Your insurer refuses to reimburse you? Beware of abusive exclusion clauses!

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This year again, the Insurance Mediator denounced the use of overly vague exclusion clauses, an illegal practice that systematically deprives the customer of reimbursements.

He describes a “society of distrust”In its annual report published on September 3, the Insurance Mediator recognizes: “The unprecedented volume of referrals received by the Insurance Mediation in 2023, which will undoubtedly be significantly exceeded in 2024, shows that distrust is expressed towards the insurer itself”According to the independent body, the French want more “to assert” their consumer rights. If, with the help of the mediator, they obtain partial or total satisfaction in 53% of cases, things would in reality be much more complicated.

And for good reason: insurers are fueling customer distrust. By using and abusing illegal exclusion clauses, because they are too vague, they are unfairly depriving their policyholders of compensation. Yet condemned “long-standing” by the Court of Cassation – the highest court in our country – this practice has not disappeared. We find these vague terms in various forms. On the car or home insurance side: the “neglect” having facilitated the appearance of a disaster, a “lack of maintenance” of housing or even a house that would not be built “in the rules of the art”. In health insurance or in pension planning, we can find them under the name “back pain” Or “mental disorders”.

Abuses highlighted by the Court of Cassation

The problem with all these terms, the Mediator points out, is that they do not respect the two fundamental characteristics of a clause: its character “formal” And “limited”. “I continue the fight. I have been denouncing this situation for 4 yearsrecalled Arnaud Chneiweiss, the Insurance Mediator, on September 3. There are legal departments at each insurer, they should know the case law of the Court of Cassation.” It is up to the insurer to specify what constitutes negligence or back pain because otherwise, the insured is not able to know whether he is covered by his contract.

The Mediator thus calls “the entire sector to comply as soon as possible”a constant that some insurers remain reluctant to do so. A request that aims to protect policyholders… but also insurers. Because since 2021, the Court of Cassation no longer takes tweezers. It has thus decided that the use of words that are too imprecise in a clause is “to fall” the entire warranty exclusion, thus forcing the professional to spend more money to cover his clients’ claims.