Ombudsman of Private Insurance and of Suva
The Ombudsman of Private Insurance and of Suva foundation was established by the SIA in 1972. The Ombudsman Office assists insured parties with questions related to insurance law and provides solution-oriented mediation for disputes. Its services are free of charge and impartial. The number of queries and complaints within the Ombudsman’s jurisdiction rose from 2,711 to 2,825 (4.2%) in 2023, the year under review.
Summary of the Annual Report 2023
2,502 cases were resolved without intervention with the insurance companies or directly with the insured party or claimant. 323 of the 1126 complaints submitted in writing resulted in interventions with the relevant insurance companies (intervention rate 28.7%). The intervention success rate was in line with the long-term average and stood at around 65% whereby an improvement in the complainant’s situation was achieved in 2 out of 3 intervention cases.
Our activities continued to focus on personal insurance which accounted for 51% of cases. There was a sharp increase in the number of queries and complaints compared with the previous year in the field of mandatory accident insurance/Accident Insurance Act (AIA) where case numbers increased from 561 to 734 (30.8%). The causality between an accident and the health problems claimed was most frequently disputed here. Processing these cases often requires the analysis of extensive records.
The daily allowance segment remains at the top in terms of case numbers in the private insurance sector. Here queries and complaints rose again in the year under review from 388 to 409 (5.4%). The policy of one daily allowance insurer was difficult to understand. Despite the applicability of the free movement agreement between daily allowance insurers in the contractual conditions, it excluded insurance benefits in the event of incapacity for work due to pregnancy complications because the pregnancy began during the cover period of the previous insurer.
The annual report reflects the activities of the Ombudsman's Office in the areas of private insurance, the LAA/UVG and occupational pensions. In addition to the development of cases in the individual areas and sectors, the activities in the three language regions are also analysed.
About the Ombudsman's Office
Within the scope of the Foundation's purpose, the Ombudsman's Office acts as an independent and neutral mediator in the event of differences of opinion between policyholders, insured persons, beneficiaries and applicants on the one hand and the private insurers affiliated to the Foundation and Suva, including the military insurance provided by Suva, on the other in insurance matters, as well as arising from mortgage loan agreements for residential property for personal use. Within the scope of its remit, it examines the complaints submitted to it, provides information and, if it deems it appropriate, makes representations to the insurer involved with a view to clarifying a specific matter submitted. It works towards a fair resolution of the conflict.
