20.04.2021

Insurance Ombudsman: Practice for the permission of insurance disputes. Who is the Ombudsman and what enters its functions principles, order and legal regulation of activities


People who are far from legislation and politics are unknown who is such a ombudsman and what its functions. Most citizens in their ignorance do not even suspect that by contacting this official, one can solve a number of issues that are difficult to resolve with other bodies (the prosecutor's office, the court, other).

Who is Ombudsman

The Ombudsman is an official or an official appointed to this position to control the activities of ministries, departments and other government bodies. It acts both on complaints of citizens and on its own initiative and is guided not only by law, but also justice.

For example, the Ombudsman in Russia is the Commissioner for Human Rights. In principle, in any country where such a position is provided, the Ombudsman can solve issues related to the failure to fulfill their duties or abuse by their powers by officials, resulting in disputes between the citizen and the authorities.

The history of the position of "Ombudsman"

According to history, for the first time, the meaning of "Ombudsman" (words) was decrypted in the XVI century in Sweden. The official who occupies this position controlled the work of the court:
transparency of court sessions, justice of sentencing. After the defeat of the Swedes under Poltava, the ombudsman was significantly expanded. Due to the fact that the King of Sweden Karl XLL has been in Turkey for a long time, the management system has declined and demanded a capital guidance of orders. An official (Royal Ombudsman of Justice) was appointed to the post of Ombudsman, who controlled government officials. The second ombudsman, the role of which was the control of the royal administration and the justice bodies, received the title of Chancellor of Justice. In 1809, the Justice Ombudsman Institute appeared in Sweden, which was separated from what was subordinate to the king.

Thus, Chancellor stood on the defense of the king, and the parliamentary ombudsman - to protect the interests of peasants and workers. To date, the meaning of the word "Ombudsman" does not know the population of such countries as Denmark, Russia, Ukraine, Sweden, Norway, Italy, Poland, Portugal, United Kingdom, France, South Africa, etc.

Who can contact the Ombudsman?

The human rights ombudsman considers complaints from private individuals who are citizens of the country, foreign citizens, stateless persons who have residence permit or simply are located in the state. Complaints of people who have previously appealed for the court or administrative bodies, but do not agree with the decision or noticed any violations were subjected to discrimination, dissatisfied with complete inaction.

The main tasks of the Commissioner for Human Rights

The main tasks of the ombudsman, regardless of the country in which he occupies a position:

  • Restoration of justice and rights that were violated.
  • Conducting activities aimed at developing international human rights relations.
  • Enlightenment of citizens relative to their rights.
  • Improving the legal legislation of the country regarding citizens.
  • Control over the work of state structures.

Ombudsman Institute in Russia

For the first time the position of the Commissioner for Human Rights in Russia appeared in 1994. The first Ombudsman of the Russian Federation - Sergey Kovalev - was appointed State Duma. In 1998-2004, this position was held by O. Mironov, and since 2004 - V. Lukin. In Russia, there is a law "On the Commissioner for Human Rights in the Russian Federation", on the basis of which these specialists fulfill their duties.

What does the ombudsman mean from Russians? If you say short, then this is a mediator between the victim
side (citizen) and officials who protect the rights and interests of citizens. But his activities are not limited to the consideration of complaints or applications. The ombudsman on its own initiative conducts an investigation by collecting information about gross violations or the complete inaction of any organs.

Powers of the Ombudsman for Human Rights in Russia

Ombudsman in Russia, which is engaged in the protection of citizens' rights, has a number of powers:

  • Protects the rights of citizens, and also monitors their observance by government agencies and officials.
  • He advocated a report to the State Duma with a request to organize the Parliamentary Commission to investigate the facts of mass violation of citizens' rights.
  • When identifying the facts of violation, he applies to the petition for the initiation of a criminal case or administrative proceedings regarding the official person (persons).
  • Appreciates the petition for the verification of the decision taken by the court (ruling or sentence), which entered into force.
  • Treats to court with a request to protect the rights and freedoms of citizens who were violated by illegal actions or inaction of government agencies or an official.
  • Contributed to the Constitutional Court regarding violations of the constitutional rights of citizens.

