Article 1 In order to standardize the handling of insurance consumers' complaints and protect the legitimate rights and interests of insurance consumers, these Measures are formulated in accordance with the Insurance Law of People's Republic of China (PRC) and other laws and administrative regulations.

Article 2 The insurance consumer complaints mentioned in these Measures include insurance consumer complaints to insurance institutions and insurance intermediaries and insurance consumer complaints to China Insurance Regulatory Commission (hereinafter referred to as "China Insurance Regulatory Commission") and its dispatched offices.

Insurance consumers complain about insurance consumption to insurance institutions and insurance intermediaries, which means that insurance consumers have disputes with insurance institutions, insurance intermediaries and insurance practitioners in insurance consumption activities, and report the situation to relevant insurance institutions and insurance intermediaries and ask for settlement of disputes.

Insurance consumers complain about insurance consumption to the China Insurance Regulatory Commission and its dispatched offices, which means that insurance consumers think that insurance institutions, insurance intermediaries and insurance practitioners violate laws, administrative regulations and the provisions of the China Insurance Regulatory Commission in insurance consumption activities, resulting in damage to their legitimate rights and interests, and report the situation to the China Insurance Regulatory Commission and its dispatched offices, and apply for them to perform their statutory regulatory duties.

Article 3 The handling of complaints by insurance consumers shall adhere to the principles of legality, fairness, impartiality and convenience, improve work efficiency and effectively protect the legitimate rights and interests of insurance consumers.

Article 4 The Insurance Consumer Rights Protection Bureau of the China Insurance Regulatory Commission is the administrative department in charge of handling insurance consumer complaints nationwide, and supervises and manages the handling of insurance consumer complaints nationwide.

The dispatched office of the China CIRC shall designate the administrative department to handle complaints from insurance consumers, and supervise and manage the handling of complaints from insurance consumers within its jurisdiction.

Article 5 Insurance institutions and insurance intermediaries shall set up or designate management departments and posts for handling insurance consumption complaints of their own units, and be staffed to handle, count, analyze and manage insurance consumption complaints of their own units.

Insurance companies and their provincial branches, insurance professional agencies, insurance brokerage companies and insurance assessment institutions shall designate senior managers responsible for handling complaints from insurance consumers as the persons responsible for handling complaints from insurance consumers.

Article 6 Insurance companies, insurance professional agencies, insurance brokerage companies and insurance assessment institutions shall strengthen the management, guidance and assessment of the handling of insurance consumer complaints by branches, and coordinate and support branches to properly handle all kinds of insurance consumer complaints.

Article 7 An insurance industry association shall establish an insurance consumer complaint handling mechanism, actively coordinate and urge member insurance institutions and insurance intermediaries to handle insurance consumer complaints in a timely manner.

Article 8 The dispatched offices of the China Insurance Regulatory Commission shall guide the establishment and improvement of the insurance dispute mediation mechanism within their respective jurisdictions, and supervise its standardized operation.

Insurance industry associations should strengthen industry self-discipline, coordinate and urge member insurance institutions and insurance intermediaries to solve insurance consumer complaints through consultation and mediation, do a good job in the construction and management of insurance dispute mediation institutions, and promote the normal operation of insurance dispute mediation mechanisms.

Insurance companies, insurance professional agencies, insurance brokerage companies and insurance assessment institutions shall guide and support branches to participate in the local insurance dispute mediation mechanism and negotiate with insurance consumers to resolve insurance consumption disputes.

The specific measures for the mediation mechanism of insurance disputes shall be formulated separately by the China Insurance Regulatory Commission. Article 9 Insurance institutions shall be responsible for handling the following complaints from insurance consumers:

(1) There is a dispute with the unit due to the terms of the insurance contract;

(two) disputes arising from insurance sales, underwriting, surrender, preservation, compensation and other businesses and units;

(three) other disputes with the unit due to insurance consumption activities.

Article 10 An insurance intermediary institution shall be responsible for handling complaints from insurance consumers arising from disputes between insurance intermediary services and its own units.

If an insurance consumer complains about insurance consumption to an insurance institution, an insurance intermediary agency that provides insurance intermediary services can assist him to reflect the situation or provide relevant convenience to promote the smooth settlement of the insurance consumer's complaint.

