When a claim reveals the limits of your insurance.

An insurance contract can be signed and then filed away. Its definitions, conditions and exclusions are all there, in writing, but they are rarely read closely until something happens. At the end of 2024, France counted 46.1 million home insurance contracts¹, and home insurance is only one line of cover. That is a great deal of text waiting for its first careful reading.

Opinions are easy to collect. Disputes record what people actually do. In France, a policyholder who disagrees with an insurer’s decision, and has already been through the insurer’s own complaints process, can refer the case to La Médiation de l’Assurance, the insurance mediator. It is a costly step in time and effort, which makes it a firm signal.

The mediator received about 15,000 referrals in 2020. In 2024 it received 36,537, up 19% on the previous year alone². Over the twelve months to the end of August 2025, the count passed 40,700³.

The leading cause is a refusal to pay a claim. It accounts for 54% of disputes, ahead of contract management (11%) and cancellation (10%)². The mediator’s own assessment is plain: the reasons for an insurer’s refusal “are still very often not understood by policyholders”² (our translation).

The mediator also names the places where misunderstanding concentrates².

The first is the word “accident”. Contracts require an event that is sudden, unforeseeable, unintentional, and the direct and exclusive result of an external cause. What a person lives through as an accident may not be one in the sense of the contract.

The second is the word “invalid”. A person recognised as invalid by the French social security system is not necessarily recognised as such by their insurer.

The third is supplementary health insurance, where the mediator asks who can understand a reimbursement expressed as “100% of the social security reimbursement base”.

None of these definitions is hidden. Each one is written in the contract. The difficulty is not access to the text. It is the moment at which the text is first read closely, and by whom.

One might expect the problem to shrink when a person explains the product face to face. The supervisor’s own fieldwork suggests otherwise.

The ACPR, the French banking and insurance supervisor, carried out 196 mystery-shopping visits across ten distribution networks, on revolving credit and the loan insurance sold with it. 70% of the mystery shoppers judged that the adviser had not been clear about the insurance. The shortcomings it recorded concern how needs were gathered, whether the cover was optional, what it cost, and how far the cover extended⁴.

This is one product and one exercise. It is also a measurement taken by the regulator, at the point of sale, in 2026.

Some limits are worth stating. The mediator counts disputes, not misunderstandings, and a refusal can be correct under the contract and still come as a surprise. The figures do not say why referrals rose. The ACPR exercise covers a single product, sold alongside credit.

Read together, the sources still point the same way. The problem is not a lack of information. Contracts, definitions and exclusions are written down and available to the people who hold them. What is missing is someone who reads them for you at the moment they matter, which is before the worst day, not on it.