Is your insurer cheating you?

Janet Abayisenga Atete was involved in a nasty car accident that almost took her life three years ago. Though the car had a third party policy, Atete footed all the hospital bills worth millions of francs. Ever since she was discharged, she has made countless trips to her insurer for her compensation to no avail.For Ntaki, it has been 11 odd years since a trailer rammed into his parked car in 2002, which was subsequently written off. “Though I submitted all the required documents to my insurer, I have not been compensated as they keep changing goal posts about settling my claim,” Ntaki said.Atete and Ntaki’s predicament is just a tip of the iceberg. The talk in town is that when you are involved in an accident, forget about compensation. “There is, therefore, a big number of people who have not been compensated by their respective insurers despite fulfilling all the requirements,” an industry watcher noted. Yet, the insurance industry is bound by law to act professionally, and because of their protective role, insurers have long operated as semi-public trusts. However, that role seems to have been forgotten. “Lately, some insurance companies have had to make a number of trips to the courtroom to defend themselves against accusations of delayed settlement of claims or trying to unjustiably reduce clients’ compensation packages,” said another sector analyst. But the blame game goes on as insurers, too, point fingers at claimants, arguing that most of the time they do not submit the necessary documents in time. According to Jean Pierre Majoro, the Association of Assurers Rwanda (ASSR) executive secretary, compensation in case of property destruction is always guided by the original contract signed by the two parties and evidence of that specific loss must be backed by statements from the police and insurers. And one must have a bank statement in case of fire, he added.“However, our clients and the police always delay to submit completed files to enable insurers process the compensation. So, it’s not a matter of us delaying or refusing to settle claims. Remember, we are business people and must also be protected from losses. That’s why we don’t just pay any claim,” Majoro said.However, most of the affected clients Business Times interviewed insisted that they submitted the documents on time and accuse insurers of using tricks to postpone settlement of claims.“Insurers will sweet-talk when selling a policy and convince you that you will get an insurance policy to cover everything. But when need arises, they look the other side; some even have the audacity of telling court that nothing was covered,” complained Ntaki.According to Stephen Sang, a senior manager in charge of assurance and advisory business services at Ernst & Young, an audit and research firm, lack of public awareness and sensitisation could be one of the reasons the public is accusing insurers of playing tricks when it comes to settling claims.“If a client did not understand the terms and conditions of the contract, it’s the role of the insurer to ensure that they explain the details of contract to the client so they understand it,” Sang noted. He said in case there are any bureaucracies, it is the responsibility of insurers to streamline the business. “If the police are delaying reports, then it’s the responsibility of the insurers to advocate for a solution.” Majoro also claimed that police reports are supposed to be delivered by customers, arguing that “insurers are not the custodians of the documents”. “It’s the clients supposed to ‘put pressure’ on the police and get those documents, which they then take to their insurers. This is because, according to ‘police procedures’, the report is supposed to be given to its rightful owner, who, in this case is the client,” Majoro pointed out. But Police refute the allegations, saying the insurance companies have to request for the reports before they can be released. “It’s our primary responsibility to ensure that justice is not only done but is done within shortest period of time. We don’t want to be a stabling block to justice. However, we always ensure that enough evidence is collected before we can reach to any conclusions and make recommendations. This usually takes about four days,” Police spokesman Supt. Theos Badege said. He added that unless there is a special case like in arson cases, where police have to request for more expertise to assist in obtaining detailed evidence, they always complete investigations and compile reports within four days.“It is not true that police delay reports. We conduct investigations with other experts, depending on the nature of accidents, and make our reports.”Badege also noted that it is the insurers who have to request for the reports and not the clients as alleged by insurance companies.Problems associated with such compensation claims are not unique Rwanda. According to a survey conducted in the US last year, 16 per cent of surveyed adults have experienced financial hardship while waiting for an insurance claim to be settled or know someone who has. The same poll found that 59 per cent of adults believe that most insurers intentionally delay claims.A claim delayed by even a month can spell financial disaster for a family, according to the US National Bureau of Economic Research study. The survey found that about 25 per cent of Americans could not come up with enough money to last them 30 days. Also, a lot of Americans believe that insurers have converted claims into a money-making process. “An investigation by the American Association for Justice, the trial lawyers’ lobby group, also discovered that some insurance firms made claims “so expensive and so time-consuming that lawyers would start refusing to help clients.”The Rwandan insurance market is currently composed of over 10 companies, including public and military medical insurance institutions. It has six brokers and 156 insurance agents, who on most occasions negotiate on behalf of clients. However, only three per cent of domestic businesses are insured, according to Majoro.Though the net written premium increased from Rwf27.3b in 2010 to Rwf32b in 2011, total premium decreased by 5.5 per cent in 2012, registering only Rwf30.2b. Total claims incurred decreased from 22.2 per cent in 2011, down to 12 per cent in 2012, with premium life insurance also declining from 21.6 per cent in 2011 to 20.7 per cent in 2012. The decline has been attributed to a lack of sensitisation and general awareness among the public and the fact that most businesses rely on foreign insurance firms.“The public perception of insurance here is still low compared to some other countries, which explains the low penetration rate of 2.3 per cent in Rwanda compared to the 11 per cent in South Africa,” said Innocent Musinguzi, the tax manager at KPMG, an international audit and business consulting frim.According to Majoro, one needs a premium of Rwf26,000 per year to insure a business worth Rwf5m, and for the big investments worth Rwf250m insured, it is about Rwf375,000 per annum.Majoro called on the sector regulator to sensitise and also review the law to ensure mandatory insurance ‘like it’s done in other countries’. “The government should, for instance, task developers of commercial buildings not to start work unless they are insured.”Recently, the police, City of Kigali and insurers signed a deal to help streamline the industryUnder the agreement if one is found guilty of causing an accident, they will not claim compensation from their insurer as has been the case.“This will help the sector because it is not fair for us to pay someone who, for example, is involved in an accident when he was drink-driving,” Majoro said.