The function of an ombudsperson is to resolve complaints. He or she provides independent and impartial conflict resolution and problem-solving services. An ombudsperson does not exercise judicial power and cannot impose a solution on the parties.
An ombudsperson only becomes active after the client has submitted a complaint for examination. The ombudsperson’s task is to examine the individual case (i.e. the complaint and documents that provide evidence of the dispute) and find out, whether the requirements of a mediation procedure are fulfilled. If the conditions are met, the ombudsperson tries to find an appropriate solution, which is acceptable to both sides.
There are many advantages of using an ombudsperson to resolve differences: Unlike traditional court proceedings the mediation procedure of an ombudsperson is neither time-consuming nor bureaucratic. No fees are charged and complainants do not give up their legal rights to pursue their claims in ordinary court proceedings.
The foundation “Ombudsman of Private Insurance and of Suva” is indirectly financed by its member companies via The Swiss Insurance Association (SIA). The amount of the contribution of each member is independent of the number of cases. This solidarity-based contribution system ensures the Ombudsman Office’s independence.
There are numerous ombudsman services for disputes with private sector companies:
If you as a policy holder, claimant or insured person have a dispute with one of our member insurance companies, you can contact the Insurance Ombudsman with questions and complaints. To find out if the insurance company that is the subject of your complaint is a member company, please see: Member Insurance Companies.
The Swiss Insurance Ombudsman is responsible for Suva and private insurance companies, which are members of our Foundation. The Insurance Ombudsman cannot look at complaints about health insurance companies (basic and supplementary insurance). In the field of occupational benefits insurance (BVG/LPP) the Insurance Ombudsman can only look at complaints about collective foundations of life insurers, which are members of our Foundation. If your complaint is not something the Insurance Ombudsman can deal with, check this list of other ombudsman schemes that may be able to help.
Before you complain to the Insurance Ombudsman you should try and resolve your complaint with the insurer. Therefore, if you want the Ombudsman to examine your case, you must first address your complaint in writing to the insurer. If you’re not happy with the response you get from the insurer – or if they don’t get back to you – you can ask the Ombudsman to get involved.
When you bring a complaint to us, you should enclose copies of the correspondence with the insurer (incl. a copy of your complaint letter and the insurance company’s reply). This allows us to consider information from both parties involved and look at the problem without taking sides.
When the Ombudsman Office receives a complaint, we look at all the documents and information and decide if it’s something we can deal with. If we find merit to your complaint, we will approach the insurer with your complaint, unless mediation appears to have no chance of success for certain reasons from the outset. With our intervention we ask the involved insurer for a written response to the complaint.
If examination of the complaint reveals no evidence of wrongdoing on the part of the insurer or shows that the insurer’s decision can’t be criticized, no mediation procedure will be initiated. In our final letter to you we will describe the outcome of our investigation and give reasons for the decision that has been reached.
The Ombudsman Office normally requires the following documents:
After a preliminary examination of your complaint, we may contact you to ask for more information. Once we have all the information we need, we will go on to the next step.
If the insurance company does not respond to your written complaint within four weeks of the date of receipt by the insurer of all relevant documents required for claim processing, you should first send a reminder. If the insurer does not reply to your written reminder, you may send your complaint incl. copies of your unanswered letters to the Ombudsman.
No. Your application to the Ombudsman Office should include copies of all relevant correspondence with the insurer that you are making a complaint about. We’re required to consider the arguments of both sides. You must therefore first ask the involved insurance company to send a written statement, before you submit a complaint to the Insurance Ombudsman.
No. The Ombudsman is a neutral mediator. He can’t act as a lawyer and bring your concerns to the other party. Try to put the complaint to the insurance company on paper in your own words. Specific skills aren’t needed. If you have difficulties using language to express yourself, ask your friends or family for help.
In principle, it is up to the complainant to gather all relevant documents and to submit a complete file containing all information that is necessary for the examination of a complaint. Only if you have unsuccessfully tried to obtain missing documents from the involved insurance company, the Ombudsman can request them from the insurer.
Making a complaint is simple. You can use our online complaint form and follow the instructions on the screen. If you wish to make a complaint in writing, you should use our complaint form. In each case, your complaint should include copies of all relevant documents.
The procedure is free of charge for complainants.
No. However, there are legal time limits to consider. If you wait too long, limitation periods or forfeiture periods may prevent you from pursuing a claim. Enquiries to the Insurance Ombudsman do not interrupt or suspend legal deadlines. It is your responsibility to ensure that such periods are observed and, if necessary, interrupted.
Once your case has been assessed as something the Insurance Ombudsman can look at, it will be examined by our experts. If they consider that your complaint does not justify an intervention with the insurer, you will receive a response showing the outcome of our investigation within one week.
If the Ombudsman decides your complaint is justified and therefore initiates an intervention, the investigation will most of the times be completed within 4-6 weeks. Of course, the response time will vary depending on how complex your case is.
Complex cases, involving amongst others medical questions that require consultation with medical professionals, can take longer. We aim to finalise such enquiries and complaints within 2-3 months.
No. The Ombudsman is a neutral mediator. He does not act as an advocate for any person. It is therefore your responsibility to ensure that legal deadlines such as limitations or forfeiture periods are interrupted or ensured.
If you are not sure about this, you can call us to discuss how best to proceed. Depending on the situation, we may give you advice and a non-binding evaluation.
Please note that the Ombudsman can deal with complaints about accident insurance (UVG/LAA), under the condition that no formal decision has been issued. Once an accident insurance issues a formal decision, the Ombudsman cannot investigate the complaint any longer.
No. The Ombudsman can’t consider complaints if the accident insurance has already issued a formal decision. After a formal decision you have to start legal proceedings. Therefore, mediation is not possible. You have to lodge an objection to the accident insurer’s decision within 30 days if you don’t agree with the position of the insurer.
Yes. But for privacy reasons we can’t examine the complaint until we receive authority from the person making the complaint. You can complete a permission (consent) form and have it signed by the person you’re making the complaint for (see our complaint form).
The Ombudsman Office is, in contrast, not allowed to investigate a complaint if you have given a mandate to a specialist (lawyer, insurance consultant, legal protection insurance etc.).
You can either make a complaint through our online form or by writing a letter to the Insurance Ombudsman (see complaint form).