Background

One of our long-standing corporate clients faced an unexpected challenge with their loss of income insurance (indemnités journalières maladie) — a policy covering employees’ salaries in case of illness.

After several consecutive years with multiple medical claims, the insurer announced a premium increase of nearly 15% at renewal. This type of adjustment is not uncommon: when an insurer’s claims ratio rises, they often raise premiums to offset higher risk exposure.

However, upon reviewing the insurer’s data, we identified that many of the so-called “open claims” were either outdated, over-provisioned, or already resolved — meaning the increase was not fully justified.

The Challenge

The client’s management team was understandably concerned.
A 15% increase represented a significant additional cost for the company’s HR budget — and it appeared to have been applied mechanically, without detailed review of the underlying claims.

Our objective was to challenge the calculation, clarify the reality of each open case, and restore fairness in the insurer’s pricing model — all while preserving the strong partnership between client and insurer.

The main difficulty lay in the insurer’s internal reserves.
When a claim remains technically “open,” even if inactive, the insurer maintains a financial provision to cover potential payments — provisions that directly influence next year’s premium calculation.

Our Approach

We requested a detailed breakdown of all open claims and scheduled a direct meeting with the insurer’s account manager and claims specialist.
Before the discussion, we analyzed each file in coordination with the client’s HR department to confirm which employees were still on medical leave, which cases were closed, and which provisions no longer reflected actual risk.

During the negotiation, we presented a structured summary of every open case, demonstrating why several provisions could be reduced or released.
In some instances, the employees had already returned to work months earlier, yet the claim reserves had never been updated.
In others, medical reports confirmed full recovery, meaning there was no further financial exposure.

By aligning the factual situation with the insurer’s technical reserves, we argued that the global loss ratio was overstated — and that a 15% premium increase was disproportionate.

The Outcome

After reviewing our analysis and accepting several provision adjustments, the insurer agreed to reduce the planned increase from 15% to 10%.
This represented a substantial saving for the company while preserving full coverage for all employees.

The discussion also strengthened transparency between both parties.
The insurer appreciated the accuracy of the data provided, and the client gained clearer insight into how claims influence annual pricing.

Our intervention transformed what could have been an automatic rate hike into a fair, data-driven outcome — maintaining both financial efficiency and a healthy long-term relationship with the insurer.

Impact

This case shows the value of having a proactive consultant who not only understands insurance products, but also the underlying financial and actuarial mechanisms.
By combining negotiation, technical analysis, and transparent communication, we helped the client save meaningful costs and restore balance in their insurance portfolio.

In insurance management, numbers alone rarely tell the full story — context, accuracy, and dialogue make all the difference.