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a. Right to fair and equitable treatment;

b. Right to disclosure and transparency of financial products and services;

c. Right to protection of consumer assets against fraud and misuse;

d. Right to data privacy and protection; and

e. Right to timely handling and redress of complaints.

a. Ensure adequate consumer protection against unfair business practices;

b. Achieve fair and beneficial consumer outcomes;

c. Empower consumers; and

d. Manage consumer risks and potential harms to financial consumers.

a. Cooling off or free-look period refers to the number of days provided in the financial product or service contract, commencing from the time of receipt of the contract by the financial consumer until the last day of the period provided in Rule II.B, Section 6, that the financial consumer may return or cancel the contract, and if ever payment was made, the amount paid shall returned in full to the consumer provided that no claim has been made. For Variable Unit-Linked (UVL) insurance products, the amount returned to the consumer shall be the sum of all charges and the market value of the units at the date of the cancellation of the policy.

b. Financial consumer or client refers to a person or entity, or their duly appointed representative, who is a purchases, recipient, or prospective purchaser or recipient of financial products or services regulated by Commission. It shall also refer to any person, natural or juridical, who had or has a current or prospective financial transaction pertaining to financial products or services regulated by the Commission.

c. Financial consumer complaint refers to an expression of dissatisfaction submitted by a financial consumer relative to a financial product or service regulated by the Commission in which a response and/or resolution is expected.

d. Financial product or service refers to financial products or services regulated by the Commission, including but not limited to insurance, pre-need, and HMO products and services. This also includes digital financial products or services which pertain to the broad range of financial services accessed and delivered through digital channels.

e. Financial service provider refers to a person, natural or juridical, which provides financial products or services regulated by the Commission.

f. Informal complaint refers to a complaint filed before the Public Assistance and Mediation Division of the Commission in relation to financial products or services defined in paragraph (d), subject to the procedures set forth in Rule VIII. This shall exclude actions filed before the Commission pursuant to the Commission's adjudicatory and administrative powers.

g. Insurance Commission-Regulated Entity (ICRE) refers to a person, natural or juridical, that is licensed, registered, regulated, and/or supervised by the Commission, as provided under existing laws, rules and regulations.

h. Market conduct refers to the manner by which a financial service provider designs and delivers its financial products or services and manages its relationships with its clients and the public.

i. Marketing refers to the act of communicating, offering, promoting, advertising, or delivering of financial products or services by financial service providers.

j. Responsible pricing refers to the pricing, terms, and conditions of financial products and/or services that are set in a way that is transparent, affordable to clients, and sustainable for financial service providers.

a. Conduct suitability and affordability assessments;

b. Ensure fairness of terms and conditions; and

c. Evaluate financial products and services.

a. Organizational values and standards of professional conduct that uphold consumer protection; and

b. Procedures to detect violations of consumer protection standards, as well as respond to and enforce sanctions relative to such violations.

a. Information on risks, return, possible warnings;

b. Any waiver of rights and limitations of liabilities;

c. Consumer's rights and responsibilities of ICREs;

d. Consequences of failure to meet obligations;

e. Rights and responsibilities of ICREs;

f. Involvement of authorized agents;

g. Cancellation of financial product or service; and

h. Full price or cost of the financial product or service including all interest, fees, charges, and penalties, and whether they can change over time.

a. Address and contact details of the ICRE's head office and branches. The name and contact details of the intermediary shall form part of the insurance contract;

b. Contact details and information of the ICRE's consumer assistance team, as well as information on its Consumer Assistance Management System (CAMS) as provided in Rule IV;

c. Statement that the ICRE is regulated by the Commission, as well as the address and contact details of the Commission's Head Office and its district offices; and

d. The jurisdiction in which the ICRE or intermediary is legally permitted to provide financial products or services.

a. Establish an effective CAMS as provided in Rule IV;

b. Develop internal policies and practices on consumer redress, including time for processing, complaint response, and customer access;

c. Maintain an up-to-date log and records of all complaints from consumers subject to the ICREs' complaints handling procedure. The following information shall be recorded by ICREs:

(i) Date the complaint was received;

(ii) Details of the complaint;

(iii) Summary of the ICREs' response;

