On this occasion, the author would like to explain some legal aspects of insurance which are fundamentally important to be understood by both the Insurer (usually the Company) and the Insured who are bound in an insurance agreement. The development of insurance companies in Indonesia has grown rapidly and it cannot be denied that the level of public awareness of the importance of insurance is getting higher every day. But this does not make all insurance users understand what legal rights and obligations arise from an insurance agreement.
Black's Law Dictionary states that the definition of insurance is as follows, “Insurance is a contract by which one party (the insurer) undertakes to identify another party (the insured) against risk of loss, damage, or liability arising from the occurrence of some specified contingency. While the definition of insurance according to Law number 40 of 2014
concerning Insurance is an agreement between two parties, namely an insurance company and a policy holder, which forms the basis for receiving premiums by the insurance company as compensation for:
- Providing compensation to the insured or policyholder due to loss, damage, costs incurred, loss of profit, or legal liability to third parties that the insured or policyholder may suffer due to an uncertain event; or
- Providing payments based on the death of the insured or payments based on the life of the insured with benefits of a predetermined amount and / or based on the results of fund management.
Cases or disputes about insurance in society are quite frequent, for example, let's call it a customer / insured who is disappointed and feels aggrieved due to the use of insurance that is not optimal and does not meet their expectations, for example in the case of Mela Sari, where Mela is the policy holder. Prudential insurance, in October 2013 underwent intensive care in the hospital due to kidney failure. Where the disease suffered by Mela is one of 34 types of critical illness that should be covered by Prudential. Mela also filed a claim according to the provisions, but after almost a month Prudential had not withdrawn it, Prudential sent a letter to Mela's attorney essentially asking for clarification of the documents related to the Policy on Mela's behalf. Despite verifying the required documents, Prudential has not paid the sum insured which is its obligation.
In fact it is very important for every insurance service user to understand all the clauses contained in the articles of the insurance agreement before signing an insurance agreement because many insurance companies do not have good legality and responsibility in running their business, not to mention “fake” insurance companies. which has a bad aim to deceive and deceive a group of people through an insurance business which is essentially also an investment.
Returning to the definition of insurance according to the Insurance Law, which can be said that insurance is essentially an agreement whose making must fulfill the legal requirements of the agreement as formulated in Article 1320 of the Civil Code but is specifically regulated in Article 1774 of the Civil Code regarding a chance agreement. that is, an act whose result, profit or loss, both for all parties, as well as for some, depends on an uncertain event.
Basically insurance is a form of protection or compensation for the insured due to an event that is not certain to occur, given the main purpose of insurance, namely the transfer of risk, where the transfer of risk is carried out by the insured to the insurer, wherein the insurer will bear all kinds of losses that can be just happens to the insured person, so that the financial risk that will be suffered by the insured or his heir is reduced / light.
The discussion above is only about health insurance, of course there are many other insurance businesses such as life insurance, movable / immovable property insurance, business insurance / certain business activities. And of course there are still many questions that arise in the midst of insurance problems in this country, for example:
- In the case of life insurance, will the insurance company carry out an investigation before paying the claim of the insured person who died or not? If so, how long will it take to carry out the investigation and are there other parties acting as supervisors to prevent potential fraud by the company as the guarantor?
- In the case of movable / immovable property or capital goods insurance, how do you determine the limit for damages to be provided by the insurance company (the insurer) and how are the arrangements in law?
- Are there any provisions that impose sanctions on the insurance company (the insurer) who deliberately allows a customer / insured claim to drag on without settlement? Etc...
To get answers to these questions, of course requires a lot of further discussion. Therefore, all readers can contact our office to get answers and more detailed explanations regarding various insurance problems in Indonesia.