Financial Ombudsman

Who is the ombudsman financial? This is an official who helps resolve a number of controversial issues that have arisen between a citizen and the bank. It may be a question about the return of money on credit cards, unreasonably overestimated penalties and fines on long-term loans, reissuing a loan from foreign currency to the national. Also, financial ombudsmen solve issues regarding illegal actions of the collector office and their employees.

But the most frequent are complaints regarding the failure of banks in the loan restructuring. This is due to an increase in the amount of debt together with fines and penalties, which is almost impossible to pay as a result. The task of the Ombudsman is to negotiate with the bank and convince him to make concessions in the form of a partial removal of sanctions subject to the remaining amount of the agreed schedule.

Insurance Ombudsman

No less claimed ombudsman intervention (who is the ombudsman, we considered higher) in the field of insurance. Some insurance companies violate the terms of the contract if the amount of insurance is insignificant, hoping that the client will not begin judicially. Insurance ombudsmen work in almost all countries where this position is provided. For example, European insurance companies relate to them respectfully, since the powers of these officials are quite wide, and they have enough rights. Moreover, European companies are unprofitable to save on non-payment of insurance, since the services of the ombudsman pay the same, and not the insurers.

Also developed the Ombudsman's Institute in Germany. The only minus system is that only members of the trade unions of insurance organizations can use the services of officials, and when transferring a case to the prosecutor's office, the influence of the ombudsman on the outcome of the case is completed.

Ombudsman for entrepreneurs

Ombudsman entrepreneurs as a separate independent position appeared not so long ago. The list of his duties includes:

  • Submission of claims aimed at protecting the rights of entrepreneurs.
  • The fulfillment of the functions of the defender in the court for entrepreneurs.
  • Registration and submission of requests to the authorities at the public and local level of entrepreneurs.
  • Visiting and consulting suspects or convicted citizens, whose causes are related to business activities.

Features of the Institute of Ombudsmen for the Protection of Public Rights

Based on the experience of European countries, it becomes clear that, resorting to the help of the ombudsman, you can solve a number of small conflicts. But there are cons in this system. For example, a solution that accepted the Ombudsman of Ukraine for two years is voluntary for insurance and credit institutions. And only after this time, it becomes mandatory for execution. Also, the Ombudsman cannot consider controversial issues that were transferred to the court or on which the arbitration decision has already been made. The advantages of the system is that consumers will no longer need to contact the courts and spend their time (and money on lawyers).

Children's Ombudsman

Children's ombudsmen are on the protection of the rights of juvenile citizens of the country. Their obligations include:

  • Protection and restoration of the rights of the child.
  • Consultation, education, children's education regarding their rights.
  • Work with federal bodies, local and public authorities at the requests and obtaining the necessary information or documents.
  • A visit to organizations and authorities to obtain clarification, checking their activities related to the rights and freedoms of children.
  • Preparation and direction in the relevant bodies recommendations for improving their work regarding the observance of the rights of the child.
  • Attracting specialists for analytical work, which concern the protection of the rights of children.

In some countries, a school ombudsman is provided. It provides assistance to all participants in the educational process: children, teachers and parents. All who believe that violations of the rights of students occur in the learning process. This may be a misunderstanding between the teacher (school administration, a class teacher) and a schoolboy, as well as the need for consultation on the rights of the child within the school, explaining the organizational issues, hygienic standards, regulations, other things. Also, contacting the Ombudsman, you can make your proposals for improving the educational process and institution. The Commissioner for Rights in School works in such directions:

  • Active participation in the school council, the purpose of which is to improve the work of the management bodies.
  • Work aimed at preventing the harmful habits of schoolchildren.
  • Control over compliance with all rights and freedoms of students.
  • Work with parents and parent committee aimed at improving relations in the family.
  • Psychological and legal support for school employees aimed at preventing emotional burnout.

