1.1 Introduction
Globally, the insurance industry has been experiencing tremendous growth. This growth has made insurance claims/disputes between insurance companies and insurance consumers (insured) inevitable. Tanzania with no exception the industry is experiencing the same, However, those disputes are solvable and are subject to resolution.
In Tanzania, insurance disputes between insurance consumers and insured (registrants) may be settled either by court process or by the Insurance Ombudsman. In particular, if one is aggrieved by the decision of the Commissioner of Insurance may knock on the doors of the Insurance Tribunal. The decisions of the Tribunal are subject to appeal to the High Court of Tanzania, then from High Court to the Court of Appeal of Tanzania. Also, the decision of the Insurance Ombudsman is subject to reference to the High Court of Tanzania.
1.2 Insurance Disputes Mechanisms in Tanzania
Responding to the tremendous growth in the insurance sector which indeed has made disputes or claims inevitable, Tanzania has in place firm mechanisms from which those claims or disputes may be determined and settled. Those mechanisms are as follows;
1.2.1 Commissioner of Insurance
The Commissioner of Insurance is appointed by the President among the person with adequate knowledge and experience in the Insurance industry and shall serve for the term of five years in the office and can be re-appointed once for a further term of five years. The Commissioner is assisted by the Deputy Commissioner of Insurance who is also an appointee of the President. The Commissioner has the following functions/ duties:
- registration and superintendence of the conduct of insurers, insurance brokers and agents;
- rormulation and enforcement of standards in the conduct of the business of insurance;
- recommending to the Minister the making of regulations for the carrying out of government policies relating to insurance;
- affording guidance to insurers to :-
· the deletion or amendment of obscure or ambiguous terms in contracts of insurance;
· the deletion or amendment of items and conditions in contracts of insurance which are unfair or oppressive to policy
holders;
· the simplification or clarification of terms and conditions in contracts of insurance; and
- performance of such other functions which are assigned to the Commissioner by the Insurance Act or any other duties which the Minister of Finance may, by regulations, prescribe.
Moreover, the decisions of the Commissioner are subject to Appeal to the Insurance Appeal Tribunal.
1.2.2 Insurance Ombudsman Service
The Ombudsman Service is established under the Insurance Act, of 2009 for settlement of insurance disputes arising between insurance consumers and insurance companies (registrants) in Tanzania. In consultation with National Insurance Board, the Minister of Finance appoints the insurance Ombudsman among those who possess acute experience and knowledge in legal matters and dispute settlement. After his appointment, the Insurance Ombudsman is sworn in by the Chief Justice and serves for a term of five years, which is subject to re-appointment for further five years.
1.2.2.1 Functions and Powers of Ombudsman
The Ombudsman has the following functions/powers;
- recommending to the Minister the making of regulations for the carrying out of government policies relating to insurance;
- The administration of all complaints filed by insurance consumers with a monetary value of the maximum of Tanzanian Shillings Forty Million (TZS 40,000,000
- Issuance of an award upon arbitration for direct losses and damages suffered by Complainant up to the maximum of Tanzanian Shillings Fifteen Million Shillings (TZS 15,000,000). It is worth saying, the Ombudsman may determine a claim whose value does not exceed TZS 40 Million but his award should not exceed TZS 15 Million.
- If the Ombudsman is of the view that the award may exceed the statutory limit of TZS 15 Million; he will advise the parties to refer the matter to a court of law.
- The Ombudsman has the power to conduct an investigation for determining the viability of the complaint and conduct mediation, reconciliation and arbitration.
- the Ombudsman may also advise both the complainant and insurance registrant as to the best way of resolving a dispute either before the Ombudsman or filing the same in a court of law.
1.2.2.2 Filing Claims with the Insurance Ombudsman and Time Frame for the Complaint to be Determined
- Complaints with the Insurance Ombudsman may be filed either orally, electronically or in writing. The use of these modes of filing has made it effective and easy for anyone with insurance claims to reach the Ombudsman service. However, the Insurance Ombudsman may also reject the Complaint.
- Upon receipt of the complaint, it takes 60 days for the Insurance Ombudsman to determine the claim from the date of admission. And it takes 30 days for the Ombudsman to issue an award provided that, no reference has been made to the High Court of Tanzania.
Thus, if any person is aggrieved by the decision of the Ombudsman may refer to the High Court of Tanzania.
1.2.3 Insurance Appeals Tribunal
The Insurance Appeals Tribunal is established under the Insurance Act, No. 10 of 2009. It has the power to receive, hear and determine Appeals against the decision of the Commissioner of Insurance. This means any person aggrieved by the decision of the Commissioner exercising his powers under the Insurance Act may, within one month from the date on which the decision is communicated to him in writing, appeal by a petition in writing to the Tribunal which may either:
- uphold,
- reverse
- revoke or
- vary that decision
1.2.4 High Court of Tanzania
The High Court of Tanzania has the power to determine Appeals from the Tribunal. Whereby, a person aggrieved by a decision of the Tribunal may, if it involves a question of law, within one month from the date on which the decision is communicated to him, appeal to the High Court. Significantly, the question of law does not include a reference to a question of whether there is sufficient evidence to justify a finding of fact but rather a pure point of law.
The High Court of Tanzania has also the power to receive and determine references from the decision of the Ombudsman. Before issuing an Award by the Ombudsman, a person may make a reference to the High Court provided that it is based on the questions of law.
1.3 Conclusion
The development of science and technology and growth in the insurance industry or businesses are inseparable. Whereby instruments, businesses and life v inevitable and force majeure. However, as businesses are insured, insurance claims are also inevitable. Nevertheless, the insurance companies and regulators of the insurance industry should make sure that the mechanisms of resolving insurance claims are effective to ensure affairs of bona fide companies and customers are safeguarded.
Disclaimer
This Article has been prepared for general guidance on matters of interest only and does not constitute professional advice. You should not act upon the information contained in this publication without obtaining specific professional advice. No representation or warranty either express or implied is given as to the accuracy or completeness of the information contained in this publication, and, to the extent permitted by law. AVC & Partners (Advocates), its members, employees and agents do not accept or assume any liability, responsibility or duty of care for any consequences of you or anyone else acting, or refraining to act, in reliance on the information contained in this publication or for any decision thereto