Article 11 The CIRC of China shall be responsible for handling the following complaints from insurance consumers:

(1) Where an insurance company violates laws, administrative regulations and the provisions of the China Insurance Regulatory Commission and damages the legitimate rights and interests of insurance consumers, it shall be handled by the China Insurance Regulatory Commission according to law;

(2) Insurance practitioners who violate insurance regulatory laws, administrative regulations and the provisions of the China Insurance Regulatory Commission and damage the legitimate rights and interests of insurance consumers shall be dealt with by the China Insurance Regulatory Commission according to law;

(3) Other circumstances that should be handled by the China Insurance Regulatory Commission according to law.

Article 12 The dispatched office of the China Insurance Regulatory Commission shall be responsible for handling the following complaints from insurance consumers:

(a) branches of insurance companies and insurance intermediaries within their jurisdiction violate laws, administrative regulations and the provisions of the China Insurance Regulatory Commission, and damage the legitimate rights and interests of insurance consumers, which shall be handled by the dispatched offices of the China Insurance Regulatory Commission according to law;

(2) Insurance practitioners within the jurisdiction violate insurance supervision laws, administrative regulations and the provisions of the China Insurance Regulatory Commission, and damage the legitimate rights and interests of insurance consumers, which shall be handled by the dispatched office of the China Insurance Regulatory Commission according to law;

(3) Other circumstances that should be handled by the dispatched office of the China Insurance Regulatory Commission according to law. Section 1 Insurance Consumer Complaints

Thirteenth insurance consumers can complain about insurance consumption by letter, fax, e-mail, telephone and interview.

If complaints about insurance consumption are made by mail, fax or e-mail, the insurance consumer shall send the complaint materials to the mailing address, fax number and e-mail address designated by the complaint handling unit.

If a complaint about insurance consumption is made by telephone, the insurance consumer shall call the telephone number designated by the complaint handling unit.

If an insurance consumer complains by interview, it shall be conducted at the reception place designated by the complaint handling unit. If more than 5 insurance consumers intend to complain about insurance consumption through interviews, they shall elect 1 to 2 representatives.

Fourteenth insurance consumer complaints by the insurance consumer himself, and provide the following materials:

(1) Basic information of the complainant, including: citizen's name, valid certificate number, contact telephone number, contact address and postal code; The name, domicile and postal code of the legal person or other organization, and the name and position of the legal representative or principal responsible person;

(2) The basic information of the respondent, including: the name of the insurance institution or insurance intermediary institution complained of; The relevant information of the complained insurance practitioners and the names of their insurance institutions or insurance intermediaries;

(three) the complaint request, the main facts and reasons, and the relevant facts.

Article 15 If it is really difficult for an insurance consumer to lodge a complaint about insurance consumption on his own, he may entrust others to lodge it on his behalf, but he shall submit the complaint materials, the original power of attorney and the identity certificate of the trustee as stipulated in Article 14 of these Measures to the complaint handling unit. The power of attorney shall specify the entrusted matters, authority and time limit, and shall be signed by the insurance consumer himself.

Article 16 If an insurance consumer's complaint is submitted by e-mail, it can also submit written materials; The complaint handling staff may also ask the complainant to provide relevant certification materials as appropriate.

If an insurance consumer complains by interview, the written materials specified in Article 14 of these Measures may be submitted at the same time, or the relevant complaint materials form may be filled in. If it is really difficult for the complainant to write, the complaint handling staff can record the basic information, complaint request, main facts and reasons of the complainant and the respondent, and the complainant shall sign for confirmation. The complaint handling staff may also ask the complainant to provide relevant certification materials as appropriate.

Where an insurance consumer complaint is made by telephone, the complaint handling personnel shall record the basic information, complaint request, main facts and reasons of the complainant and the respondent, and may require the complainant to provide relevant certification materials as appropriate.

The written materials submitted by the complainant shall be signed by the complainant. Where a legal person or other organization makes a complaint about insurance consumption, the complaint materials shall be stamped with the seal of the unit.

Article 17 The administrative department for handling insurance consumer complaints shall register the complaints accepted by insurance consumers. If the complaint materials are incomplete, the complainant shall be notified to make corrections within 5 working days from the date of receiving the materials.

If an insurance consumer complains about insurance consumption to an insurance institution or insurance intermediary, the insurance institution or insurance intermediary shall not require the complainant to supplement the materials that he has mastered or can obtain through relevant information files.

Article 18 Insurance consumers shall make complaints about insurance consumption objectively and truthfully, and be responsible for the authenticity of the materials they provide. Do not provide false information or fabricate or distort facts, and do not falsely accuse or frame others.

Insurance consumers shall abide by laws, administrative regulations and relevant provisions of the state in the process of complaints about insurance consumption, and maintain public order and the office order of complaint handling units.

