As reported, FWD Vietnam Life Insurance Company Limited was accused of being slow to pay benefits to thyroid cancer customers, citing the reason "there is currently a disagreement between legal documents". Meanwhile, customers have provided complete documents, including the results of a medical examination concluded that the rate of body damage was 81%.
Analyzing this move, Dr.LS Dang Van Cuong ( office of Legal Lawyers, Hanoi Bar Association) pointed out legal violations, affirming that the act of "temporarily suspending" payment was unfounded.
Insurance contracts must be respected
Lawyer Cuong said that an insurance contract is a civil contract, protected by law and bound by all individuals and organizations. In essence, a legally signed contract will take effect. The unilateral "temporary suspension" of one party's performance of obligations without being in the agreement is a violation of the basic principles of contract law (Civil Code 2015).
More specifically, the Law on Insurance Business has clearly stipulated the responsibilities of enterprises:
Article 20 stipulates that insurance companies are obliged to "compensate and pay insurance when an insurance event occurs".
Article 29 stipulates the period of compensation and insurance payment: "When an insurance event occurs, insurance companies and branches of foreign non-life insurance companies must compensate and pay insurance according to the period agreed in the insurance contract. In case there is no agreement on the term, the insurance company or a branch of a foreign non-life insurance company must compensate and pay the insurance within 15 days from the date of receipt of complete valid documents on the compensation and insurance payment request".
In case reported by the press, the company's "temporary suspension" of payment with the reason of waiting for instructions from outside not only violates the signed contract but also goes directly against the above legal regulations.
The law does not allow "temporary suspension" of payments
Lawyer Cuong affirmed that the law on insurance only allows businesses to pay insurance or refuse to pay if there is a reason in accordance with contract regulations and legal regulations. There is no regulation allowing insurance companies to "temporarily suspend" the payment of benefits indefinitely as in this case.
If they refuse to pay insurance, they must "Explain in writing the reason for refusing to pay insurance" according to Point e, Clause 2, Article 20 of the Law on Insurance Business. However, in the above incident, the insurance company did not respond in writing but only responded via email about the suspension, trying to delay its obligations. This insurance company did not fulfill its rights and obligations according to the law.
Proposal to amend the law without justifying current violations
Lawyer Cuong analyzed that the Association and businesses' recommendation to the Ministry of Health to amend Circular 28 is a reasonable and necessary move to make the market more transparent. However, it is necessary to clearly analyze this move:
"First, the association's arguments are logically incorrect when taking an action towards the future (requesting to amend the law) to justify not fulfilling legal obligations at present. The signed contract must comply with the law at the time of signing. Businesses cannot use the excuse of "waiting for the new law" to delay a commitment that has come into effect.
Next, if this argument is accepted, it will create a bad precedent that affects the rights of insurance buyers later. Whenever a business has to pay a large compensation or a legal issue that is not beneficial, the business can "temporarily suspend" the payment and use the excuse of "waiting for instructions from the state agency". This will paralyze consumer rights and break trust in the entire market" - Dr.LS Cuong analyzed.
What should customers do to protect their rights?
Dr.LS Cuong shared that in such cases, customers should not wait silently but should proactively take the following steps to protect their legitimate rights:
First, customers can send an official request to the insurance company, asking them to respond in writing about the reason for the payment delay, citing the terms in the contract and the payment period according to the law.
If they do not receive satisfactory feedback, customers have the right to file a complaint with the Insurance Management and Supervision Department (under the Ministry of Finance). This is the competent authority to monitor the activities of insurance companies and can request the companies to explain and provide instructions to help customers protect their rights.
filing a lawsuit in court is a last resort but may be the most effective. An insurance contract is a civil contract, and the Court is the agency authorized by law to resolve disputes arising in a contractual relationship. Customers can completely file a lawsuit to request the court to force the insurance company to fulfill its obligations.
Customers can seek the help of lawyers and media as a supplementary measure in the process of reclaiming their legal rights. Lawyer consulting will help customers have a solid legal roadmap.
In short, Dr.LS Cuong emphasized that the delay and delay of an insurance company in paying insurance benefits to customers and the violation of insurance law and civil law also shows the lack of professionalism in the business activities of the business, losing public trust in the core value of insurance services, which is to protect the legitimate rights and interests of customers.
