1. The Insurance Ombudsman Association
The activity of the Insurance Ombudsman started in 2001. That year the board of trustees was founded. As a registered association it is a legal person and therefore has legal capacity. Respectively the association has its own organisation and is institutionally independent.
The association is based in Berlin, along with the head office and the office of the Ombudsman.
The purpose of the association is the promotion of out of court dispute settlement with consumers, especially regarding insurance contracts or the procurement of those. Members of the association are insurance companies and the German Insurance Federation (GDV). They support and finance the arbitration board. Almost 300 members belong to the association.
The organs of the Insurance Ombudsman are the board of directors and the general meeting. In addition, there is an advisory board, which is of great importance as an expression and guarantor of the independence of the Ombudsman. The committee consists of representors of the following groups: Consumer organisations, member companies, insurance supervisors, academics, parliamentary fractions and insurance agents. Its tasks, which are within the law of the Statutes, include the appointment of the Ombudsman and to participate in amendments of the code of procedures. A further function of the committee is to accompany and advise on the work of the Ombudsman.
2. Arbitration board
The arbitration board consists of the elected Ombudsman and staff, who support the board in its activity. 45 people help to settle disputes, among them legal experts, insurance clerks and administration employees as well as office assistants.
The Ombudsman has two jurisdictions that are based on different principles:
- Complaints against insurance companies, who are members of the association and have equipped the Ombudsman with certain powers
- Complaints against insurance agents according to a statutory rule.
This applies to all classes of insurance except for private health and nursing care insurance.
The Versicherungsombudsmann e. V. (association Insurance Ombudsman) is a state-approved consumer arbitration board.
3. The Ombudsman in person
Since 2008 Professor Dr. Günter Hirsch is the Insurance Ombudsman. For many years he worked as prosecutor, as a Judge, as well as in ministerial service. In 1994 he was appointed as German Judge to the European Court of Justice. Afterwards, for eight years Professor Dr. Hirsch was president of the Federal Court of Justice in Karlsruhe, the highest German civil and criminal Court. In the pursuit of these activities, he dealt, among other things, with questions of national and European insurance law and out-of-court dispute resolution. Professor Hirsch is free in his official duties and is not subject to any instructions.
- a) General Information
Complainants may have themselves represented within the limits of law by for example a relative, friend or lawyer. The proceedings are free of charge, except for own expenses as for example postage or for the representative. You should not wait too long before filing the complaint as the enforcement of a claim may already fail due to statutory limitation. Therefore, the Ombudsman should be involved as soon as possible after claiming at the insurance company or the insurance agent. Complainants do not need to accept the decision of the Ombudsman but may go to court any time.
- b) How can the Ombudsman help?
The Ombudsman handles difficulties of the insurance customers, non-bureaucratically. He must look at the complaint impartially and has to judge only on the basis of the facts. In doing so, he applies the same standard as a court: legal rules and regulations.If the Ombudsman ascertains that the claim is not legally justified, he will explain the contexts generally in plain language and without the typical “insurance language”. Complainants get an overview about their legal situation and may consider whether for example they wish to pursue their claim further in court. Of course, the dispute resolution proceedings do not lead to any disadvantages – all legal remedies can be used without any further effect.The Ombudsman may decide only on a distinct basis. If the parties describe the facts differently and if witnesses should be heard, the written dispute resolution reaches its limits. It is not uncommon to conclude the dispute by mutual settlement. A settlement requires that both parties agree.The Ombudsman is neutral and impartial. Therefore, he cannot represent consumers like a lawyer, who only has to consider the interests of his client. The Ombudsman will, however, ensure a fair trial.The Ombudsman cannot give legal advice, neither on insurance matters nor on financial matters. His task is to settle disputes.
Please note that the language of the Ombudsman is German. Therefore, the complainants themselves have to make sure that they submit their concerns to the ombudsman correctly and completely. The Ombudsman writes his decision and the relevant documents in German. Occasionally, it is possible to translate the essence into English or French without obligation.
