Tue, Jun 11, 2019 - Page 12 News List

Healthcare coverage, false marketing spur 44% surge in insurance disputes

By Kao Shih-ching  /  Staff reporter

Insurance complaints to the Financial Ombudsman Institution (FOI) surged by 44 percent in the first quarter, led by disputes over health insurance coverage and claims of false sales information.

Consumers submitted 1,354 insurance complaints in the first three months of this year, with life insurance disputes making up 72 percent and property insurance disputes 25 percent, an agency report said.

As few new policies were offered in the first quarter, the increase in complaints might be due in part to increased consumer awareness, Peng Jin-lung (彭金隆), chairman of National Chengchi University’s department of risk management and insurance, told the Taipei Times by telephone yesterday.

Consumers are more willing to fight insurance companies and know how to collect evidence when they feel lied to by sales agents, said Peng, who serves on the committee that handles ombudsman cases.

However, given that the number of disputes fluctuates, a longer period of observation is necessary to see if the trend continues, he said.

Most claims-related disputes were related to health insurance policies, with policyholders complaining that insurers refused coverage, denied claims for certain procedures or provided unsatisfactory compensation, the agency report said.

Sales agents giving false information regarding policy coverage, guaranteed interest rates or regulations on premium payments made up the majority of non-claims-related cases, it said.

Disagreements often crop up when consumers and insurance firms have differences of opinion over issues such as criteria of diseases, the need for hospitalization and the definition of a medical disability, Peng said.

A policyholder who could not move his legs after an accident sent in a claim for higher compensation, thinking he was disabled, but the insurer denied the claim for not meeting the definition of a medical disability, Peng said.

Among the 978 complaints about life insurers, Cathay Life Insurance Co (國泰人壽) led the list with 169 complaints, followed by Nan Shan Life Insurance Co (南山人壽) at 136 complaints and Farglory Life Insurance Co (遠雄人壽) at 114, agency data showed.

In terms of the complaint ratio — a more useful gauge that divides the overall policies sold by the number of complaints — BNP Paribas Assurance TCB Life Insurance Co (合作金庫人壽) led the list by 0.34 basis points, followed by AIA International Taiwan (友邦人壽) and Chubb Life Taiwan’s (安達人壽) at 0.19 basis points apiece, the data showed.

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