The daughter of a Cuban doctor, a client of the National Insurance Company (ESEN) He denounced the breach of what was agreed in his mother’s life insurance policy, after a stroke that permanently disabled her.
“My mother, a doctor by profession, has paid for life insurance since 2007. In September 2021 she suffered a stroke, from which she was permanently disabled, with a medical commission certificate that supports it,” she explained. Yoana Pérez Marshall on their social networks.
After 6 days of hospitalization, the daughter delivered the summary of the clinical history to the insurance agent who attends her in the Havana municipality of Marianao. “That’s where my ordeal begins,” lamented Pérez Marsall.
“Until today I have delivered as many papers as the agent has requested; I have gone to the hospital file to request his clinical history, because the summary of the clinical history is not enough, and the rehabilitation summaries for 4 months, ”she recounted.
However, after having gathered all the required documentation, the company continued to investigate her mother’s case, with the intention of finding out if her mother “had high blood pressure at the time of admission.”
“If the pressure was high or normal, does the permanent disability that my mother has on her left side, which was her main hand, change?” asked the daughter of the ESEN insurance beneficiary.
“According to what I read in the contract, ‘permanent disability’ is the lifetime loss of the functional capacity of any of the members or organs of the body caused by encephalic vascular accidents,” he described.
The complainant claimed to have all the documentation provided and received. “No one from the insurance company has visited my mother, nor has the fellow agent who is attending me charged me more for the insurance fee… I don’t know why,” said the affected daughter.
“Remember that my mother is retired and disabled, and she is only claiming money that is hers, because she has paid it into life insurance for 15 uninterrupted years. She is not asking for help from anyone and she feels cheated … A person who has to be calm, “she claimed in a publication to which she turned” after having exhausted all resources.
ESEN is part of the Grupo Empresarial Caudal, belonging to the Ministry of Finance and Prices. According to the company’s website, the ESEN offers insurance for natural persons, including “life insurance” and that covers the economic need that occurs in the event of the death of a person whose personal income is decisive in the family economy. .
As advertised, life insurance covers the following risks arising from the death of the insured, due to total or partial permanent disability, temporary disability and pharmaceutical expenses.
In the case of coverage insurance for total or partial permanent disability, “those suffered by the insured as a result of accidents, cardiovascular diseases, encephalic vascular diseases, diabetes and cancer are covered; provided that the incapacity manifests itself within 12 months after the diagnosis of the illness or accident”.
“I am still waiting for a response to a complaint made to the National Insurance Company,” concluded the daughter of a Cuban doctor who feels cheated by a state company that sells policies that, according to her, does not honor the terms of the contracts that it signs with its customers.
In 2017 the news was known that ESEN paid from January to August of that year more than 990,000 Cuban pesos (about 39,600 dollars) due to permanent disability to 63 Avilanians, at an average of 628 dollars per head. In addition, he paid 1,919,000 CUP (about 76,760 dollars) to beneficiaries for risk of death.
A year later, the information emerged that 88 percent of the money paid by ESEN in Ciego de Ávila was intended to compensate losses in agriculture.
According to Cuban News Agency (ACN)“insurance is a form of risk transfer through which the insured becomes a creditor, based on the payment of a relatively small remuneration (the premium), of a much larger benefit that the insurer will have to satisfy in the event of a loss , and this includes death, medical expenses, disabilities, fires, crashes, theft and pests, among others”.
“The presence of insurance in Cuba at present is insufficient, since according to recent figures, it only reaches 25 percent of the potential market in the territory, which reveals little perception of risk in the population and little culture in this regard,” said the ACN in June 2021.
Created in 1978, the company “has among its purposes to develop insurance and reinsurance operations for Cuban and foreign natural and legal persons, as well as to carry out preparatory and complementary activities to insurance, aimed at risk assessment and damage prevention.”