Insurance ombudsman (France)
A free out-of-court dispute resolution scheme between an individual policyholder and its insurer or intermediary, which the consumer brings after an unsuccessful written complaint, and whose opinion does not bind the consumer.
Insurance mediation is the scheme through which an individual policyholder can have a dispute with its insurer or intermediary examined free of charge by an independent mediator, before or instead of going to court. It falls within the general consumer mediation regime, which requires any business selling to consumers to guarantee them effective access to a mediator. The consumer must first have sent a written complaint to the insurer's relevant department; failing a satisfactory answer, it refers the case to the mediator, who investigates and issues a reasoned opinion within ninety days of receiving the complete file. The opinion does not bind the consumer, who keeps the right to go to court; member insurers generally undertake to follow it. Referral suspends the limitation period during mediation. The scheme mainly concerns individuals' disputes, denials of cover, indemnity amounts, cancellations, and its annual reports give a valuable view of the handling practices that generate complaints. For insurers, a high rate of unfavorable opinions is a quality signal it would be unwise to ignore.
Textbook case: a policyholder disputes the insurer's refusal to pay for water damage on grounds of poor maintenance. After a written complaint left unanswered for two months, he refers the case to the mediator, who finds the exclusion was not drafted in a formal and limited way and recommends payment; the insurer follows the opinion and pays 6,500 euros.
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