The Insurance and Pension Funds Supervisory Authority (ASF) published the first Market Conduct Regulation and Supervision Report (RRSCM) for 2019. Analyzing the conduct of the insurance market, the report identifies the companies with the highest number of complaints in the most representative insurance lines in the market. The analysis is based on a ratio of the number of complaints completed to the volume of premiums.
In complaints related to the automobile industry, the leader is Popular Seguros (Santander); followed by Generali and Ageas Seguros and Ociedental. One of the leading companies has a low number of complaints - Fidelidade, being among the three with the best ratio. Only surpassed by CA Seguros and AIG Europe.
With regard to occupational accident insurance, the weighted average number of claims to Seguradoras Unidas, Ocidental, Generali and Lusitânia Seguros are at the top of the table. While the companies with the lowest claims ratios on premium volume (always considering completed cases) are Liberty Seguros here; Caravela and Zurich PLC.
Number of complaints rises in 2019
As for the number of complaints, 2019 cases were initiated in 9.989, representing about 10% more than the amount recorded in the previous year. Of this number of complaints received, 9.415 were analyzed in 2019. This compares with 9.061 received and 8.356 analyzed in 2018.
The increase observed was accompanied by an increase in response capacity, also increasing the number of complaints processes analyzed, about 13% more than in 2018.
The submission of the complaint directly to the ASF remains the main route chosen, as in previous years. However, it should be noted that, in 2019, there was a significant increase in the number of complaints submitted via the Complaints Book, approximately 48% more than in the previous year, due to the implementation of the electronic format of the Complaints Book, made available to companies. financial sector entities as of the second half of 2019.
Until the end of 2019, 1.246 complaints were submitted through this new format. In comparative terms with the year 2018, the predominant medium used for the submission of complaints continued to be electronic mail, assuming a slight increase in 2019 (about 6%).
Non-life branch leads complaints
Following the trend of previous years, it appears that, in 2019, the highest percentage of closed complaints refers to the Non-Life branches, with an increase of approximately 14% compared to 2018, as revealed by the ASF data , a fact that accompanies the evolution presented in the set of complaints analyzed. In 2019, 8.352 cases related to non-life insurance claims were concluded (88,71% of the total).
Within the scope of the Non-Life branches, the “Auto insurance” typology stands out with almost half of the cases closed.
Motor insurance was the one that registered the highest number of claims submitted, followed by accident and sickness insurance. The total of these insurances represents 62,7% of the total claims, with 37,2% of these claims resulting in favorable responses to the claimants.
Also noteworthy is the proportion of favorable responses to claimants in accident and illness insurance (44%). By comparison with the figure recorded globally (about 34%).
“In turn, with respect to the matters that are the subject of a complaint, the topic of Claims continues to be predominant (about 61%), which includes matters relating to the definition of liability for the claim, due compensation and the procedures and conduct of operators in settling the claim ”, adds ASF.
In motor insurance, the weighted average corresponds to 2,4 claims per million euros of premiums, with the indicator varying between 6,3 and 0,7 claims / million for the various operators considered (considering the completed cases). The insurers considered in this analysis were: Popular; Generali; Insurance Ageas; Western; United Insurance Companies; Via Directa; GNB Seguros; Victoria; Una Seguros; Mapfre Seguros Gerais; Allianz; Liberty Seguros; Lusitania Seguros; Caravel; Zurich PLC; Loyalty; CA Seguros and AIG Europe.
In turn, in terms of occupational accident insurance, there was a weighted average of 0,8 claims / million euros in premiums, and the values observed for each insurance company varied between 1,3 and 0,2 claims / million.
ASF safeguards that “it cannot be removed from here, following a simplistic reading, that the degree of litigation in motor insurance is higher than insurance for accidents at work, given the differences in business logic, in the surrounding environment and even in the level of average premium associated with each type of contract ”.
Proceedings concluded in 2019 in all insurance lines rose 12,67% compared to 2018.
With regard to the Life branch (2019 cases were completed in 1.012) and pension funds, the majority of complaints, about 72,5%, continue to concern life insurance. In 2019, there was a significant increase in the scope of complaints related to pension funds (62,8%), “a reality that fits the alteration that occurred as of August 2018, with the reversal of the supervisory powers of the CMVM for ASF, in relation to individual adhesions to open pension funds, as a result of the application of Law No. 32/2018, of July 20, ”says the insurance regulatory authority.
Outcome of complaint processes
With regard to the outcome of the complaint processes, the ASF reports that, “with regard to the outcome and direction of the completion of the complaint processes, it is important to note that a considerable percentage of complaints (about 61%) had not been previously assessed by the claimed entity ”.
With regard to the outcome of the cases, the trend of previous years remains, with around 42% of complaints concluded with a favorable outcome compared to 58% with unfavorable outcome. However, it should be noted that in about 92% of complaints where the outcome was unfavorable to the claimant, the position taken by the operator was legally or contractually justified.
“It is expected that of the processes opened in 2019 only 4,9% correspond to situations that cannot be overcome in the scope of complaints management, and which may involve the intervention of the ASF core area of behavioral supervision or the recourse of consumers alternative dispute resolution mechanisms or, ultimately, the Courts ”, advances the ASF.
With regard to the information reported on the complaints assessed by insurance companies, the report states that consumers submitted to insurance companies, during 2019, a total of 29.271 complaints, of which the assessment was favorable to the claimants in 9.830 representing an increase of 2,1% over the previous year. In turn, compared to the previous period, it was found that the number of complaints assessed with a favorable result to the claimant increased by 9,3%, which led to a level of favorable responses higher than that observed in 2018 (2,2 pp ).