. When you have more policies, complaints will also rise.” said Tsui.
“Proportionally, I have a feeling that it’s actually not rising that much compared to the number of policies issued every year.”
He added that disputes over the meaning of terms in insurance policies continued to be a significant cause of conflicts.
In one case last year, an insurer refused to reimburse the medical expenses incurred by an infant girl suffering from urinary tract infection with gross vesicoureteral reflux because traditional medical literature regarded the illness as a congenital condition, which was usually not covered by medical policies.
However, upon considering a second medical opinion, which found the girl’s condition was non-congenital and arose from an infection, the panel ruled in favour of the insurance policy holder, who received an reimbursement of HK$258,000 from the insurance company.
Explaining the difficulty in reaching a decision on the case, which took the panel nearly a year to process, Tsui said: “We were in a dilemma. Do we believe this doctor?
“Anyway, we put all the evidence together and we decided that this case was non-congenital and the insurance company needed to pay out.”
He added: “Insurance policies basically do not cover congenital disease because the risk is 100 per cent. You can never insure something you will definitely pay out on. The premium would be sky-high.”
Separately, the bureau received 30 complaints from mainland residents last year. Most of these cases were related to life or medical insurance.
