FAQ

The Insurance Ombudsman (AAS) is an alternative dispute resolution system (ADR). The Ombudsman is an independent and impartial body to which citizens and businesses can turn to resolve insurance disputes that may arise with insurance companies and intermediaries.

The complaint to the AAS can be filed online and without the assistance of a lawyer; it costs 20 euro, which will be returned to the complainant if the complaint is upheld in whole or in part.

After the preliminary investigation stage, which is completed within 90 days after the complaint is filed, the AAS decides the dispute, usually within the next 90 days. This deadline may be extended up to an additional 90 days for particularly complex disputes.

If the complainant is not satisfied with the AAS's decision, they may submit the dispute to the civil court.

The Ombudsman is a Panel composed of five members, all appointed by IVASS, including:

• 3 members selected by IVASS (including the Chair);
• 1 member selected by the trade association representing undertakings and 1, jointly, by the trade associations representing intermediaries. Only 1 of these members participates in the Panel, depending on whether the recipient of the complaint is an undertaking or an intermediary;
• 1 selected by the National Council of Consumers and Users (CNCU) representing customers and 1 selected by the trade associations representing non-consumer customers. Only 1 of these members participates in the Panel, depending on the nature of the complainant.

The AAS Technical Secretariat is established at IVASS, manages the procedure but does not participate in decisions.

Before submitting a complaint to the Ombudsman, you must have lodged a claim with the insurance undertaking or intermediary against whom relief is sought. The facts set forth in the complaint must be the same as those in the claim. If no claim has been lodged, the complaint submitted to the AAS will be declared inadmissible and will not be examined.

This step is necessary because the company or the intermediary must be given the opportunity to respond and resolve the problem.

A claim is a written request to report a problem and ask for a direct solution. The undertaking or intermediary must reply within 45 days. If, after filing the claim, the problem has not been resolved or a response has not been received, you can contact the AAS.

The claim should be addressed to the Complaints Office of the insurance company or intermediary, depending on the party whose behaviour is complained of.

The contact details of the Complaints Offices can be found in the documents received when the policy is taken out or on the IVASS website, where the Guide on how to file complaints is also published.

Attention: the claim to IVASS should not be confused with the claim to the undertaking or intermediary: only the latter satisfies the prerequisite for filing a complaint with the AAS.

The following may file a complaint to the Insurance Ombudsman:

1. the policyholder (including the co-holder), the insured and the beneficiary (in life insurance policies);
2. the injured party who has a direct right of action against the company, for example for MTPL claims.

Members of a collective policy may also file a complaint.

Attention: only the policyholder, in his/her capacity as the holder of the rights and obligations arising under the contract, can file a complaint on aspects relating to such contract, such as for example the reimbursement of an undue premium or changes in contract terms.

For further guidance, read the page dedicated to the prerequisites for filing a complaint.

It is not possible to file a complaint with the Insurance Ombudsman if the insurance contract has not been concluded.

A professional (typically, the agent or broker) working in the insurance, banking, and social security sector cannot submit a complaint on matters that concern his/her professional activity.

A person who has been injured by an uninsured or unidentified vehicle cannot complain to the Insurance Ombudsman but can turn to the Guarantee fund for victims of road accidents, managed by CONSAP (for more details visit the dedicated section on CONSAP's website).

For further guidance read the page dedicated to the prerequisites for filing a complaint.

A complaint can be filed with the AAS for issues arising from an insurance contract, such as the non-payment of compensation or indemnity, or the enforcement of a contractual clause, as well as for the behaviour of a company or intermediary that is deemed not to comply with the rules governing the sale or management of the policy.

The filing of the complaint initiates proceedings before the AAS, which reviews the documentation submitted by the parties and decides who is wrong or right.

The AAS is only able to consider complaints regarding facts or behaviours that occurred or of which the complainant has become aware up to three years prior to the filing of the claim to the undertaking or intermediary.

The complaint to the AAS may not be filed if more than twelve months have passed since you submitted the claim to the insurer or the intermediary.

Any complaint submitted beyond this deadline will be declared inadmissible and will not be examined.

If the claim was lodged before the date the AAS became operational, the complaint may be filed within twelve months of the AAS becoming operational.

As a general rule, both the claim and the complaint must be filed against the same parties, subject to certain exceptions (see table below). As stated above in section 1.3, the facts complained of in the complaint must be the same as those raised in the claim.

The following table helps identify the counterparties to whom the claim should be addressed and against whom the complaint to the AAS should be filed, depending on the party whose conduct is being challenged.

* The claim may also be submitted to the intermediary concerned, who shall forward it to the insurance undertaking.

Where the complaint concerns the payment of a sum of money, the competence of the AAS is subject to value limits.

It is therefore important to determine the value of the dispute: this corresponds either to the sum of money claimed in the complaint or to the performance under dispute.

For example, if the insurance company has denied a €20,000 indemnity which the complainant considers fully due, the value of the dispute to be brought before the AAS will be €20,000. If, instead, the company has already paid €15,000, but the complainant believes he is entitled to €20,000, the value of the dispute to be brought before the AAS will be €5,000 (the difference between the amount paid by the company and the amount claimed).

