Rules the SLASPO Ombudsman Follows in Alternative Dispute Resolution

Art. 1

Submission of a proposal for alternative dispute resolution

(1) The Slovak Association of Insurance Companies (hereinafter referred to as "SLASPO") is designated to handle consumer protection matters as outlined in Article I, Section 1, letter f) of its Statutes. SLASPO is responsible for alternative dispute resolution (hereinafter referred to as "ADR") between insurance companies and their clients (consumers) concerning disputes arising from or related to consumer contracts. To facilitate this, SLASPO is establishing a specialized department within the Ombudsman.

(2) A consumer who believes that an insurance company—whether it is a domestic insurance company, a branch of a foreign insurance company, a branch of an insurance company from another Member State, or an insurance company from another Member State operating under the right to provide services freely and also a member of SLASPO (hereinafter referred to as "insurance company")—has harmed their interests in the provision of services and has failed to address the issue as per the consumer's complaint may seek recourse.

(3) A consumer is defined as a natural person who, in relation to a consumer contract or any obligation arising from it, or in business practices, does not act within the scope of their business activity or profession.

(4) Consumer proposals that would impose a disproportionate burden on the Alternative Dispute Resolution (ADR) process, such as those requiring complex evidence, are not subject to ADR under these Rules.

(5) The ADR proceedings commence on the day the complete proposal is received and are provided free of charge.

(6) Proposals may be submitted

in writing,
orally, recorded in the minutes,
by e-mail or
using an electronic proposal form for starting an ADR.

(7) The proposal can be submitted in both Slovak and English, and the ADR can also be conducted in these languages.

(8) The proposal must clearly indicate

The specific matter it concerns,
The insurance company against whose actions the proposal is directed, and
What the consumer is requesting through the proposal

(9) The proposal must include

The insurance company's response to the complaint, or proof that the consumer has contacted the insurance company without receiving a response, specifically that the insurance company did not reply to the consumer’s complaint within 30 days of its submission;
Copies of all relevant documents related to the matter, particularly the insurance contract and all its components and attachments, such as insurance conditions, any other agreements, final liquidation reports, other communications with the insurance company, and photo documentation;.
Consent to process personal data, including a special category of personal data, for the purpose of preparing the proposal for alternative dispute resolution. This includes consent for SLASPO to obtain and process additional personal data regarding the client’s health from the insurance company, as needed for resolving the dispute;
Client's consent allowing the insurance company, as the other party to the dispute, to provide SLASPO with information and documents relevant to the client, which are confidential under Section 72 of Act No. 39/2015 Coll. on the Insurance Industry, to the extent necessary for managing the alternative dispute resolution;
Agreement with the ADR procedural rules;
A statement confirming that the same proposal has not been submitted to another ADR entity, that the court or arbitration tribunal has not ruled on the matter, that no mediation agreement has been concluded, and that the ADR has not been terminated in accordance with Section 20, para. 1, letters (a) to (e) of Act No. 391/2015 Coll. on alternative dispute resolution for consumer disputes, as amended (hereinafter referred to as "ADR Act").

(10) If the proposal does not meet the requirements specified in Article 1, paragraphs 6 and 7, the authorized person shall promptly request that the consumer supplement or clarify the incomplete or unclear proposal within a designated period, which shall not be less than 15 days. If the consumer fails to complete or clarify the proposal within the given timeframe, and this deficiency prevents the continuation of the proposal, the authorized person will reject the proposal. The consumer must be informed of this potential outcome.

(11) A proposal to initiate ADR that does not include the consumer's name, surname, and address is considered anonymous. An authorized person will reject such an anonymous proposal unless otherwise specified by a special law.

(12) Documents may be delivered to the consumer electronically if an electronic address is provided in the ADR proposal and the consumer does not specifically request postal delivery.

(13) For delivery purposes, if the addressee fails to collect an invitation delivered by registered mail from the post office, it is considered delivered three days after the return of the undelivered item, regardless of whether the addressee is aware of the deposit. For electronic mail delivery, the invitation is deemed delivered three days after it is sent, even if the addressee does not become aware of it

Art. 2

Persons acting on behalf of the Ombudsman

(1) The Ombudsman’s Office conducts its activities through authorized persons who are employees of SLASPO.

(2) Each authorized person carries out their duties independently, impartially, consistently, and with appropriate professional care.

(3) The authorized person acts based on the consumer's proposal and is responsible for informing the parties involved about the initiation of the procedure.

(4) The authorized person shall forward the consumer's proposal to initiate ADR, along with the attached documents, to the insurance company, requesting a response to the facts presented in the proposal within a period of no less than 15 days (Section 15, para. 2 of ADR Act).

(5) Proposals are assigned to authorized persons randomly to ensure impartiality. After receiving the proposal, the parties to the dispute may raise concerns about the impartiality of the authorized person. If bias is established, the proposal will be reassigned to a different authorized person.