- c)The most important differences between both tasks
- aa) Proceeding against insurance companies
First of all the Ombudsman is responsible for complaints of consumers concerning an insurance contract. If the proceedings end with a decision against the insurer, the latter must comply if the value of the complaint does not exceed EUR 10,000. If the value is above this, the decision is also non-binding for the insurer. According to experience, however, insurers usually also follow the Ombudsman's view.
If the Ombudsman ascertains that the insurer has handled the case correctly or has already provided adequate compensation, he will explain the legal context in a comprehensible way.
Claims against the insurer do not expire during the proceedings.
- bb) Proceedings against insurance agents
The Ombudsman is only concerned with claims, if
- they concern procurement of an insurance contract,
- the complainant is policyholder; and
- they concern an insurance agent or broker
The insurance agent does not have to adhere to the decision of the Ombudsman. The law, on which the proceedings are based, does not provide any handle. The complainants must pay attention to the limitation period of the claims in the proceedings against insurance brokers themselves. The statute of limitations does not suspend the limitation of any claims. Maybe a legal regulation intervenes.
- aa) Proceeding against insurance companies
- d) Which information and documents are important?
- Personal details of the policyholder,
- copies of relevant correspondence
- Aim to be achieved with the complaint (e. g. payment of a certain amount of money, rescission of contract)
- And, if not already included,
- A brief description of the facts,
- Name of the insurer or the intermediary, insurer's certificate or claim number,
- Other documents (e. g. expert opinions, cost estimates, repair invoices).
The complaint may be submitted online. There is also the possibility to download a form on the website or request one here. The staff of the arbitration board is glad to help. When calling, the documents should be kept available.
- e) Legal information for complainants
- aa) General information
The Versicherungsombudsmann e. V. is a consumer arbitration board approved by competent authorities. Therefore, proceedings are ruled by the Consumer Dispute Settlement Act. Therefore, the involved parties are to be informed of the following facts:
Usually, the code of procedure of the Insurance Ombudsman (VomVO) applies to the proceedings. If the claim is directed against an intermediary personally, the code of procedure for complaints concerning procurement of insurance contracts (VermVO) may be applied. Both codes of procedure may be viewed on our website or may be sent to you on request. By participating in the proceedings, you agree to the respective regulation.
The conclusion of dispute settlement proceedings may differ from the result of judicial proceedings. The Ombudsman will assist you in submitting the complaint. Our staff helps to formulate the aim of the complaint and provide information on the documents and information needed. The parties to the proceedings may advise someone, on their own expenses, who is legally authorised to represent and / or counsel them. However, this is not necessary.
At any time, you may withdraw the application for dispute resolution or object to the further execution of the proceedings. Then the proceedings end with the receipt of the statement by the Ombudsman.
The proceedings are free of charge for the complainant. Only own costs are incurred, such as postage. In exceptional cases, a misuse fee may be required.
The Ombudsman treats all information strictly confidential. Personal data is not passed on to third parties but is exclusively recorded and used for the purpose of handling the complaint. If necessary, for the examination of the claim, the Ombudsman will pass on the documents to the opponent of the complaint. In the contrary, usually, he is passing on to you documents of the opponent as well. The principle of the right to be heard is respected.
- bb) Important information about the legal consequences of a settlement
With conciliation you enforce part of your position, the other part is abandoned. However, this also applies to the other party. The whole purpose of conciliation is to settle the dispute by mutual agreement.
Conciliation is considered if the facts or the legal assessments are ambiguous. Thus, conclusion of legal proceedings is uncertain. Conciliation may be used to end the dispute, thus saving time and money, as well as avoiding the risk of judicial defeat.
Both sides must keep to conciliation. If new insights arise, the settlement cannot simply be reversed.
Conciliations may differ from the result of court proceedings, both positive and negative. Only you decide on accepting a conciliatory proposal. Of course, you may reject the proposal and go to court.
- aa) General information