Section 2 Acceptance of Insurance Consumption Complaints

Article 19 The administrative department for handling complaints from insurance consumers is the working body of the unit that accepts complaints from insurance consumers.

Article 20 After receiving the complete complaint materials, the administrative department that accepts the complaints of insurance consumers shall promptly review them and deal with them according to the following circumstances:

(a) in accordance with the provisions of these measures, accept the complaints of insurance consumers handled by the unit;

(two) the provisions of the insurance consumer complaints, but do not belong to the unit to deal with, inadmissible, can be handed over to the relevant units;

(3) Complaints from insurance consumers that are not provided for in these Measures but should be handled by other departments of the unit shall be transferred to relevant departments for handling in accordance with relevant regulations;

(four) complaints from insurance consumers that do not belong to these provisions and are not handled by other departments of the unit shall not be accepted;

(five) one of the circumstances stipulated in the first paragraph of Article 21 of these Measures shall not be accepted.

Twenty-first insurance consumer complaints in any of the following circumstances, the complaint handling management department will not accept:

(1) The complaint is not made by the insurance consumer himself or the insurance consumer's trustee;

(two) the unit has accepted the complaint, and the insurance consumer has no new facts and reasons to file the same complaint again within the processing period;

(three) the unit has made a decision on handling the complaint, and the insurance consumer has no new facts and reasons to make the same complaint again.

If an insurance consumer makes the same complaint again within the processing period, but there are new facts and reasons to be verified, the complaint handling management department may combine them, and the processing period shall be recalculated from the date of receiving the new complaint materials.

Article 22 The administrative department handling complaints from insurance consumers shall inform the complainant whether to accept them within 10 working days from the date of receiving the complete complaint materials, and explain the reasons for not accepting them.

Section 3 Decision on Handling Complaints from Insurance Consumers

Article 23 Insurance institutions and insurance intermediaries shall promptly organize investigation and verification of the complaints accepted by insurance consumers, and make the following decisions according to the different situations of complaints:

(1) Performing obligations in accordance with laws, administrative regulations, relevant state regulations and insurance contracts;

(two) does not comply with laws, administrative regulations, relevant state regulations and insurance contracts, the complainant shall do a good job of explanation;

(3) If there is no clear stipulation in laws, administrative regulations and relevant provisions of the state, and there is no clear stipulation in the insurance contract, the complainant's opinions shall be solicited in accordance with the principle of fairness and reasonableness;

(4) If the insurance consumer's complaint is not filed by the insurance consumer himself or the insurance consumer's client, the handling of the insurance consumer's complaint shall be terminated and the complainant shall be informed;

(five) before the decision is made, if the complainant withdraws the insurance consumption complaint, the handling of the insurance consumption complaint shall be terminated and the complainant shall be informed.

Article 24 After accepting complaints about insurance consumption, insurance institutions and insurance intermediaries shall make a decision on handling them within the following time limits:

(a) the complaint of an insurance consumer with clear facts and simple disputes shall be handled within 10 working days from the date of acceptance;

(2) Complaints about insurance consumption other than those specified in Item (1) shall be decided within 30 days from the date of acceptance. If the situation is complicated, with the approval of the person in charge of handling the complaints of insurance consumers, the processing period may be extended, but the extension period shall not exceed 30 days, and the complainant shall be informed of the reasons for extending the period.

Article 25 Within 5 working days from the date of decision, insurance institutions and insurance intermediaries shall inform the complainant. The contents of the notice shall include:

(1) Whether the complaint request complies with laws, administrative regulations, relevant state regulations and insurance contracts;

(2) Handling opinions;

(3) If the complainant disagrees with the decision, he may apply for verification in accordance with the provisions of Article 26 of these Measures, or settle it through insurance dispute mediation mechanism or litigation or arbitration.

Article 26 If a complainant refuses to accept the handling decisions of an insurance company branch, an insurance agency branch, an insurance brokerage company branch or an insurance assessment institution branch, he may, within 30 days from the date of receiving the handling decisions, apply in writing to a higher-level institution for verification.

The verification institution shall verify the handling process, handling time limit and handling results of insurance consumer complaints, and make a verification decision within 30 days from the date of receiving the verification application. Within 5 working days from the date of making the verification decision, the verification institution shall inform the complainant.

Twenty-seventh China CIRC and its dispatched offices shall promptly organize investigation and verification of the complaints accepted by insurance consumers, and make a decision within 60 days from the date of accepting the complaints; If the situation is complicated, the handling period may be extended with the approval of the person in charge of the unit, but the extension period shall not exceed 30 days, and the complainant shall be informed of the reasons for extending the period. Where laws, administrative regulations and rules provide otherwise, such provisions shall prevail.

