Conclusions from FI’s analysis of personal injury claims handling

2017-12-15 | Reports Consumer Insurance

The outcome of personal injury claims can have a considerable effect on the injured party. Some injured parties do not have confidence for the claims handling process at insurance undertakings. Given the total number of personal injury claims, there are relatively few complaints regarding claims handling.

FI has not been tasked in either its ongoing supervision or this assignment from the Government to review individual cases. FI's position in this report is forward-looking and focuses on continuous improvement.

FI finds that the handling of personal injuries to a large extent functions well, but there is room for improvement. FI will therefore monitor the claims handling process through its ongoing supervision and dialogue with the insurance undertakings. This can contribute to the further development of the meaning of the concept, "good insurance standards".

FI believes that there is a need for special supervision of the medical advisory services to ensure independent quality assurance and greater confidence. Such supervision as minimum should include criteria for how and on what grounds doctors are selected, requirements on the doctor having the correct and adequate competence, including insurance medicine training, and questions about conflicts of interest.

FI also considers there to be a need to evaluate whether the medical assessments are objective, uniform, performed on a proper basis and sufficient in scope. This supervision requires medical knowledge to assess whether a doctor's competence is correct and adequate, whether the assessment of a medical case is performed on a proper basis and whether the scope of the assessment is sufficient.

FI also takes the position that:

  • the review boards must consider the conflicts of interest that may arise and through its composition safeguard consumer interests. It is also important for the boards to ensure that they have sufficient access to medical competence in order to be able to decide on matters.
  • the undertakings should ensure that their system support is adapted to their operations to achieve an efficient and legally sound claims handling.
  • the undertakings should ensure that claims are properly investigated. Direct claims handling and desktop assessments should not become overly simplified.
  • the undertakings should actively and continuously work on developing the information they provide to and dialogues with injured parties. The undertakings should provide clear and comprehensible information throughout the entire claims handling process, and material decisions should be provided in writing and with the underlying reasoning. Furthermore, calculations must be explained in more detail than what they are today.
  • the undertakings should assure the quality of the entire claims handling process on a regular basis, regardless of whether the claims handling is performed in-house or outsourced. This requires well-documented processes and procedures as well as follow-up of both.

FI will maintain a dialogue with the insurance industry to ensure that necessary measures are taken in accordance with that set out above.

FI's assignment

FI was given an assignment to map and analyse whether the insurance undertakings maintain follow good insurance practices in personal injury claim adjustments. FI has reviewed the processes, procedures and system support used by insurance undertakings in their claims adjustment, internally and in review boards and assessed whether they function satisfactorily or there is a need for improvement. The assignment tasked FI in particular with highlighting the handling of traffic injuries, but FI does not consider there to be cause for a separate report on claims handling for traffic injuries since these processes are in general in line with the processes for other personal injury claims handling.

Read more

Laddar sidan