(iv) Action taken to resolve the complaint;

(v) Details of any other relevant correspondences or records; and

(vi) Date of complaint was resolved.

d. Ensure that information on how to file a complaint is clearly visible in the ICREs' premises and websites;

e. Undertake an analysis of the patterns of complaints from consumers on a regular basis including investigating whether complaint indicate an isolated issue or more widespread issue for consumers. This analysis of consumer complaints must be escalated to the ICREs' compliance / risk management division unit, as well as to senior management; and

f. Provide for adequate resources to handle financial consumer complaints efficiently and effectively.

a. Governance structure;

b. Policies;

c. Processes;

d. Measurements; and

e. Control procedures.

a. Approving the CPRMS and CAMS, taking into considerations the ICREs business model, market, product lines, and relationships with third parties that may give rise to consumer protection risks;

b. Reviewing and approving the ICREs' Code of Conduct;

c. Ensuring that relevant information pertaining to the CAMS and ICREs' compliance with the FCPA, other consumer protection laws, rules and regulations, and market conduct guidelines promulgated by the Commission, as well as actions taken relative thereto, are reported to the Board on a regular basis;

d. Ensuring adequate provision of resources and effective implementation of training and competency requirements for officers and personnel;

e. Approving competitive remuneration and compensation packages structured to encourage responsible business conduct and fair treatment, and mitigate conflicts of interest; and

f. Periodically reviewing the implementation of the CPRMS and CAMS, including how findings are reported and whether the audit mechanisms in place provide adequate oversight in relation to the ICREs' business model and/or operating environment.

a. Ensure that the approved CPRMS and CAMS policies and procedures are clearly documented, properly understood, and appropriately implemented across all levels and business units;

b. Ensure that adequate systems and controls are in place to promptly identify issues that affect the consumer across all phases of the relationship with the consumer;

c. Ascertain that weaknesses in the consumer protection practices or consumer protection emerging risks are addressed and/or corrective actions are taken in a timely manner;

d. Establish an effective monitoring and management information system to regularly measure, aggregate, and analyze consumer-related issues to determine the level of consumer protection risk. The management information system should be able to:

(i) Provide adequate information on the performance and quality of the ICRE's CAMS that allows for identification of emerging consumer issues and root cause analysis;

(ii) Determine the level of consumer protection risk exposure;

(iii) Identify and monitor, in a timely manner, consumer protection risks that may result in financial loss to consumers, legal and reputational risks, and other related risks; and

(iv) Identify and assess emerging or increasing consumer risks that affect the ICRE's consumers through social media monitoring, market monitoring, and other relevant means.

a. Receiving;

b. Recording;

c. Evaluating;

d. Resolving; and

e. Monitoring and reporting.

a. Corporate structure of the unit, group, or department implementing the CAMS ("the Consumer Assistance Team"), with an enumeration of the roles and responsibilities of all persons involved in CAMS implementation. The Consumer Assistance Team shall be separate and independent from the ICREs' claims handling units. Any complaint or disagreement relative to claims handling may be referred to the Consumer Assistance Team;

b. Capacity building for their respective Consumer Assistance Teams, which includes the conduct of regular trainings on the following, among others:

(i) ICRE's corporate structure, and financial products and services;

(ii) Interpersonal skills / counter service;

(iii) Basic and advanced listening skills;

(iv) Written and verbal communication skills;

(v) Handling financial consumer feedback;

(vi) Dealing with difficult people; and

(vii) Problem-solving and conflict resolution.

c. Consumer assistance process and timeline. ICREs may provide for their own periods for addressing consumer complaints, requests, and inquiries which shall not, in any case, exceed the following periods:
 

CONCERN	TIMELINE
For complaints or requests
Acknowledgment	Simple	Within two (2) working days from receipt of complaint / request
	Complex	Within two (2) working days from receipt of complaint / request
Processing and resolution (assessment, investigation, and resolution)	Simple	Within seven (70) workings days from receipt of complaint / request
	Complex	Within forty-five (45) days from receipt of complaint / request
Communication of resolution to requesting consumer	Simple	Within nine (9) days from receipt of complaint / request
	Complex	Within forty-seven (47) days from receipt of complaint / request
For inquiries	By next business day

d. Complaints recording / data management system;

e. Risk assessment strategies;

f. Reporting of complaints statistics to the ICRE's board of directors and the Commission;

g. System for evaluating effectiveness of the CAMS; and

h. Glossary.