If the complainant withdraws the complaint about insurance consumption before making the decision, or if the China Insurance Regulatory Commission and its dispatched offices find that the complaint about insurance consumption is not made by the insurance consumer himself or the insurance consumer's client, it shall terminate the handling of the complaint about insurance consumption and inform the complainant. According to the relevant regulations, if it is handled by other departments of the unit, it shall be transferred to the relevant departments for handling.

Article 28 Within 5 working days from the date of decision, China CIRC and its dispatched offices shall inform the complainant. The contents of the notice shall include:

(a) whether the respondent violates or is suspected of violating laws, administrative regulations and the provisions of the China Insurance Regulatory Commission on insurance supervision;

(2) Handling opinions;

(three) if the complainant has any objection to the decision, he may apply for verification in accordance with the provisions of Article 29 of these Measures.

Article 29 If a complainant refuses to accept the decision on handling insurance consumption complaints made by the dispatched office of the China Insurance Regulatory Commission, he may, within 30 days from the date of receiving the decision, apply in writing to the China Insurance Regulatory Commission for verification.

China CIRC shall verify the handling process, time limit and results of insurance consumer complaints, and make a verification decision within 30 days from the date of receiving the verification application. Within 5 working days from the date of making the verification decision, China CIRC shall inform the complainant.

Section 4 Insurance Consumer Complaint Handling System

Article 30 Insurance institutions and insurance intermediaries shall publish the telephone number, fax number, mailing address, reception address and e-mail address of their insurance consumers' complaints, and display the complaint handling procedures of insurance consumers on official websites and business premises.

The China Insurance Regulatory Commission and its dispatched offices shall establish and improve the insurance consumer complaint hotline, publish the telephone number, fax number, mailing address, reception address and e-mail address of insurance consumer complaints, and display the procedures for handling insurance consumer complaints on official websites and offices.

Article 31 Insurance institutions, insurance intermediaries, the China Insurance Regulatory Commission and its dispatched offices shall establish an insurance consumer complaint registration system and an insurance consumer complaint file management system, and regularly collect complaint data for analysis and research.

Article 32 Insurance institutions, insurance intermediaries, China CIRC and its dispatched offices shall improve their own insurance consumer complaint handling system, complaint evaluation system and accountability system.

Article 33 Insurance institutions, insurance intermediaries, China Insurance Regulatory Commission and its dispatched offices shall, in accordance with the relevant provisions of the state, formulate emergency response plans for major and group insurance consumer complaints, and do a good job in the prevention, reporting and emergency response of major and group insurance consumer complaints.

Insurance institutions, insurance intermediaries and the dispatched offices of the China Insurance Regulatory Commission shall, in accordance with the relevant provisions of the China Insurance Regulatory Commission, report complaints about insurance consumption of five or more people in groups or with significant influence.

Article 34 The staff responsible for handling complaints about insurance consumption shall abide by the following provisions:

(a) adhere to the principle of seeking truth from facts, act in accordance with the law, and shall not prevaricate, perfunctory or delay;

(two) listen to the facts and reasons of the complainant comprehensively and carefully, and handle them properly to avoid intensifying contradictions;

(3) If he has a direct interest in the complaint of an insurance consumer or the complainant, he shall withdraw;

(4) Comply with relevant confidentiality provisions. Article 35 An insurance institution or an insurance intermediary institution shall, when handling the complaints about insurance consumption transferred by the China Insurance Regulatory Commission or its dispatched offices, report the following information in writing according to the requirements of the transferred unit:

(a) whether to accept the complaint, if not, it shall explain the reasons;

(two) the complaint handling process, time limit and opinions;

(three) whether the complainant accepts the result.

Thirty-sixth insurance institutions and insurance intermediaries in handling complaints from insurance consumers, in any of the following circumstances, the China Insurance Regulatory Commission and its dispatched offices can promptly put forward improvement requirements, and supervise the complaint handling units to make rectification within a time limit:

(a) not accepted according to the provisions of these measures;

(2) Failing to inform the complainant whether to accept or not according to the provisions of these Measures;

(3) Failing to make a decision in accordance with the provisions of these Measures;

(four) failing to inform the complainant of the decision in accordance with the provisions of these measures;

(5) Failing to inform the complainant that he can apply for verification if he has any objection to the handling decision stipulated in these Measures;

(six) other circumstances that violate the provisions of these measures and damage the legitimate rights and interests of insurance consumers, and need to be rectified.

