In his annual report recently published for 2023 the Médiateur de l'Assurance states there were 30,620 referrals in the year, an increase of +42% compared to 2022.

In the 12 months ending August this year there have been 35,000 complaints.

In 53% of the cases in 2023 the investigation found in favour of the claimant, in whole or in part.

Disputes over property insurance (mainly house and vehicles) accounted for 65% of the referrals, and 35% concerned personal insurance (mainly health and credit).

Although based on previous findings the Ombudsman was able to report progress in the simplification of the process for terminating contracts, and on exclusion clauses, there remained other areas of concern.

Experts

The Ombudsman was particularly critical of the lack of transparency in the use of experts.

He considered that policyholders must be reassured about the independence of the experts and that the time limits for the intervention of the experts should be regulated (appointment of the expert within 15 days of the declaration of the claim, and a period of 3 months for the completion of the expert report and the submission of the report, with a possible extension in complex cases). Currently, there is no deadline.

The Ombudsman also considered that the professional and ethical rules surrounding experts must be strengthened: there is currently no requirement for a diploma or experience to proclaim oneself as an "insured's expert".

Duration

There remain concerns about the time it takes to manage a claim, notably in relation to the appointment period for an expert, the decision of the expert and the decision and payment. There was no uniform practice, and most insurers fell short of providing a clear framework.

Exclusion Clauses

The Ombudsman also expressed concern about exclusion clauses, many of which were vague. This is despite the fact the law requires that such clauses be formal, limited and mentioned in clearly visible characters in the contract.

Advice

Finally, the Ombudsman considered that there should be a duty on insurers to alert their clients to the limitations of a contract at the time of subscription, as well as during the life of the contract if either the circumstances of the client or the policy changed.

Complaints Procedure

To refer a matter to the Médiateur, the online referral form is available at Saisine le médiateur.

It is also possible to write to: Médiation de l'Assurance, TSA 50110, 75 441 Paris Cedex 09.

However, before a complaint can be received an insured is required in the first instance to have tried to resolve the dispute using their insurers own the mediation/complaints process. Each year nearly half of all referrals to the Médiateur are inadmissible as the complainant had failed to use the internal complaints procedure of their insurer.