Om­buds­man of Pri­vate In­sur­ance and of Su­va

Portrait20 March 2020

The Foundation «Ombudsman of Private Insurance and of Suva» was established by the SIA in 1972. The Ombudsman has proven to be a solidly-founded and widely-accepted independent institution. The number of problems dealt with by the Ombudsman show that this institution enjoys the confidence and trust of the public at large. Its services – which it renders free of charge – contribute to assisting dissatisfied or uncertain customers.

Summary of the Annual Report 2019

The number of queries and complaints within the Ombudsman’s jurisdiction increased by 4.9% from 3,192 to 3,350 in 2019, the year under review.

A total of 2,958 cases were resolved directly with policyholders or complainants without the need to contact the insurer. 392 of the 1501 complaints submitted in writing resulted in interventions with the relevant insurance companies (intervention rate 26.1%). The intervention success rate stood at 60.2%. The highest dispute value in an intervention case was around CHF 425,000, while the lowest contested amount was CHF 96.

As in previous years, the Ombudsman’s activities primarily focused on personal insurance, which ac-counted for 52.8% of the caseload. There was a significant increase of 34% compared to the previous year in the caseload in the legal protection sector where a strict damages policy of insurers and an increased propensity to make claims by policyholders were observed. In terms of numbers, the great-est increase in queries was in the field of mandatory accident insurance/Accident Insurance Act (AIA), which rose from 694 to 869 (i.e. by around 25.2%). The queries referred to in the 2018 Annual Report from sports clubs facing the problem of finding AIA insurance for staff subject to Old Age and Survi-vors’ Insurance (OASI) fell but have still not been resolved.

Complaints concerning mortgage contracts were submitted to the Ombudsman for the first time against an insurer which took negative interest rates into account in the calculation of the prepayment penalty incurred when prematurely terminating a fixed-interest mortgage. 

Isolated issues with travel insurers were difficult to comprehend. For example, an insurance company which refused to bear the costs for antibiotics prescribed by a hospital because they are not authorised in Switzerland despite insurance cover for any necessary treatment costs incurred abroad. The Ombudsman has no sympathy for an insurer which it notified that policies concluded online were be-ing issued incorrectly after a complaint by a policyholder. However, the insurer only rectified the error after a delay of several months and pressure from the media engaged by the policyholder in Ticino.  

An insurer’s refusal to pay out on cover for the theft of a bicycle from the bike shelter at a railway station because the policyholder had previously had a bicycle stolen from the same location was also a cause for concern.