The complaint handling unit that receives the rectification requirements shall report the rectification in writing within 30 days.

Article 37 The China Insurance Regulatory Commission and its dispatched offices may, according to the needs of their work, pay a return visit to the handling of insurance consumer complaints by insurance institutions and insurance intermediaries, and listen to the complainant's opinions on the handling decision.

Article 38 An insurance company shall, in accordance with the requirements of the China Insurance Regulatory Commission, report its own complaint handling system, complaint evaluation system, responsibility investigation system, list of persons responsible for handling complaints from insurance consumers and changes in the above matters.

Provincial branches of insurance companies and insurance intermediaries shall, in accordance with the requirements of the local CIRC offices, report the changes in the complaint handling system of insurance consumers, complaint evaluation system, accountability system, list of persons responsible for handling complaints of insurance consumers and the above matters.

Article 39 An insurance company shall, within 65,438+00 working days after the end of each quarter, submit to the China Insurance Regulatory Commission a written report on the handling of insurance consumption complaints of insurance institutions in this quarter.

Branches of insurance companies and insurance intermediaries shall, within 7 working days after the end of each quarter, submit a written report on the handling of complaints from insurance consumers to the local dispatched office of the China Insurance Regulatory Commission.

Article 40 Insurance institutions and insurance intermediaries shall conduct self-inspection on the handling of complaints from insurance consumers in their own units every year, and submit written self-inspection reports to the China Insurance Regulatory Commission or local dispatched institutions before March/KLOC-0 of the following year.

The self-inspection report shall explain the relevant system and implementation, existing problems and improvement measures of the unit in handling insurance consumer complaints.

Article 41 The China CIRC shall establish an evaluation system for handling complaints from insurance consumers by insurance institutions and insurance intermediaries, select reasonable indicators, and comprehensively and scientifically evaluate the handling of complaints by insurance institutions and insurance intermediaries.

Article 42 If an insurance institution or insurance intermediary institution violates the provisions of these Measures and is under any of the following circumstances, the China Insurance Regulatory Commission and its dispatched offices may, according to the specific circumstances, list it as a key regulatory object, conduct regulatory talks with its senior managers, or take other regulatory measures according to law:

(1) Failing to establish a complaint handling system for relevant insurance consumers in accordance with the provisions of these Measures;

(2) Failing to publish relevant information on handling complaints of insurance consumers in accordance with the provisions of these Measures;

(3) Failing to truthfully report the handling of insurance consumers' complaints within the time limit stipulated in these Measures;

(four) in violation of the provisions of article thirty-sixth, not according to the requirements of rectification, the circumstances are serious;

(five) other violations of the provisions of these measures, causing serious consequences. Article 43 The term "insurance consumption activities" as mentioned in these Measures refers to purchasing insurance products and receiving related insurance services within the territory of People's Republic of China (PRC).

The term "insurance consumers" as mentioned in these Measures includes the applicant, the insured and the beneficiary.

The term "insurance employees" as mentioned in these Measures refers to the staff of insurance institutions, employees of insurance intermediaries and other insurance sales employees who sell insurance products for insurance institutions.

Article 44 The term "insurance institutions" as mentioned in these Measures refers to insurance companies and their branches.

The term "insurance intermediaries" as mentioned in these Measures refers to professional insurance agencies and their branches, insurance brokerage companies and their branches, insurance assessment institutions and their branches.

Article 45 If an insurance consumer thinks that the legitimate rights and interests of a part-time insurance agency and its employees have been damaged due to violation of laws, administrative regulations and the provisions of the China Insurance Regulatory Commission, and has reported the situation to the China Insurance Regulatory Commission and its dispatched offices, it shall be implemented with reference to these Measures.

Article 46 The administrative department handling complaints from insurance consumers shall inform the complainant of relevant matters in accordance with the provisions of these Measures, unless the complainant cannot contact.

In accordance with the provisions of these measures, inform the complainant that the insurance consumer complaint will not be accepted or inform the decision on handling the insurance consumer complaint, it shall be informed in writing; With the consent of the complainant, it can also be done by telephone, e-mail, etc., and keep the written or recorded information about the notification.

In case of written notice, relevant written documents shall be sent within the notice period stipulated in these Measures; Informed by telephone, it shall call the complainant within the notice period stipulated in these Measures; If the notification is made by e-mail, relevant electronic documents shall be issued within the notification period stipulated in these Measures.

Forty-seventh the term "in the capital".

Article 48 The China Insurance Regulatory Commission shall be responsible for the interpretation of these Measures.

Article 49 These Measures shall come into force as of 2013110/October 65438.