Insurance: Financial Services Complaints Tribunal Report Form (Form TM2)

Summary

This is Form TM2, the standard report and complaint form used to bring an insurance-related dispute before the Financial Services Complaints Tribunal in the British Virgin Islands. It is completed by a policyholder or claimant (or their representative) who has an unresolved complaint against an insurer, and is submitted under Rules 15(2) governing the Tribunal.

• Parties and representation: Requires details of the Applicant/Complainant, the Insurer, and any representative acting on the complainant's behalf, including contact information.
• Claim history: Asks for the start date of the insurance relationship, type of insurance involved, premium payment status, any payment plan or part-payment arrangement, and details of any loss adjuster visit, assessment or medical report.
• Financial details: Requires the date the Proof of Loss or claim was submitted, the amount claimed, whether any payment offer or actual payment was received, and whether negotiations with the insurer are ongoing.
• Narrative and evidence: Requires a written narrative of the complaint and confirmation of whether supporting documents (policy copy, signed proposal/application, and other evidence) are attached, using an accompanying complaints checklist.
• Witnesses: Allows the complainant to request witnesses be called before the Tribunal, with their names and contact details.
• Declaration: Requires the complainant or representative to sign a declaration authorising the Tribunal to obtain information from the insurer and confirming the information provided is true and complete.

The completed form and supporting documents must be returned to the Secretary of the Financial Services Complaints Tribunal at the address, email or phone number listed on the form. This is a procedural/administrative form rather than a rule imposing ongoing compliance obligations on regulated entities.

Key obligations

• A complainant submitting Form TM2 must declare that the information provided is true and complete and authorise the Tribunal to obtain information from the insurer.
• The completed form and any supporting documents (policy copy, signed proposal, medical reports, etc.) must be returned to the Secretary of the Financial Services Complaints Tribunal at the specified address, email or phone number.

Applies to

insurers, insurance policyholders/claimants, Financial Services Complaints Tribunal