Groupama contests if withholding of SME claims details is breaking TCF
By Lucy Quinton
A private medical insurance (PMI) provider has lambasted the market over its claims sharing practices in the small and medium-sized enterprises (SME) market.
Groupama Healthcare has criticised its competitors for not sharing claims statistics when reviewing premiums saying it impinged on the regulator's Treating Customers Fairly (TCF) initiative.
Sharing claims information is normal practice in the general insurance and corporate PMI markets as well as in the individual market. However, it appears that the SME market is falling between the gaps.
Both Axa and Bupa were named by intermediaries as firms that did not share claims information.
Claire Ginnelly, head of business development healthcare at Groupama, said: "Insurers are putting intermediaries in a very difficult position."
Geoff Spillett, national manager, health and risk practices at HSBC, agreed and added that the firm was committed to TCF but the healthcare team found it a huge issue in the SME market. "How can insurers possibly rate an SME renewal using the claims experience to influence the terms and then not give details of the claim or, at best, just give sketchy inconsistent information?"
Spillett said many clients were "astounded at the lack of transparency in the PMI market and often believe we are to blame".
He added he was astounded that the Financial Services Authority could "continue to turn a blind eye to the current practices in this sector" with all the hoops intermediaries go through to give good advice. "In many cases in the SME PMI market we simply can't be sure we are giving good advice due to the withholding of vital information from the insurers, with the exception of maybe one or two of the smaller players," Spillett said.
Lindsey Joseph, healthcare director at LEBC corporate healthcare solutions, said: "Axa PPP comes up with inaccurate statements about how it is a breach of the data protection act, but it actually isn't, as no personal information is requested."
She added Axa was the most aggressive in policing this by arguing it was 'commercially-sensitive' suggesting intermediaries would use the information inappropriately. However, Joseph disputed this and said: "It should identify those brokers that mishandle the information and then withdraw them from the list of approved intermediaries."
Neither Axa nor Bupa were able to respond to multiple requests for comment by the time COVER went to press.
