I Preliminary Notes

I receive 20,000 to 25,000 complaints annually from policyholders and from claimants about their insurance companies. For the most part, these involve petitions (Art. 17 of German Basic Law (Grundgesetz - GG)) which give rise to an examination in accordance with section 83 (1) no. 1 of the Insurance Supervision Act (Versicherungsaufsichtsgesetz - VAG). For the insurers, handling these complaints can contribute to their:

• quality management,
• efforts towards the company's goal of "customer satisfaction" and
• public relations work.

The following guidelines are designed to assist you in handling complaints.

II BaFin's procedure

In most cases I send the insurer a copy of the petition and request a statement. After receiving their statement - and if it sufficiently explains the matter - I assess the issue based on both sides' accounts. Subsequently, I notify the complainant of my opinion, enclosing a copy of the insurer's response. If a deficiency is observed on the part of the insurer it has to be rectified. In such cases where it is a matter of an isolated incident of misconduct by the insurer, the company is normally willing to remedy the issue on its own.

III Your statement

1. Please prepare your statement in a thorough manner, enabling me to assess the complainant's request as well as the underlying problem without further enquiry. Moreover, please address all points brought forward by the complainant.

   1. Please always check if the following documentation is essential for my work on and my understanding of the issue, as well as for the complainant's understanding thereof, and if so, please attach it to your statement:

      • the underlying insurance conditions of the contract and, if necessary, the provisions on premium rates,
      • a copy of the insurance application and insurance certificate or
      • the consumer information in accordance with Annex D of the Insurance Supervision Act.

   2. For complaints concerning technical calculations for life insurance (including Pensionskassen and death benefit funds) and accident insurance with premium refund, I need a verifiable presentation of these calculations in the form of a separate letter that will not be forwarded to the complainant.

      The description should include the following points:

      • technical contract details,
      • mathematical formulas with numerical values,
      • bonus declarations and rates of interest applied to accumulated surpluses,
      • if applicable, data on the approval of the operating plan and
      • the principles for the calculation of premiums and mathematical provisions, unless these have already been submitted to me (in this case it would be helpful to let me know when this information was submitted).

      When sending the statement, please enclose, if applicable, the table of guaranteed surrender value attached to the insurance policy and the most recent notification of the policyholder on the bonus credited to him.

   3. Regarding motor vehicle third party liability insurance, I need to receive an extract from the tariff conditions regulating the premium for complaints about

      • the premium amount in conjunction with section 5 (3) of the Compulsory Insurance Act (Pflichtversicherungsgesetz - PflVG) or about
      • surcharges or discounts that were imposed or granted but differ from the general company premium rates.

   4. When transferring information about an individual's state of health, data protection requires particular discretion. These kinds of data should only be submitted if they are necessary for handling the complaint.
   5. It may be the case that I require additional information while assessing a complaint and consequently request this from you. Therefore, please designate a contact person for me in your statement.

2. If there is or was a case pending before a court or ombudsmen, it is appropriate to report on the specific issue of the case, its status and, if applicable, the court's ruling or the ombudsman's decision. Please include in your statement whether a settlement concerning the complaint has been reached.
3. Please report in detail also in cases where you consider the issue settled or if you have reason to assume that the complainant views the matter as settled.
4. If the complainant has accused one of your members of staff or an intermediary of any personal misconduct, then it is appropriate to include a statement from that member of staff or intermediary in your statement to me.

5. Please attach to your statement a duplicate to be forwarded to the complainant. In doing so, please consider the following points:

   • Use a writing style that is understandable for the complainant. Avoid abbreviations, legal terms and specialised terminology that are difficult for non-experts to understand.
   • Refer only to those attachments that I can forward to the complainant.
   • Please refer to any statements that the complainant is not supposed to have knowledge of (i.e. general management issues, confidential information, a statement as in no. 4 above as an exception in an individual case) in a separate report with the clearly identifiable reference "To be read by BaFin only".
   • It is not sufficient to merely forward external statements or submit letters written to the complainant.

IV Important formalities

1. Please respond

   • within four weeks if your German business is concerned,
   • within six weeks, if your business in other countries is concerned.

   If you are unable to meet the deadline, please provide me with an intermediate reply and specify the reason for the delay as well as when I can expect to receive your statement on the issue.

   If I have further enquiries, please respond promptly.

2. As my request for your statement is based on
   section 83 (1) no. 1 of the VAG, your statement should be signed by

   • at least one member of the board of directors and one other person authorised to represent the company or
   • the authorised agent.

   This procedure has proved to be effective in many respects.

3. In most cases you will not receive a confirmation once a complaint has been settled. Such information will be given only if there is a special reason for doing so.

4. When the complainant's petition results from a claim based on an insurance contract with you, and a third party (e.g. a collection agency) has been hired by you to collect such payment, then it is normal and helpful to discontinue the collection efforts for the duration of my examination. The same applies if you take legal action against the complainant or a third party does so on your behalf.

   My examination of the matter will take some time. The complainant should not be adversely affected by this. Therefore, please assist, for example by extending any relevant deadlines.

   If you decide not to comply with these practices, please duly inform me in advance.

5. Should you decide to fulfil the complainant's request either completely or partially, after having stated to me that the complainant's petition is unwarranted from your point of view, please inform me of the scale of and reasons for the concession.
6. If a legal dispute involving a complaint is settled after you have sent in your statement, then you should inform me of this.
7. Circular 2/95 (Official Bulletin of the BAV 1995, page 314) is rescinded.

8. Please confirm receipt of this circular within two weeks, using the attached form.