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Procedure descriptions

Insurance ombudsman - lodge a complaint against insurance companies

If you consider an insurance company's decision to be incorrect, you can contact the insurance ombudsman.

The insurance ombudsman is an independent and neutral consumer arbitration board. It is intended to help,

Settle disputes between insurance companies and customers out of court and thus
and thus contribute to relieving the burden on the courts.

The consumer arbitration board is organised as a registered association. The same standards apply before the consumerarbitration board as in court: law and order.

Responsible department

the insurance ombudsman

Details

Prerequisite

The most important requirements for the complaints procedure are

You are a consumer.
The insurance company against which you are making a complaint participates in the Insurance Ombudsman's arbitration proceedings, i.e. it is a member of the organisation
The subject of the complaint is your own claim arising from the insurance contract or a claim listed in Section 2 (2) of the Insurance Ombudsman's Rules of Procedure (VomVO). Complaints from other persons (e.g. opponents of an accident who have been injured by the insured person and wish to assert their claims against the latter's insurance company) are not admissible.
The subject matter of the complaint may also be a claim against the insurer arising from the brokerage or initiation of an insurance contract.
You have not already approached another body (e.g. a court or the insurance supervisory authority) about the subject matter of the complaint.
The subject matter of the complaint has not already been conclusively dealt with by another body (e.g. a court).
You have already asserted your claim against the respondent without success.
You wish to lodge a complaint against an insurance intermediary on the basis of a statutory regulation.

For the duration of the arbitration proceedings, the limitation period for the possible claims affected by the complaint is suspended. If your claim is time-barred and the insurer invokes this limitation period, no proceedings can take place before the ombudsman.

Procedure

You can complain by telephone, letter, e-mail, via the online complaint form at versicherungsombudsmann.de or in any other suitable form or submit a request for mediation. Your complaint/application must contain the following information:

Your personal details as the policyholder
Name of the insurance company, policy and claim number, insurance parties (you can also upload your insurance documents as a file)
Specification of what you wish to achieve with your complaint (e.g. payment of a certain amount, cancellation of the contract)
a brief description of the facts of the case (if this is not clear from the enclosed documents).

Once all the necessary information and documents have been submitted, the consumer arbitration board Versicherungsombudsmann e.V. Will examine your claim and usually obtain a statement from the insurance company involved.

Note: The employees of the consumer arbitration board will investigate the facts of the case on their own initiative and may ask you for additions. You yourself do not need any specialised or legal knowledge. You can, however, be involved in the proceedings before the consumer arbitration board at your own expense be represented by a lawyer at your own expense.

The complaints procedure can end with a decision or a recommendation from the ombudsman, for example. If the value of the complaint is EUR 10,000, the decisions are binding; if the value of the complaint is higher, a non-binding recommendation is issued.

If you as a consumer do not agree with the ombudsman's decision, you still have the option of taking the matter to an ordinary court.

Deadlines

There are no time limits, but the statutory limitation period must be observed.

Required documents

Copies of correspondence relevant to the complaint (especially the letters in which the insurer explains its decision)
if you are represented in the proceedings: a written power of attorney for the authorised person

Costs

Note: You must bear your own costs, for example for copies, postage, telephone calls and representation by a lawyer.

Processing time

Most complaints procedures take around three months, in difficult cases even longer.

Miscellaneous

For arbitration proceedings before the Insurance Ombudsman that are directed against insurance intermediaries, different provisions and requirements apply, as well as different rules of procedure. Decisions against intermediaries are therefore always non-binding. The proceedings do not suspend the limitation period for your claims. You can find more information on this on the Insurance Ombudsman's website.

The subject of the complaint must not be claims arising from a health, long-term care or credit insurance contract.
The"Private Health and Long-Term Care Insurance Ombudsman" is responsible for complaints relating to private health and long-term care insurance.