There is no threshold if the complaint does not concern the payment of a sum of money, but only relates to verifying the existence of a right, obligation or power arising from an insurance contract, provided that the latter has been concluded.

Determining the value of the dispute is essential in order to assess whether it is possible to complaint to the AAS, as the regulations set thresholds beyond which the Ombudsman cannot decide. These thresholds vary depending on whether the policy concerns life insurance or non-life insurance.

In any case, when the claim exceeds the limits established for referring a matter to the AAS, other alternative dispute resolution mechanisms remain available.

If the complaint concerns a life policy, the amount to be paid must not exceed:

• € 300,000, if the policy provides benefits due only in case of death of the insured (TCM - term life insurance);
• € 150,000, for all the other life policies.

For instance, in the case of a term life insurance (TCM) policy covering only the death of the insured within a specified period, the beneficiary can complain to the AAS only if the sum to be paid does not exceed €300,000. If, on the contrary, the dispute concerns an insurance-based investment product (for example a unit-linked or a with-profit policy) the value limit for submitting a complaint to the AAS is € 150,000.

If the complaint concerns a non-life policy, the sum of money claimed by the complainant must not exceed € 25,000.

If the complaint is filed by the injured party with a direct right of action against the company, the value must not exceed € 2,500.

For example, the party injured in a road accident receives compensation of € 2,000 from the company instead of the required € 4,000. The injured party can complain to the AAS because the value of the dispute in this case is € 2,000.

If, on the other hand, the amount claimed exceeds € 2,500, it is not possible to complain to the AAS. In such circumstances, it is possible to initiate assisted negotiation proceedings and, if no agreement is reached with the insurer, to bring the matter before a court.

Proceedings before the Ombudsman take place exclusively online, from the submission of the complaint to the communication of the decision.

The complaint must be filed solely via digital means through the AAS Portal, accessible from the official AAS website. Complaints cannot be submitted by ordinary e-mail (PEO, e-mail), certified electronic mail (PEC), registered letter, fax or delivered by hand.

The AAS Web Portal, through a specific guided procedure, assists users in filling in the complaint form and uploading the necessary documentation.

The matter in dispute must be described clearly and in detail, with supporting documents attached to substantiate the facts submitted to the Ombudsman and the related compensation claims.

An electronic receipt confirms the correct submission of the complaint. Through the platform, it is possible to monitor the status of your complaint at any time and receive communications from the AAS.

It is always possible to file the complaint through another person holding a power of attorney, or through a consumer association of which the complainant is a member.

The AAS decides solely on the basis of the documents received, so it is essential to submit all the information necessary to support one’s case. Where it deems it appropriate, the AAS may request additional documents.

The following documents must be attached to the complaint:

1. copy of the claim sent to the company or intermediary and any reply;
2. all documents useful to prove the facts in dispute;
3. the receipt of payment of €20 to cover the procedural costs;
4. a copy of the power of attorney and identity documents of the complainant and the authorised representative, in cases where the complaint is filed on behalf of another person.

Do not attach documents containing health data (medical records and certificates, pictures) and/or data relating to criminal convictions or offences. The AAS could not take them into account.

Before lodging a complaint you must pay €20 to cover the procedural costs. In the absence of payment the complaint will be declared inadmissible and will not be examined. The amount is returned if the complaint is upheld in whole or in part.

Payment can be made via PagoPA, directly online using a credit card, bank transfer, or other payment methods provided by PagoPA. Alternatively, it is possible to print the payment notice and pay it at banks, tobacconists, enabled ATMs, and other affiliated operators.

Once the complaint has been submitted, the cross-examination phase begins, during which documents are exchanged to compile the complaint file. This entire phase takes place online through the AAS Portal.

The AAS Technical Secretariat verifies the formal regularity of the complaint and if it finds that documentation is missing, it requests that it be supplemented through the AAS Portal. The complainant has 10 days to regularize the documentation.
After its regularity is established, the complaint is forwarded to the insurance company or intermediary, which has 40 days to submit its defence brief.

The Technical Secretariat forwards the defence brief of the insurance company or intermediary to the complainant who, in turn, has 20 days to reply, always online, and attach further evidence to support his/her position.

The reply is forwarded to the insurance company or intermediary which may in turn reply with a rejoinder within 20 days. With this latter document, the cross-examination phase may be considered complete.

The cross-examination phase lasts for a maximum of 90 days and concludes either when all defences and documents have been filed, or when any of the relevant time limits expire without a response (for example, if the undertaking or intermediary fails to submit its defence brief within 40 days of receiving the complaint).

Once the cross-examination phase is closed, the file is forwarded to the Panel for a decision.

The Panel examines the documentation filed by the complainant, the insurance company or the intermediary and decides based on the documentation available. The absence of a reply by the company or the intermediary does not imply that the complaint is automatically upheld.

After the closure of the cross-examination phase, it is no longer possible to submit new documents, although the Panel may request additional documents to clarify aspects of the dispute if it considers this necessary or useful for its decision. Any such request is transmitted, again via the Portal, by the Technical Secretariat, which will indicate which documents are required and the deadline for submission.

