Financial consumers of insurance, pre-need, and health maintenance organization products may now also seek recourse from the Insurance Commission.
On 12 March 2023, the Insurance Commission or IC issued Insurance Memorandum Circular 2023-01 to carry out Republic Act 11765, otherwise known as the “Financial Products and Services Consumer Protection Act” or FCPA.
The IC required entities licensed, registered, regulated, and/or supervised by the Commission or ICRE to establish their own Consumer Assistance Management System or CAMS for handling consumer complaints, inquiries, or requests. Moreover, ICREs are required to establish, maintain, and implement manuals that contain the internal policies, processes, and practices they follow in handling complaints, inquiries, and requests from financial consumers.
Key features of the CAMS shall be published in conspicuous places within the premises of ICREs, including terms and conditions of the ICRE’s products and services, various channels of service delivery, and market materials.
A financial consumer, who is unsatisfied with a financial product or service may avail of an informal complaints mechanism or initiate the adjudicatory process with the IC.
A financial consumer may file an informal complaint by submitting the Claimant’s Assistance Request or CAR Form either physically or through electronic mail. A copy of the policy or relevant contract, denial letter (if any), and other supporting documents should also be filed with the CAR. Within seven days from receipt of the CAR and supporting documents, the IC shall inform the financial consumer of any of the following actions:
(1) Inform the complainant of other appropriate actions if the IC finds that there is no basis for the filing of the complaint;
(2) Conduct of mediation/conciliation conference upon request of the financial consumer or if the IC determines that the concern(s) adduced by a financial consumer cannot be addressed by mere referral to the ICRE or
(3) Referral to the concerned ICRE for its comment(s) if the IC finds that the concerned ICRE has not yet acted on the claim with finality.
On the other hand, a financial consumer may file a formal claim or complaint with the IC by filing a verified complaint and paying docket fees. The IC has the authority to adjudicate all actions arising from or in connection with financial transactions with ICREs, specifically:
(1) Claims and complaints where the amount of actual damages, excluding interest, costs, and attorney’s fees being claimed or sued upon any kind of insurance, bond, reinsurance contract, or membership certificate does not exceed in any single claim Five Million Pesos;
(2) Claims and complaints pertaining to membership issues or benefits and services with an HMO under an HMO agreement, including actual damages, attorney’s fees, and costs;
(3) Claims and complaints involving pre-need plans;
(4) Claims involving Compulsory Motor Vehicle Liability Insurance; and
(5) Claims where the amount being claimed or sued does not exceed in any single claim One Million Pesos, exclusive of interest, costs, and attorney’s fees.
In accordance with the FCPA, the IC may impose enforcement actions on ICREs for failing to comply with applicable laws and may impose, among others, restrictions from collecting unreasonable or excessive interests, fees, suspension of operation, and issuance of a cease-and-desist order.
(To be continued)
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