(6) The authorized person is required to maintain confidentiality regarding personal protection, data protection, and all information acquired during their tenure, even after their role as an authorized person has concluded.

Article 3

Procedure for handling the proposal

(1) The authorized person is required to review the proposal and conclude the proceedings within 90 days from the start of the process. In complex cases, this deadline may be extended by 30 days, with the possibility of further extensions. Any extension must be promptly communicated to the parties involved, along with the reasons for the extension.

(2) The actions of the authorized person are informal but must comply with legal regulations. In examining the proposal, the authorized person may use evidence at their discretion.

(3) If the authorized person determines that the proposal, by its nature, constitutes a remedy under administrative or judicial proceedings, a lawsuit, or an administrative court or constitutional complaint, they must promptly notify the consumer who submitted the proposal.

(4) The authorized person shall reject the proposal if

Incomplete proposal: The consumer did not complete the proposal within the specified period after being requested to do so.
Lack of jurisdiction: The dispute is not within the authorized person's competency to resolve, or it concerns a type of dispute not listed, including those that would impose a disproportionate burden on the ADR entity, such as those requiring complex evidence.
Previous resolution: The matter has already been decided by a court, arbitration tribunal, ADR entity, or an agreement on mediation has been concluded regarding the same issue.
Unfounded proposal: The proposal is deemed unfounded, meaning that after a thorough review of the proposal and attached documents, it is evident that the consumer is not seeking protection of their legally protected rights and interests. This includes cases where the proposal is a repeat of a previously resolved dispute without new facts, or if the consumer has expressed a lack of interest in pursuing alternative dispute resolution before it begins.
Harassing proposal: The proposal is considered harassing, meaning it is a repeated submission that has already been rejected by the ADR entity at least twice in one of the manners described in paragraph 1 or 2, and it does not include any new facts that would warrant a different procedural approach.
Anonymous proposal: The proposal is anonymous, i.e., it lacks the consumer’s name, surname, and address.
Removal from list: SLASPO has requested to be removed from the list maintained by the Ministry of Economy of the Slovak Republic.

(5) The authorized person shall reject the proposal if

Late claim: The claim was submitted more than one year after the date of:

The insurer’s negative response to the consumer’s request for redress, or
The expiration of the 30-day period following the consumer’s request for redress to the insurer, if the insurer did not respond.

Lack of prior attempt: The consumer has not made a demonstrable attempt to resolve the dispute through communication with the insurer before filing the claim.
Insufficient value: The quantifiable value of the dispute is less than EUR 20.
Previous resolution: The matter has previously been addressed by the SLASPO Ombudsman’s office, the consumer has been informed of this resolution, the claim does not present any new facts, and ADR would be clearly inappropriate given the circumstances.
Disproportionate cost or effort: It is evident that pursuing ADR would incur disproportionate costs or require excessive effort given the circumstances.

(6) The authorized person shall postpone the proposal to start the ADR, if

Previous ADR initiation: ADR has already been initiated before another ADR entity, or the matter has been decided by a court or arbitration tribunal, a mediation agreement has been concluded, or ADR has been terminated in accordance with Article 4, letters (a) to (e).
Lack of cooperation: The consumer fails to provide necessary cooperation despite requests from the authorized person.
Withdrawal of participation: The consumer withdraws their participation in ADR.
Lack of consent: The parties to the dispute do not provide written consent for the procedure according to Section 16, para. 5 of ADR Act, and the dispute cannot be referred to another ADR entity.
Insufficient evidence of violation: The established facts do not indicate that the insurance company has violated the consumer’s rights according to consumer protection regulations.
Non-cooperation of the trader: The trader has not provided the necessary cooperation as required by Section 15, and the ADR entity does not consider the facts to be sufficiently established to conclude the ADR under letter (e) or Section 18.
Need for expert opinion: It is determined that continuing ADR requires an expert’s opinion on facts discovered so far, and it would involve disproportionate effort to obtain such an opinion.

(7) The authorized person shall promptly notify the consumer of the refusal or postponement of the proposal, along with the reasons for such actions. This notification requirement does not apply to anonymous proposals.

(8) Upon request from the authorized person, the insurance company is obliged to provide, within a reasonable period specified by the authorized person (not less than 15 days from the date of delivery), the following:

A statement addressing the facts stated in the proposal.
An explanation, statement, or any documents related to the subject of the dispute that are available to the insurance company.

(9) If the insurance company fails to cooperate with the authorized person and the Slovak Trade Inspection Authority imposes a sanction under Section 27, para. 1 of ADR Act, the authorized person is entitled to publish the company’s business name and registered office or place of business on its website for a maximum period of 90 days.