How does this system work

Regardless of the direction in which the Ombudsman works, the scheme of its actions is practically standard. As mentioned above, it works on the basis of a complaint received from a private person or on its own initiative. Commissioner cannot disassemble the case, which is transferred to the court. For the period of consideration of the controversial issue, the applicant undertakes not to transfer the case to court.

Before contacting this specialist, a citizen must send a complaint to the bank or insurance company and wait for a response within 30 days. A complaint directed by the Ombudsman must be issued in the form of a statement with copies attached to it (contracts, correspondence, receipts, other). A specialist addresses disputes regarding financial institutions that have joined the institute. At the same time, the decision made by him is not appeal.

But the credit institutions of the Ombudsman can send proposals for the settlement of disputes or send an appeal to the court. The result of the consideration of disputes is a conciliatory agreement signed by the parties, or a decree allowing them.

When introduced in Russia, the Institute of Insurance

ombudsman is necessary at the legislative level to oblige all working

in the market, insurance companies join this association and legitimate

fasten the requirements for the Ombudsman. This opinion was expressed at a meeting with

journalists of the Insurance Ombudsman of Germany, Professor Gunter Hirsch.

Insurance ombudsman in Germany is recognized as a state as a mechanism

pre-trial resolution of disputes between the insured and insurers. He was

created to protect the interests of consumers of insurance services. Hirsch

located in Russia at the invitation of the All-Russian Union of Insurers (WCS),

which currently worries the possibility of creating similar

institute and in Russia.

"I would have made a bid for Russia for the Ombudsman Institute system, which

based on a private basis, "said Hirsch.

He noted that at the same time he would ask the legislators to take two

regulating mechanism.

"The first is the law that each insurance company is obliged to enter into

the organization representing the Institute of Ombudsman to participate in it

100% insurance companies. Secondly, I would require legislatively

consolidate the requirements for the ombudsman - absolute independence and its

professional qualifications, "said Professor.

this moment was the chairman of the Supreme Court of Germany.

Experience in Germany

According to the principles of the institute, the insurer at the conclusion of the contract is obliged

inform the client about his right to turn to the Ombudsman. Apparatus

ombudsman helps the consumer to draw up and issue a complaint

insurer. Ombudsman has the right to consider complaints, the amount of claims for

which does not exceed 100 thousand euros. In this case, the decision on complaints size

up to 10 thousand euros must be fulfilled and cannot be challenged

insurer, and a decision on complaints of 10 thousand to 50 thousand euros -

According to him, in Germany, this institute was created 10 years ago when

"The reputation of insurance in the country left much to be desired." In this

the moment in the organization includes 96% of insurers working in German

insurance market.

"Only about 4% in this union is not included," said Hirsch, clarifying that

these are mainly companies that do not work with individuals, reinsurers and a number

foreign companies.

According to the insurance ombudsman, he has to consider about 18

thousand complaints per year. At the same time, the term of consideration of complaints is four months, "that

faster than through court. "

More than 90% of cases of appeals to the ombudsman concerns complaints of less than 10

thousand and only 10% - over 10 thousand euros.

"In most cases, the case comes to the settlement agreement," he said.

As Hirsch noted, the consumer submits a complaint for free, while

the company on which this appeal was filed is paid to the association

100 euros for the fact of filing a complaint, regardless of whether it was recognized

her wines or not.

Thus, this annually brings the institution in the budget of the order of 1.8

million euro. The second budget article make up membership fees

insurers who are charged depending on the collected premium. Generally

annual budget of the organization is three million euros.

Plans for Russia

According to him, currently in Germany there are about 450

millions of existing insurance contracts, that is, per resident

there are about 5.5 contracts.

In Russia, according to the statistics of Rustkhnadzor, at the end of 2010

268.964 million insurance agreements (excluding OMS)

the population is about 140 million people. So in

The Russian Federation per person accounts for an average of 1.9 insurance policies.

In October 2010, a working group for development was created at WCS

proposals for legislative regulation of extrajudicial permission

disputes between subjects of insurance business. He headed the group counselor

president of the Union Konstantin File.