a. Conspicuous places within the premises of ICREs;

b. Terms and conditions of the ICREs' products and services;

d. Marketing materials.

a. Full name and contact details including email address, if available;

b. Nature of complaint / request and relevant details;

c. Resolution or action requested; and

d. Name of ICRE's claims handling personnel that originally handled the subject concern, if applicable.

a. Overall consumer satisfaction;

b. Processes needing improvement;

c. Personnel needing improvement; and

d. Any suggestions for improvement.

a. Name of the complainant;

b. Date of receipt of the complaint;

c. Subject or nature of the complaint;

d. Name of the personnel directly handling or in charge of the complaint and the officer supervising its resolution;

e. Actions taken on the complaint;

f. Resolution of the complaint;

g. Date of resolution; and

h. Other relevant information.

a. General category of complaints received;

b. Number of complaints received per category;

c. Number of complaints resolved;

d. Aging of complaints;

e. Explanations for deviations, if any, from the required resolution period;

f. General description of resolutions and actions taken relative to complaints received; and

g. Recommendations on how to avoid recurring complaints and suggestions for process and personnel competency improvement.

a. Misselling;

b. Claims practice, including instances of underpayment, late payment, and non-payment;

c. Engaging in business as regulated by the Commission without a license;

d. Selling regulated products without prior approval from the Commission;

e. Deviations from approved products;

f. Customer satisfaction / feedback;

g. Improper complaints handling;

h. Establishment of branches without prior approval from the Commission; and

i. Activities of licensed and unlicensed agents and intermediaries, including instances of underpricing, overpricing and misrepresentation.

a. Obtaining information about the ICREs' policies, activities, and compliance program to assess the effectiveness of the ICREs' CPRMS

b. Assessment of the ICREs' overall compliance with the FCPA and these Rules, other laws and regulations on market conduct and consumer protection, and such other rules and regulations issued by the Commission; and

c. Assessment of the risks to consumers and markets of financial products and services.

a. Visits to the head office and/or branches;

b. Interview of any of the directors, trustees, officers and personnel;

c. Walkthrough of relevant areas of operations;

d. Validation of results of surveillance activities; and

e. Verification, review, and evaluation of documents and records, including policy and ICRE's claims database.

a. For complaints against Non-Life Insurance Companies:

1. Copy of the policy;

2. Copy of the denial letter, if any; and

3. Copy of supporting documents, if any.

b. For complaints against Life Insurance Companies:

1. Copy of the policy;

2. Copy of the denial letter, if any; and

3. Copy of supporting documents, if any.

c. For complaints against Pre-Need Companies;

1. Copy of the contract; and

2. Copy of the Certificate of Full Payment.

d. For complaints against HMO Companies:

1. Copy of the contract. Provided, That if the financial consumer is an individual planholder, they may submit the CAR Form directly to the Commission along with the prescribed document. However, if the financial consumer is part of a corporate account and has not been furnished a copy of the Service Agreement between their employer and the HMO, the financial consumer should coordinate with their employer which shall, in turn, accomplish the CAR and submit the same to the Commission.

a. Termination of the complaint if the Commission finds that there is no basis for the filing of the complaint;

b. Conduct of Medication/Conciliation Conference if the Commission finds that the complaint involves complex issues; or

c. Referral to the concerned ICRE if the Commission finds that the concerned ICRE has not yet acted on the claim with finality.

a. The entire Mediation/Conciliation Proceedings shall be conducted for a period not exceeding thirty (30) days;

b. There shall be a maximum of three (3) Mediation/Conciliation Conferences for each specific complaint;

c. For cases involving simple issues or in instances where the financial service provider has previously denied the claim of a financial consumer, there shall be a maximum of two (2) Mediation/Conciliation Conferences;

d. If at any point during the Mediation/Conciliation Proceedings, the financial consumer and financial service provider agrees to enter into a compromise settlement, the complaint and the proceedings shall be terminated; and

e. If after the conduct of the maximum number of Mediation/Conciliation Conferences or after the lapse of thirty (30) days as provided in this provision, whichever comes first, the financial consumer and financial service provider fail to come to an agreement or enter into a compromise settlement, the Mediation/Conciliation Proceedings shall be deemed terminated. Upon termination, the financial consumer may opt to file a formal claim under Rule IX and/or an administrative case under Rule X.