The decision is issued by the Panel, composed as described in FAQ 1.2.

The Panel examines the file and decides by majority, based on the documents submitted by the parties. It cannot, of its own motion, order expert reports nor take witness evidence but, as stated above, it may request further documents if it considers this appropriate.

The decision is issued by way of a reasoned order, meaning an order that explains the grounds for the ruling and cites the applicable legal provisions. The order may contain specific instructions and/or orders for the payment of sums of money by the recipients of the complaint in favour of the complainant.

The Panel decides within a period of 90 days from the completion of the cross-examination. If the dispute is particularly complex, the term may be extended only once for a further period of 90 days.

A decision based on equity is one taken with more flexibility than a decision based on law: it is tailored to the specific circumstances of the case and is adopted without rigidly applying legal rules alone.

The AAS decides according to equity in two specific situations.

The first concerns complaints lodged by injured parties who hold a direct right of action against the insurance undertaking. This occurs, for example, in cases of motor third-party liability.

The second situation arises at the joint request of the parties when the complaint concerns the settlement of damages or the determination of the benefit due.

If the AAS finds the complainant’s requests to be well-founded, it upholds the complaint. The decision may regard the existence of a right, the payment of a sum of money or the provision of a benefit.

The decision is reasoned and communicated to the parties (to the complainant via the AAS Portal). The company and/or the intermediary must comply within 30 days of the notification of the decision.

If the complainant is upheld, the undertaking and/or intermediary must also reimburse the complainant for the €20 fee initially paid to commence the proceedings before the Ombudsman.

If the AAS dismisses the complaint and the complainant is dissatisfied, they may bring the matter before the Judicial Authority.

In this case, the €20 fee is not refunded.

Unlike decisions issued by the Judicial Authority, AAS decisions are not binding.

However, if the company or the intermediary does not comply with the decision of the Ombudsman, its non-compliance is made public in a dedicated section on the AAS’s website for five years. Moreover, the undertaking or intermediary is required to publish the same information on its website, or, if it does not have one, to post it on its premises for a period of six months, and must notify the Technical Secretariat within thirty days. In the event of failure to provide such notification, this fact is recorded on the AAS website.

In case of non-compliance, the complainant may enforce their rights by applying to the Judicial Authority.

The judge is not bound by the decision of the AAS and may rule differently.

The AAS decision cannot be modified. The proceedings conclude with the ruling of the Panel, and no review or reconsideration of the merits of the case may be requested.

It is however possible to ask for the correction of material errors such as a calculation error, typo or formal inaccuracy. The request for a correction must be filed within 30 days of the communication of the decision, including the reasoning.

If the parties reach a settlement before the Panel issues its decision, they must promptly notify the AAS Technical Secretariat, which will close the proceedings. In such cases, the Panel declares that there is no longer a matter in dispute. Where the AAS does not rule on the merits — i.e. it does not uphold the complaint in whole or in part — the fee is not refunded.

The complainant may withdraw the complaint at any time until the Panel has issued its decision. The withdrawal must be submitted via the AAS Portal. In the event of withdrawal, the €20 fee is not refunded.

If the complaint has been filed by multiple co-complainants, the withdrawal must be accompanied by a statement of agreement to the withdrawal signed by all co-complainants. If the complaint was lodged through a professional, a legal representative, or a trade association under a power of attorney, it must be verified that the original power of attorney expressly authorises withdrawal; otherwise, a new power of attorney will need to be attached.

The AAS may declare the complaint inadmissible where a necessary prerequisite for proceeding is lacking. For example, this may occur when the complainant is not one of the parties entitled to complain (the policyholder, insured, beneficiary, or injured party), if the dispute does not concern an insurance contract that has been concluded, if no preliminary claim has been filed with the undertaking and/or intermediary, or if the dispute concerns claims managed by specific guarantee funds or “large risks” insurance.

If the AAS declares the complaint inadmissible, the complainant may file a new complaint on the same matter only if the reason for inadmissibility can be remedied. For instance, if the complaint was declared inadmissible because no prior claim was submitted to the undertaking and/or intermediary, the defect can be cured by submitting the claim and, in the event of no response within 45 days or of an unsatisfactory response, lodging a new complaint.

If inadmissibility is due to reasons that cannot be remedied (e.g. if the dispute falls outside the AAS’s competence), it will not be possible to file a new complaint on the same issue.

In the case of inadmissibility, the €20 fee is not refunded.

The conciliation proposal issued by the Panel is a proposed solution to the dispute aimed at achieving an agreement between the parties. The proposal is sent by the Technical Secretariat to the parties (to the complainant via the AAS Portal), who have 10 days to decide whether or not to accept it.

If both parties accept, the complaint concludes with an agreement between the parties. Otherwise, the complaint proceeds as normal, and the Panel examines the merits of the dispute.

In cases where the complaint concludes without a decision on the merits, the €20 fee paid by the complainant to initiate the proceedings before the AAS is not refunded.