The recent increase in consumer complaints against insurance companies in Mexico has generated concern among public agencies responsible for financial protection.
During the first four months of the year, the number of complaints grew by 8%, in contrast to the downward trend recorded last year and in the first months of 2024.
This increase has been attributed mainly to incidents related to car accidents and cases linked to medical expenses.
According to Óscar Rosado Jiménez, president of the National Commission for the Protection and Defense of Financial Services Users (CONDUSEF), last year and much of 2024 saw a 5% reduction in claims, even though the number of policies issued and the frequency of claims continued to grow.
This data was considered a positive sign, as it indicated that, despite greater insurance penetration and more covered risks, disputes remained low.
The situation took a turn in the first four months of the year. Growth in policy issuance and claims continued, but for the first time in two years, user complaints also increased.
The head of CONDUSEF (National Commission for the Protection and Defense of Financial Services Users) highlighted that, until recently, complaints related to health insurance had remained stable, even during the pandemic, but are now showing an increase.
This data reveals a break in the improvement that had been observed in the relationship between insurers and clients. The increase in the number of policies and insured incidents is now accompanied by greater dissatisfaction, especially in two key segments: auto and health insurance.
The official explanation indicates that CONDUSEF serves as the last resort for dissatisfied users.
Rosado Jiménez himself emphasized that ideally, clients would purchase their policies, avoid claims, or, if a claim were to occur, have it resolved at the insurer’s initial service levels.
Only in exceptional cases should it be necessary to resort to the Commission’s intervention.
The official lamented the lack of a perceived substantial change in the actions of companies in the sector, urging them to adopt preventive and corrective measures “upstream,” that is, in the initial stages of customer service and claims resolution.
The persistent flow of complaints suggests that most conflicts are not adequately resolved within the insurers’ internal processes.
Another cause for concern for CONDUSEF is the increasing use of artificial intelligence (AI) by insurance companies, especially in claims management and risk assessment processes.
The agency warns that the automation of decisions can “dehumanize processes and generate algorithmic discrimination.”
The concept of the “black box” of AI, cited by experts in the field, refers to the opacity with which many algorithms operate, making it difficult to verify how and why certain decisions are made.
According to the Commission, the situation in Mexico is particularly complex, as claims data from state authorities and court records exhibit more pronounced deficiencies and biases than those observed in countries like the United States.
The organization identifies variables such as age, social status, and place of residence as potential triggers for discrimination in automated claims assessment and resolution systems.
Given this risk, the official recommendation is that the integration of new technologies in the insurance sector always be carried out under principles of transparency and ethics, to prevent algorithms from exacerbating existing inequalities or creating new forms of exclusion.
The Importance of Prevention and Transparency
Given this scenario, the authority urges the insurance sector to strengthen its early intervention mechanisms and improve communication with clients from the moment they purchase a policy.
A preventative approach and swift resolution in the initial stages can significantly reduce the need for intervention by public agencies and, above all, improve users’ perception of and trust in the insurance system.
Furthermore, the responsible use of technology, with clear protocols to prevent discrimination and guarantee data protection, is considered an urgent task for the industry.
Thus, CONDUSEF emphasizes the need to adopt more transparent and ethical practices, both in human resource management and digital processes, to prevent technological innovation from becoming a new source of conflict and inequality among policyholders.
Source: infobae
