iii aida europe conference amsterdam, 26/27 may 2011
TRANSCRIPT
III AIDA EUROPE CONFERENCE
AMSTERDAM,
26/27 MAY 2011
The French Insurance Mediation Scheme
Francis Frizon
The MediatorOF THE FRENCH FEDERATION OF INSURANCE COMPANIES
1993 : The French Insurance Association Mediation Charter
- The Mediator- The Role
Insurance Mediation in France: How does it work ?
The scheme complied with the1998, 2001Recommendations and 2008 Directive of the EU, even before their publication
Main characteristics
INDEPENDANCE
TRANSPARENCY Information on the procedureInformation on the activity : annual report
publication on internet (www.ffsa.fr and www.conso.net )
ADVERSARIAL PRINCIPLE The parties present their viewpoint, arguments and documents LEGALITY - written motivated Advice is communicated to both parties - complies with the law- preserves right to go to Court- forclosure prespcription rule is suspended ( Civil Code)
Main characteristics
EFFECTIVENESS - Easily accessible (no legal representative) - Free of charge for the plaintiff - Short procedure
LIBERTY
IMPARTIALITY - no conflict of interest with either party
Main characteristics
The advocated solutions
A formal written Advice is issued by the Mediator within 3 months after submission of the case with all necessary documentation
The Advice is delivered according to the law, but also in equity
Both parties are free to follow or not the Advice. They are free to refer the matter to the Court
Procedure
Mediation : last chance before lawsuit All means of internal agreement or
conciliation must have occured without success
Possibility to seize directly the Mediator Written procedure No Court action on the case must have
been proceed by the parties.
Results
4746 demands of mediation 2670 recommendations 342 formal Advices 59% unfavourable Advices to the claimant
25% Advices favourable
16% partially favourable
These statistics are reversal since 1993
98% of the Advices though not binding are accepted and followed by the parties
The new tendancy
More demands : 500 in 1993 – 5000 today
Less Formal Advices : less than 10% of the demands
More cases solved within the companies
Majority of Advices in favour of the insurer
Mediation: A driving force
The annual report gives an opportunity to suggest improvement on specific matters.
For example, this year proposals have been made in the field of :• life insurance• unemployment insurance • attempts at fraud
Last years, proposals have been made in the field of : Medical secrecy,Funeral insurance, Health questionnaire, legal protection ….
Two new laws have followed the reports : clear information in life insurance and legal protection .
Mediation at international level
The international activity is growing further.
-The Fin Net Network :created in 2001 to deal with cross-border claims between consumers and financial service providers. (46 members in 21 different Member States)http://ec.europa.eu/internal_market/fin-net/- The INFO Network: develops skills and expertise ot its members through the exchange of informations and experiences . (37 members from 25 countries )www.networkfso.org
• Jean Etienne PORTALIS : “ When there is no relevant law or when it is obscure it is necessary to consult equity. Equity constitutes a return to natural laws ”
• ARISTOTE : “ Equity makes it possible to hope for true justice, as this is a justice tempered by love adding a human dimension to the inflexible coldness of the rule of law ”
Conclusion
Things are improving
A better balance
A progress for the insured AND for the insurer
More and more insurance companies seeking for Mediation
An insurance company refused to reimburse a family who cancelled a trip after their six years old boy broke his arm, because they considered that just a broken arm still permit to walk around.
Question : Can one consider that a six years old boy seriously injured can stay alone at home during his parents trip ?
The Mediator invited the insurance company to reimburse the trip.
Travel insurance
The use of counterfeit keys
In a case of theft or robbery, some insurance companies forced their clients to prove the use of counterfeit keys to grant the guaranty.
Today thieves are clever enough to steel cars or open doors without any traces .
The Mediator had to explain that this proof is almost impossible to obtain and therefore the situation is unfair and in opposition with the spirit of an assurance contract based on good faith.
The insured of a personal insurance contract has been murdered by her husband.
The insurance company refused to make the payment to her son beneficiary of the contract explaining that the murder of the insured was not in accordance with the definition of an accident which is a « sudden, involuntary and unforeseen event ».
The Mediator had to explain that a murder is aleatory, unsure and unpredictable for the victim, so it must be interpreted as an accident.
Definition of an accident
Definition of an accident
In the same way, an insurance company refused to consider that a fall from a stepladder was not an accident because the origin of the injury was the rough contact of the body with the ground.
The Mediator refused this theory and argued that the origin of the injury is the fall and the contact with the ground is only the consequence of.
Health questionnaire
Only the insurance company knows the sort of information wich is needed. Therefore : - the questionnaire must be precise, accurate with no ambiguity - all vague and general questions such as « You declare to be in good health » should be void - the insurer should draw attention on the importance of true and correct disclosures