Art. 4

Termination of alternative dispute resolution

(1) ADR ends in the following circumstances

Agreement: The parties reach and conclude an agreement on the resolution of the dispute, as described in paragraph 4.
Reasoned opinion: The issuance of a reasoned opinion, as outlined in paragraph 5.
Postponement: The proposal is postponed according to Article 3, paragraph 6.
Death or legal status change:
Death or declaration of death of a party to the dispute who is a natural person.
Dissolution without a legal successor of a party to the dispute that is a legal entity.
Removal of SLASPO: The deletion of SLASPO as an authorized entity from the list maintained by the Ministry of Economy of the Slovak Republic.
Non-objection: Notification of the resolution of the dispute without an agreement according to Section 17, if the other party did not raise an objection within the period specified by the ADR entity, following the notification described in paragraph 2.

(2) If alternative dispute resolution is terminated pursuant to paragraph 1, letters (d), (e), or (g), the authorized person must promptly notify the other party to the dispute in writing, including the reason for the termination of the ADR process.

(3) If the ADR is terminated pursuant to paragraph 1, letter (f), the authorized person must notify the parties to the dispute in writing before being removed from the list. Additionally, the authorized person must return all documents submitted by the parties. This termination does not affect the consumer's right to appeal the closed dispute to another ADR entity, as specified in paragraph 1, letter (g).

(4) Dispute resolution agreement

4.1) If, after a thorough evaluation of all facts and statements from the parties involved, it is determined that the parties are interested in reaching an amicable settlement, the authorized person will prepare a draft agreement for the resolution of the dispute (hereinafter referred to as the "draft agreement").

4.2) The draft agreement must include, in particular:

The name of the insurance company and the name, surname, academic degree, and signature of the authorized person who prepared the draft agreement.
An exact designation of the parties to the dispute.
A proposal for the adjustment of the rights and obligations of the parties as a result of the alternative dispute resolution.
Information regarding the binding nature of the parties' consent to the draft agreement.
The date on which the agreement was drafted.

4.3) The authorized person shall deliver the draft agreement to the parties to the dispute and simultaneously instruct them on the following:

The opportunity to decide within a specified period whether they agree with the draft agreement.
The fact that by signing the agreement, it becomes binding for the parties to the dispute.
The fact that the acceptance of the draft agreement does not affect the parties' rights to pursue legal action in court.
The fact that the outcome of court proceedings may differ from the result achieved through ADR.

4.4) Upon receipt of the written consent from both parties regarding the draft agreement, an agreement to resolve the dispute will be deemed concluded. The authorized person shall promptly notify both parties that the ADR process has concluded with the agreement as mentioned.

4.5 The agreement resulting from ADR is binding for the parties involved; however, this does not affect their right to pursue the same matter in court.

4.6 The provisions of this article apply accordingly if the agreement is concluded in the physical presence of both parties before the authorized person.

4.7) If the parties to the dispute conclude an agreement before the authorized person after SLASPO has been removed from the list pursuant to Section 7, paragraph 2, letters (a) of ADR Act, either party has the right to withdraw from the agreement within 30 days from the date of SLASPO's removal from the list. If no withdrawal occurs within this period, the effects of the agreement remain in force. This does not affect the consumer's ability to bring the dispute to another ADR entity.

(5) Reasoned opinion

5.1) If the parties to the dispute do not reach an agreement and the authorized person, based on the established facts, determines that the insurance company has infringed upon the consumer's rights according to consumer protection regulations, the ADR shall be terminated by issuing a reasoned opinion. This opinion is non-binding.

5.2) The reasoned opinion must include the following:

Exact identification of the parties to the dispute.
Conclusion with legal basis: A statement indicating which specific provision of the legal regulation the insurance company is believed to have violated, according to the legal opinion of the ADR entity.
Justification:

A detailed description of the factual situation surrounding the dispute.
A summary of the evidence used as the basis for issuing the reasoned opinion.
An explanation of the ADR entity’s procedure in assessing the established facts.

Other important facts: Any additional facts that are crucial to the issuance of the reasoned opinion.
Non-binding nature: Information clearly stating that the reasoned opinion is not legally binding.
Date of issue: The date on which the reasoned opinion was issued.
Details of SLASPO and the authorized person: Information about SLASPO, including the name, surname, academic degree, and signature of the authorized person who prepared the reasoned opinion.

5.3) SLASPO must deliver the reasoned opinion to the parties involved in the dispute without delay.

Article 5

Activity report

(1) The SLASPO Ombudsman Office is required to submit an annual report on its activities to the SLASPO Presidium and Assembly. This report must present the conclusions of its activities in an aggregated form, ensuring that it does not mention the names of any specific insurance companies or consumers.

(2) SLASPO is also obligated to publish this activity report on its website, www.poistovacioombudsman.sk, by March 31 each year.

Article 6

Effectiveness

(1) This regulation was adopted with effect from July 1, 2024.