Transcript Diapositive 1

III AIDA EUROPE CONFERENCE
AMSTERDAM,
26/27 MAY 2011
The Mediator
OF THE FRENCH FEDERATION OF INSURANCE COMPANIES
The French Insurance Mediation
Scheme
Francis Frizon
Insurance Mediation in France:
How does it work ?
1993 : The French Insurance Association Mediation
Charter
- The Mediator
- The Role
The scheme complied with the1998, 2001Recommendations
and 2008 Directive of the EU, even before their publication
Main characteristics
INDEPENDANCE
TRANSPARENCY
Information on the procedure
Information on the activity : annual report publication
on internet (www.ffsa.fr and www.conso.net )
Main characteristics
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
The advocated solutions
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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
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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
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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
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98% of the Advices though not binding are accepted and
followed by the parties
The new tendancy
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More demands : 500 in 1993 – 5000 today
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Less Formal Advices : less than 10% of the demands
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More cases solved within the companies
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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 crossborder 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
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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
Thank you for your kind attention
Francis FRIZON
French Insurance Mediator
[email protected]
Travel insurance
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.
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.
Definition of an accident
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
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