Huge differences in success rates and complaint scores

06/07/2022 – The success rate of company complaints to the ombudsman last year was between a good quarter in the life segment and nearly two-thirds in the “other” category. Auto insurance is almost always about low claim values. It is exactly the other way around in disability insurance. This is how it emerges from the 2021 annual report of the arbitration board.

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According to the 2021 annual report (PDF, 1.5 MB), the Insurance Ombudsman eV received 18,344 complaints in 2021. That was 1.2 percent more than the previous year (VersicherungsJournal May 18, 2022). Only 3.7 percent of the submissions (677 articles) were directed against insurance brokers, the rest against insurance companies.

In total, about 13,550 of the 17,300 claims against insurance companies received by the arbitration board (more than three quarters of the total) were admissible. In about one in 20 cases, the complainant did not comply with his request.

The remaining sixth of the admissible complaints were declared inadmissible. The most common reasons for this were that the complaints were from third parties or about private health and long-term care insurance (May 30, 2022). The ombudsman for private health insurance and long-term care (PKV ombudsman) is responsible for the latter.

Car insurance usually costs a small sum

Statistical assessments of the number of complaints and success rates in the various sectors are also provided in the publication.

Result: Clearly, 85 percent of the claims settled in the year under review had a total claim value of up to €5,000. The largest share was in motor vehicle liability insurance with nearly 99 percent.

In at least nine out of ten cases, this also applied to accident insurance, legal protection, all-risk motor vehicle insurance and the “other” category. According to the report, the latter include “smaller lines of business such as travel insurance and those claims that affect several lines of business, for example because they are combined contracts.”

Higher sums in disability insurance

A comparatively small proportion of less than 70 percent is included in life insurance. The work disability division (BU) has the lowest value.

Unsurprisingly, this was by far the most frequently involved in higher sums. In more than 60 percent of the cases, the value of the complaint was between 20,000 and 100,000 euros.

Complaint levels (image: defender of the insured)
Number of complaints (Image: Insured Ombudsman, 2021 Annual Report)

Depending on the division, different chances of success.

As the annual report further shows, the success rate of permitted filings against insurance companies in the life segment was 29.7 percent, the highest value in the last five years. The minimum was reached in 2017 with less than 24 percent.

In the additional category “All lines of business without life insurance,” the rate fell slightly to 45 percent after three previous increases.

Complaints were most often successful, each at about 60 percent, in the areas of motor vehicle liability, comprehensive motor vehicle insurance, and in the “Other” segment. Comparatively, this was rarely the case in the real estate lending, business unit and construction sectors. Values ​​of less than 30 percent are given here.

A positive trend can be observed in most of the categories shown in the period under review. It does not include Occupational Disability and Real Estate insurance or the “Others” area.

Success rates (Image: Insurance Ombudsman)
Success rates (Image: Insurance Ombudsman, Annual Report 2021)

What about interpreting success rates…

The publication states the following regarding the success rate: “All claim procedures are considered successful in this sense if they bring the desired legal or economic advantage to the policyholder in whole or in part.”

This could be the case, for example, if the term of the contract is adjusted according to the wishes of the policyholder. Consequently, it ends before or after what was initially decided by the insurer, depending on the object of the claim.

As examples of economic advantages, greater compensation for damages in building insurance or assumption of costs for legal representation of interests in legal protection insurance are cited.

…to be noticed

“In these cases, however, success can also come from the insurer’s side. On the one hand, resolving a disagreement avoids the processing overhead that would be incurred if it had to be discussed further.

On the other hand, the relationship with the policyholder usually also improves in these cases, since the result of the procedure that prospered for the claimant is mainly based on the remedies provided by the insurer. This voluntary accommodation signals the client’s orientation and interest in continuing the contractual relationship. A customer relationship that has been freed from disputes has the prospect of being maintained and developed,” the report continues.

Why are there less chances of success in life?

The comparatively low chances of success in the area of ​​life are explained as follows: Entries “are often directed against status notifications, the amount of surplus or against payments due.

The Ombudsman can certainly understand the complainants’ concerns in this regard, because the figures are not mathematically understandable to consumers. They lack values, formulas, and often specialized knowledge. Furthermore, insurers’ representations often appear unclear or ambiguous.

Reported dimensions can also be disappointing if they fall short of expectations. However, the Ombudsman’s examination does not usually give rise to any reason for complaint, neither in terms of calculations nor from a legal point of view.”

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