The business model of insurance companies is more successful and profitable if the insurance company sells more insurance policies on the one hand, but also if it manages to reduce costs. In addition to the standard costs for each company, insurance companies are faced with the challenge of paying out sums for the payment of claims to those insured who have suffered a certain loss.

Thus, if we accept that each insurance company should present itself to its shareholders as a profit center, we must also accept that the motive of each insurance company is to find a way to reduce the amount of damage that it has to pay out to its policyholders, or else to reject the claim completely.

Bearing this in mind, in the continuation of this text we will discuss the ways of indemnifying the insured against the insurance company, without starting court proceedings:

I. The petition to the Agency for supervision of insurance, as an alternative way for compensation from the insurance company

At the moment when the insured submits a request to be compensated, the interests of the insurance company and the insured are opposite, that is, the insurance companies are motivated to refuse the damage or pay it in a smaller amount.

For this reason, the insured can find a way to negotiate with the insurance company or to start legal proceedings against it.

However, in addition to this, they have the opportunity to submit a complaint to the Agency for supervision of insurance in order to get compensation from the insurance company. This Agency is obligated to protect the rights of the rights of policyholders and other insurance users in accordance with the Law on Consumers Protection, Law on supervision of insurance and the Law on obligations relations.

II. What should you expect from the Insurance Supervision Agency

It should be noted that the Agency for supervision of insurance is taking this mechanism for exercising the rights of policyholders more seriously from year to year. Namely, according to the Agency’s announcement, the total number of complaints filed by dissatisfied insured persons in 2022 reached 267, which is a 30 percent increase compared to 2021.

The agency emphasizes that this data is a clear indicator that citizens increasingly recognize the Insurance Supervision Agency as a protector of their insurance rights, which is a priority and permanent commitment of the management of this regulatory body. The Agency for supervision of insurance (ASO) resolved 62 complaints in favor of policyholders who complained about the quality of services they received from insurance companies last year. The number of complaints resolved in favor of the insured last year was 48 percent higher than in the previous year, 2021.

III. How to submit a complaint to the Insurance Supervision Agency

There are several ways to submit a complaint to the Supervision Agency and it can be submitted personally by the insured or through an authorized proxy in order to get compensation from the insurance company. The complaint can be submitted electronically or to the Agency’s archive.

It is recommended that the petition itself be well-reasoned and that all the evidence on the matter as well as the decision-making method of the insurance company be submitted in addition to it.

IV. Other ways of out-of-court enforcement of rights

According to the Insurance Supervision Law, it is provided that in the event that the insured, i.e. the beneficiary of the insurance, believes that the insurance company does not comply with the provisions of the insurance contract, it can submit a complaint to:

1) the appropriate organizational unit responsible for resolving disputes between contracting parties within the insurance company;

2) the internal audit service in the insurance company;

3) the consumer protection organization and

4) Insurance Supervision Agency.

Learn more how the Agency would decide for the compensation from the insurance company on the following link: https://aso.mk/aso-reshi-48-poveke-pretstavki-vo-korist-na-osigureniczi-najchesto-se-zhalat-na-shteti-pokrieni-so-evropski-izveshtaj/ 

Note: The above does not constitute legal advice and in no way can be accepted or understood as an instruction to act in a specific case. Each legal situation has its own characteristics that should be reviewed at separately, and for that reason we recommend that you contact a professional – a lawyer – for legal advice.