Insurance and Savings Ombudsman

Members of the Insurance Council participate in the Insurance and Savings Ombudsman scheme.

The Insurance and Savings Ombudsman is an independent authority. It considers complaints regarding all types of personal and domestic insurances, and savings services, provided that the amount claimed does not exceed $100,000. The scheme is free of charge for insured people, and the Ombudsman's decision is binding upon the insurance company involved in the dispute.

A number of insurance and savings companies participate in the Insurance and Savings Ombudsman scheme, including members of:

* Insurance Council of New Zealand
* Health Funds Association of New Zealand
* Investment Savings and Insurance Association of New Zealand

Investigation Process

The process used by the Insurance and Savings Ombudsman for investigating a complaint is as follows:

1. Insurance and Savings Ombudsman receives a complaint.
2. The details of the complaint are sent to the insurance company involved. The insurance company is also sent a document signed by the complainant and any other relevant person(s) stating that:
1. They are happy for the company to provide the Ombudsman with information, and
2. They accept certain conditions relating to the non-provision of information in court proceedings.
3. The insurance company must then provide any information it has in relation to the complaint and comment on any relevant issues.
4. After having received and considered the necessary information, the Ombudsman will try to resolve the complaint by agreement between the parties.
5. If this is not possible the Ombudsman may, at the request of either party, make a written recommendation as to how the complaint should be resolved. Each party is then given one month to make further comments.
6. If the Ombudsman recommends the insurance company should make a payment to the complainant, the complainant may only accept the payment if they agree not to take any further action on the matter without the insurance company's consent.
7. If the complainant agrees to the Ombudsman's recommendation within one month, the Ombudsman may make an award of money against the insurance company. The Ombudsman is able to make binding decisions on member companies up to $100,000.

Complaints Which Cannot Be Investigated By The Insurance & Savings Ombudsman

The Insurance and Savings Ombudsman may not consider complaints:

* Where an amount greater than $100,000 is under dispute (unless the insurance company agrees)
* That would be better dealt with by a court or other body
* That the complainant has not taken up with the company concerned
* That have been previously considered (unless new evidence is available)
* That have been considered by a court or any other body
* That are pursued in a trivial, frivolous or vexatious manner or in bad faith
* That relate to an insurance company's commercial judgement, and methods or procedures for determining prices or premiums payable
* That relate to an insurance company's decision to impose conditions or limitations on a policy, or terminate or refuse cover under an existing policy or agreement, as a result of material non-disclosure.

Helpful Tip:

The Insurance Council recommends that you take your complaint to the Insurance and Savings Ombudsman since it is a free and impartial service to you.

While member companies must accept the Ombudsman's ruling, you do retain your right to take your case through to the disputes tribunal or the courts, should the Ombudsman not rule in your favour.