The priority area of \u200b\u200bthe Group's work is the issues of consideration of disputes

between insurers and customers who account for more than 90% of all

disputes in the insurance market. As evils, extrajudicial permission

disputes will help unload arbitration courts. It is estimated as a result

the implementation of these measures up to 70% of disputes can leave the judicial system.

It is intended to protect the rights of citizens in the insurance market, in the field of lending and placement of funds, explains the head of the GU Bank of Russia in the Central Federal District Nadezhda Ivanova.

The Institute of Financial Ombudsman is in many Western countries. His main task is to resolve the disputes of citizens with financial organizations to the court in cases where the parties could not do it. The relevance of the establishment of the Institute of Financial Commissioners is confirmed by the number of claims from the consumers of financial services entering the courts: in 2017, there were more than 390 thousand only on the ICSAgo issues.

What kind of disputes to deal with the financial ombudsman? First of all, associated with violations of citizens' rights by insurers, including software, as well as consumer lending to citizens.

The financial ombudsman will consider the appeals of citizens if the amount of claims for the recovery of monetary amounts does not exceed 500 thousand rubles (and in relation to the OSAGO - regardless of the amount of the claim). At the same time, from the moment when the consumer of financial services learned or was supposed to learn about the violation of his right, should pass no more than three years.

Before appealing to the financial authorized consumer, it must first send a statement in writing or electronic form directly to the financial organization whose actions he intends to challenge. Only after receiving a refusal to the financial organization, or the default response within the deadline, it appears the right to contact the Finnubudsman. The law has established a tough time frame for consideration by the dispute of the Ombudsman - 15 days from the moment the transfer of the conversion to the financial authority. This time can be extended for ten days if it is necessary to conduct technical expertise. The decision of the financial ombudsman comes into force ten working days after its adoption.

The financial company is obliged to inform the financial authorized on the execution of its decision or to refuse execution. If the company did not execute this decision, the Commissioner issues a certificate to a citizen, which, in fact, is analogous to the court decision. Based on this certificate, the bailiff cites the decision of the financial authorized in execution.

The decision of the Financial Commissioner can be appealed in court as the consumer itself and the financial company. At the same time, a citizen may apply to court within 30 days after the decision taken into force, and the financial company is only within ten days. If the court decides in favor of a citizen, companies can also aneg a fine of 50 percent of the amount of the claim.

The law gives the financial ombudsman independence from federal and regional authorities. There will be the Board of Directors of the Bank of Russia (on the submission of the Chairman of the Bank of Russia, agreed with the President of the Russian Federation) for a period of five years. It is forbidden to occupy the position of financial authorized more than three times in a row.

The candidate for the position of financial authorized is fairly stringent requirements. They may have a Russian at least 35 years old with a higher legal or economic education, which has experience in the financial market, regulation, control and supervision in the financial market or the protection of consumer rights of financial services in a totality of at least five years, or has a judge experience Less than ten years.

Financial Ombudsman is not entitled to work in the authorities, as well as engage in commercial activities. He can teach, lead scientific and other creative activities. Of course, should have a flawless business reputation and be independent of the parties when considering a specific appeal.

At the stage of formation, the work of the Financial Commissioner service will be financed by the Bank of Russia. Then the source will be the contributions of financial organizations, the size of which will depend on the number of lost disputes, the completeness and timeliness of the execution of decisions. The final formula of the calculation will determine the Council of Service of Financial Commissioner, it will be made public.

Financial organizations that resolve disagreements with the consumer prior to its appeal to the financial authorized or before making a decision, will be released from the fee for the consideration of the dispute or will pay it in a minimal amount. Information on such disputes will not be included in the public statements of the financial authorized.

The entry into force will be phased. From the third of September the preparatory period will begin. Since first of June 2019, the law will become mandatory for the OSAGO segment, from November 28, 2019 - for other types of insurance.

From January 1, 2020, he will spread to microfinance organizations, and from January 1, 2021 - on banks, credit cooperatives, non-state pension funds, pawnshops.

Voluntary financial organizations can join the system of financial authorized already 90 days after the entry into force - from the third of December 2018 (there are already insurance companies, banks and MFIs who are ready to do this). Voluntary early joining is welcome and will be taken into account by the Bank of Russia in the exercise of supervision.

