Africa-Press – Uganda. The Insurance Appeals Tribunal has raised serious concerns over unethical practices by some insurance providers, accusing them of intentionally frustrating policyholders through vague and unenforceable contracts.
Speaking at the 65th CEO Breakfast Meeting organized by the Insurance Regulatory Authority (IRA) at the Kampala Serena Hotel, the Tribunal’s Chairperson, Rita Namakiika Nangono, revealed that since its establishment in 2019, the tribunal has reviewed numerous appeals exposing worrying trends in how some insurers handle claims.
“We have encountered policy documents with vague clauses that render them practically unenforceable. These documents often lack clarity, leaving policyholders confused and at a disadvantage. We have seen documents which are archaic and in English which the insurer himself can’t understand. There are clauses which are not aligned and contradictions in policy,” Nangono stated.
She highlighted that in several cases, insurers have failed to offer clear guidance on how and when to make claims, creating unnecessary barriers for clients seeking compensation.
“We’ve seen instances where the claims process is so unclear that it borders on bad faith. If an insurer is not providing proper support or deliberately creating obstacles, that conduct could amount to bad faith—something for which they could be held liable,” she added.
The tribunal also flagged inadequate claims support and a worrying trend of insurers investigating claims not with the intention to pay, but seemingly to deny them. Nangono emphasized that investigations should be aimed at validating and settling claims, not avoiding them.
Additionally, the tribunal noted a general lack of technical expertise in claims investigations and loss adjustment, which often leads to poor-quality reports and contributes to disputes between insurers and policyholders.
“Ambiguous policy terms and unreasonable claims handling practices should be scrutinized. These findings should prompt reforms in insurer procedures and improve how clients are treated,” Nangono urged.
“By leveraging these insights, the industry can improve its practices , enhance policyholder trust and demonstrate a commitment to excellence.”
She said since 2022, the tribunal has handled 51 appeals but they are increasing, with 25 so far reported this year.
Nangono said the top three disputes handled by the tribunal including group life, motor comprehensive and medical claims.
Top three are disputes around group life, motor comprehsnive and medical claims
Insurance Regulatory Authority CEO, Al Hajji Ibrahim Lubega Kaddunabbi told the insurance industry loss assessors and adjustors that they are doing a service for other people to make decisions.
“Professionalism has to be emphasized while doing your work. For the underwriters, it has come out clearly that when you are looking at a claim, look at all reasons to pay and drop all reasons not to pay. If you do that you will make our work easy,” Kaddunabbi said.
He noted that the tribunal stands as a cornerstone of accountability and fairness within the insurance sector.
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