Question & AnswerQ&A (IC CIRCULAR LETTER NO. 17-2013)
The ADReM process applies only to disputes arising from denied microinsurance claims or those not fully paid within 10 working days from receipt of complete documents. It does not preclude parties from seeking other modes of settlement.
Mediation is a process where the mediator facilitates negotiation between disputing parties to reach a voluntary, mutually satisfactory outcome. Conciliation is a process where the conciliator actively assists the disputants in formulating solutions to reach an amicable settlement.
Mediation is a structured process with a neutral facilitator who does not provide opinions or judgments, focusing on needs and interests. Conciliation is less structured, with the conciliator often acting as an authority figure giving opinions and advice to find the most favorable reconciliation of positions.
Qualified individuals listed on the official roster or list posted and regularly updated on the Insurance Commission's website serve as mediators or conciliators.
1) File the complaint with the mediation-conciliation committee of their primary cooperative, including necessary details. 2) The complaint recipient notifies the insurance provider within 24 hours. 3) A preliminary conference is held within 3 working days to agree on a mediator, venue, and schedule. 4) If unresolved, the case may elevate to Cooperative Insurance Society or Insurance Commission levels.
For individual cooperative members, the first level process should be completed within 15 working days, and the entire mediation-conciliation proceedings within 30 working days from filing. For primary cooperatives, mediation-conciliation must be completed within 30 working days.
No, legal counsels are not allowed during mediation-conciliation proceedings; only complainants and authorized representatives of insurance providers may be present.
If parties fail to agree, the complainant may elevate the case to the second level mediation-conciliation process with the Cooperative Insurance Society or directly to the Insurance Commission, upon presentation of a letter from the recipient indicating such failure.
Mediators-conciliators may charge fees not exceeding five hundred pesos (Php500.00), or an amount determined by the Insurance Commission, subject to possible cost-sharing arrangements between parties.
ADReM processes must comply with the rules on confidentiality, competence, impartiality, consent and self-determination, and enforcement of settlement agreements as provided under Republic Act No. 9285 (ADR Act of 2004) and its implementing rules and regulations.
CIS mediates and conciliates disputes elevated from primary cooperatives or individual members when the first level process fails, provides information on outcomes in annual statements, and promotes mediation and conciliation among stakeholders.
ADReM is characterized by being least cost (affordable), accessible (convenient and easily understood), practical (feasible and appropriate for microinsurance sector), effective (resulting in mutually acceptable and doable agreements), and timely (resolved within prescribed timeframes).
The complaint must include the name of the insured, policy number, name of insurance company, nature of claim, and amount of insurance.
Cooperative Insurance Societies shall provide information on the outcome of cases referred to ADReM processes in their Annual Statements.
Yes, if no settlement is reached at any level within the prescribed timeframe or parties fail to appear for two consecutive sessions, the case may be elevated to the next level: from primary cooperative to CIS, then to the Insurance Commission.