In 2017, more than 390 thousand lawsuits were received in the courts in the courts, and in the Central Bank there are about 38 thousand complaints of incorrect calculations of insurers in resolving the stated claims on this type of insurance. Over the same period, more than 21 thousand lawsuits were filed in the courts on the CASCO and on other types of property insurance, and the number of complaints in the Central Bank for insurers (except the OSAO) was 12 thousand.

On September 3, a new Federal Law on Commissioner for Consumers of Financial Services comes into force. Work on the bill was carried out for a very long time - a total of more than six years. In the first reading, the draft law was adopted by the State Duma back in 2014. After that, there was a lively discussion about the advantages and cons of the Institute of Financial Commissioner and in general on the need for its introduction in the country at various sites.

The initial text of the bill has undergone significant changes. Many of his provisions, taking into account the proposals of the insurance society, were finalized, others - rewritten again. But the very idea and those goals that were put in the preparation of the draft law were saved.

The law provides for the creation of a special fund financing of financial authorized activities. On the issue of insurers' contributions as one of the sources of financing the activities of the Financial Commissioner were carried out very hot discussions. As a result, they came to the next design: the amount of the contribution of the financial organization will be determined by multiplying the number of appeals against it adopted for consideration by the Financial Commissioner, at the rate, which will be determined by the Board of Financial Commissioner Service.

In my opinion, this is a sufficiently weighted and objective approach. By and large, the amount of the contribution will be largely determined by the quality of the settlement of the requirements claimed directly to the insurer.

Procedure for consideration of appeals

The financial authority will consider appeals against insurance organizations if the size of the requirements of the consumer of financial services on the recovery of monetary amounts does not exceed 500 thousand rubles. (And on disputes arising from the CTP, regardless of the amount of the claim). At the same time, from the day when the consumer of financial services learned or was supposed to learn about the violation of his right, should pass no more than three years.

It is important to note that before applying to the financial authorized consumer of financial services should send a statement in writing or electronic form directly to the insurance organization.

Accordingly, the right to appeal to the financial authorized by the consumer of financial services arises after receiving the insurer's response, with whom he disagrees, or in case of non-receipt of the response of the financial organization after the expiration of the statutory period.

Obligation of the execution of the solution of the Finnubudsman

The decision of the Financial Commissioner comes into force upon expiration of 10 working days after the date of its signing. It is executed no later than the period specified in it ranging from 10 to 30 business days.

In case of non-fulfillment by the insurer who has entered into force, the decision of the financial authorized (or the conditions of the agreement achieved) is issued by the Consumer of Financial Services the so-called certificate. The certificate is essentially an analogue of the executive document, the form of which is established by the Government of the Russian Federation.

Based on the certificate, the bailiff leads to a decision of a financial authorized or an agreement on a compulsory order in accordance with the requirements of the legislation of the Russian Federation.

At the same time, the insurer is obliged, and the consumer of financial services is only entitled to inform the financial authorized on execution, or in refusing to fulfill the decision taken by him.

In turn, non-performance by the company in a voluntary order to solve the financial authorized or condition of the agreement, on the basis of the application of the consumer of financial services entails a penalty for the court in favor of the client in the amount of 50% of the amount of the consumer's claim, which was subject to satisfaction in accordance with the decision of the financial ombudsman or with a convention.

It should also be noted that the decision of the Financial Commissioner in the event of disagreement with it can be appealed in court and the consumer himself, and the insurer. At the same time, a claim in court may be declared by the consumer within 30 days after the decision taken into force, and the insurer is only within 10 days.

Requirements for the finisombudsman

The candidate for the position of financial authorized is fairly stringent requirements. They may be appointed citizen of the Russian Federation at least 35 years old with higher legal or economic education, which has experience in the financial market, regulation, control and supervision in the financial market or the protection of the rights of consumers of financial services in a totality of at least 5 years, or has experience The judge is at least 10 years old.