a. Claims and complaints where the amount of actual damages, excluding interest, costs, and attorney's fees being claimed or sued upon any kind of insurance, bond, reinsurance contract, or membership certificate does not exceed in any single claim Five Million Pesos (PHP5,000,000.00);

b. Claims and complaints pertaining to membership issues or benefits and services with an HMO under an HMO agreement, including actual damages, attorney's fees, and costs;

c. Claims and complaints involving pre-need plans;

d. Claims involving Compulsory Motor Vehicle Liability Insurance (CMVLI);

e. Claims where the amount being claimed or sued does not exceed in any single claim One Million Pesos (PHP1,000,000.00), exclusive of interest, costs, and attorney's fees (hereinafter referred to as "Small Claims Cases").

a. Names and addresses of the parties;

b. Details of the complaint/claim (if related to a policy);

i. Date when the loss occurred;

ii. Amount of loss/claim;

iii. Grounds for complaint/claim;

iv. Action by the insurer;

c. nature of the complaint (if not related to a policy):

i. Brief description;

ii. Supporting documents;

d. Relief sought.

a. When the Commission has no jurisdiction over the subject matter;

b. When there is another action pending between the same parties for the same cause; or

c. When the action is barred by the statute of limitations.

a. Restriction on the ability of ICREs to continue to collect excessive or unreasonable interests, fees, or charges;

b. Disqualification and/or suspension of directors, trustees, officers, or employees of ICREs responsible for the violations of the provisions of the FCPA, these Rules, and/or such other relevant guidelines, issuances, or orders of the Commission;

c. Imposition of fines, suspension, or penalties for any non-compliance with or breach of the FCPA, these Rules, and/or other guidelines, issuances, or orders of the Commission on consumer protection and market conduct;

d. Issuance of a Cease-and-Desist (CDO) to the financial service provider without the necessity of a prior hearing if in the Commission's judgment, the act or practice, unless restrained, amounts to fraud or a violation of the provisions of the FCPA and these Rules, or may unjustly cause grace or irreparable injury or prejudice to financial consumers. The financial serfice provider shall be afforded an opportunity to defend its act or practice in a summary hearing before the Commission, upon request made by the ICRE within five (5) days from receipt of the order. If no such hearing is requested within the said period, the order shall be final. If a hearing is requested within the said period, the order shall be final. If a hearing is requested by the ICRE, the proceedings shall be conducted summarily without adhering to the technical rules of evidence, and all issues shall be determined primarily on the basis of records, after which the Commission may either reconsider, modify or affirm its order.

It is understood that the foregoing shall be without prejudice to the application of the rules of procedure as may be promulgated by the Commission;

e. Suspension of operation, after proper notice and hearing, of any ICRE in relation to a particular financial product or service when in the Commission's judgment and based on its findings, the ICRE is operating in violation of the provisions of the FCPA and these Rules; and

f. In any proceeding in which the Commission may impose a penalty for non-compliance with or breach of the FCPA, these Rules, and other existing laws and regulations, the Commission, in addition to the imposed fine, may issue an order requiring account and disgorgement of profits obtained, or losses avoided, as a result of a violation of the FCPA, these Rules, and other pertinent laws and regulations, including reasonable interest. The Commission is authorized to adopt rules, regulations, and orders concerning the creation and operation of a disgorgement fund, payments to financial consumers, rate of interest, period of accrual, and such other matters as deemed appropriate to implement this provision.

The enforcement actions enumerated above shall be at the discretion of the Commission, without necessity of providing that the violative acts committed are performed with such frequency as to indicate a general business practice.

a. Conduct a gap analysis of their current consumer protection practices vis-a-vis the provisions of these Rules; and

b. Create an Action Plan duly approved by the ICREs' Board of Directors to achieve full compliance within a reasonable period of time but in no case longer than one (1) year and six (6) months from the effectivity of these Rules.