At the same time, the financial authorized authority is not entitled to be a member of the representative authorities (and on the federal, and regional levels), as well as to engage in other paid activities, with the exception of teaching, scientific and other creative activities.

In addition, the Financial Commissioner must have an impeccable business reputation and be independent of the parties when considering a specific appeal.
The financial ombudsman cannot be a person whose authority as a judge of the Court of General Jurisdiction or Arbitration Court, an arbitrator, a lawyer, a notary, investigator, a prosecutor or another law enforcement officer was discontinued in connection with the commission of incompatible work offenders.

The financial authority cannot be a person who has a dismantling or outstanding conviction for the commission of a deliberate crime, as well as a person in respect of whom the decision was made about his disqualification, or a person included in the database, which is conducted by the Bank of Russia.

The Financial Commissioner is also not entitled to consider the appeals in the event of a personal interest in the performance of official duties, which leads or may lead to conflict of interest, and must take measures to prevent any possibility of conflict of interest, as well as measures to prevent or resolve conflict of interest in accordance with The law on countering corruption.

Potential risks and possible problems

Among the main risks for insurance companies related to the adoption of the law, I would allocate the following:

  1. The most stringent time consideration compared with world practice. For example, in the UK, Germany, Denmark, the deadlines for the decision of the Financial Commissioner are up to 180 days, in Hungary, Austria - up to 90 days. We also have only 15 business days. For insurers, it imposes additional obligations on the competent organization of business processes at the stage of resolving the stated claims and interaction with the consumers of financial services. In this situation, there is a risk of violation by insurers of the timing of consideration of the flow of appeals.
  2. The need to increase the staff number of insurance organizations and, as a result, the increase in costs.It is obvious that the implementation of the law will require the involvement of additional labor resources for high-quality support of interaction processes both with the consumer themselves and with the financial authorized service.
  3. Financing.We can talk about the incompatibility of expectations of insurers with real expenditures on financing the activities of the Financial Commissioner Service
  4. It is impossible to exclude legal conflicts.I mean making opposite solutions for similar controversial situations.
Additional charges of insurers in connection with the adoption of the law

The Insurance Organizations are entrusted with a whole number of responsibilities:

  • provide the preparation of a response to a claim of an individual within 15 days from the date of its receipt, and at the request of the financial authorized - within 5 days;
  • organize the execution of the decision of the Financial Commissioner;
  • inform the financial authorized on the execution of the decision.
For violation of the laws of the law - in particular, in the case of a non-fulfillment of the insurer within one year, the insurer of the provided duties - the financial ombudsman is entitled to place on its official website relevant information and contact the Bank of Russia with a proposal for the application for this insurance organization of supervisory response .

What to do insurers now?

In my opinion, at the initial stage, before the entry into force of the law, insurance organizations need to regulate internal regulations:

  • the procedure for interaction with the financial authorized service and consumers of financial services,
  • the procedure for considering consumer consumers of financial services,
  • the procedure for execution and appeal against the decisions of the Financial Commissioner, the procedure for informing the execution of the decision, etc.
It is important to ensure the connection to the electronic document management to interact with the financial authorized in order to comply with the response time to requests, provide consumers with the possibility of submitting a claim in electronic form.

After the entry of the law into force and the start of the work of the Financial Commissioner service, it is necessary to form procedures for analyzing considerations from consumers to improve the quality of services provided and quality control of decisions, constantly improve the mechanisms of self-resolution disputes in order to reduce financial costs.

I would like to note one important detail associated with the deadlines for the entry into force. Yes, indeed, the law enters into operation on September 3, 2018. However, at the initial stage, the voluntary nature of the interaction between insurers and financial authorities is supposed. In relation to insurance organizations engaged in OSAGO and insurance of terrestrial transport, the action of the law will become mandatory, starting from June 1, 2019, and for insurance organizations carrying out other types of insurance - from November 28, 2019

In conclusion, I want to report that CJSC CJSC, together with ARUs, plans to hold a training seminar in the interests of this year in the interests of the entire insurance community, dedicated to the practical implementation of the Institute of Financial Commissioner at the Insurance Market.


2021.
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