RECONSTRUCTING THE LEGAL FRAMEWORK OF
STANDARD CLAUSES IN INSURANCE AGREEMENTS FOR CONSUMER PROTECTION
Wawan Suryadinata1,
Naya Amin Zaini2, Wieke Dewi Suryandari3
Universitas Darul Ulum Islamic Center Sudirman, Semarang, Indonesia
[email protected], [email protected], [email protected]
ABSTRACT
Standard
clauses in insurance agreements often result in legal certainty and adequate
consumer protection. This study aims to reconstruct the legal framework
governing standard clauses in insurance agreements to enhance consumer
protection and ensure legal certainty. Using a normative juridical research
method, the study adopts a statute and conceptual approach. Data were collected
from legislative texts, legal literature, and case studies involving disputes
over standard clauses in insurance agreements. The analysis focuses on
identifying weaknesses in the current legal framework and proposing solutions
to address them. The results reveal that the unilateral drafting of standard
clauses by insurers often diminishes consumer rights and creates imbalances in
contractual relationships. This research highlights the need for simplification
of legal language, active consumer participation in drafting agreements, and
stricter regulatory oversight. The study contributes to developing a fairer
insurance policy framework, promoting transparency, accountability, and
consumer trust in the insurance industry.
Keywords:
consumer
protection, insurance agreements, legal certainty, standard clauses
Corresponding Author: Wawan Suryadinata
E-mail: [email protected]
Historically, practices resembling insurance have been known for nearly
two thousand five hundred years, particularly during the glory days of Greece
under the rule of Alexander the Great (356-323 BC)
Insurance in Indonesia has historical roots in the Dutch legal system,
whereas in the Dutch, insurance is known as verzekering, which means
"coverage" in Indonesian
The Commercial Code (KUHD) Article 225 stipulates that insurance
agreements must be made in written form, namely a policy document. This policy
contains the agreed terms and conditions that form the basis of the rights and
obligations of the parties (insurer and insured) to achieve the insurance's
objectives. Insurance policies are generally drafted in standard form by
insurance companies, which means these are standardized contracts that have
been pre-designed by companies according to applicable regulations
Law Number 8 of 1999 concerning Consumer Protection Article 18 Paragraph
(1) prohibits business practitioners from including opaque, unreadable, or
incomprehensible standard clauses. Using standard agreements raises legal
issues concerning the validity of contracts and the injustices reflected in the
rights and obligations of the parties involved. Government Regulation Number 73
of 1992 Article (19) Paragraph (2) states that policies or other forms of
insurance agreements, along with their attachments, must not contain words or
interpretations that differ. Other regulations concerning standard clauses in
insurance policies are outlined in the Financial Services Authority (OJK)
Regulation Number 1/POJK.07/2013 concerning Consumer Protection for Financial
Services and OJK Circular Letter Number 12/SE.OJK.07/2014 regarding Standard
Agreements.
Regarding insurance agreements, they must adhere to Article 1320 of the
Indonesian Civil Code, which explicitly states that an agreement or contract
must meet four primary requirements, namely the existence of mutual consent
between the parties binding themselves, legal capacity to create obligations,
the existence of a specific object, and a lawful purpose. The agreement is
valid and legally binding for the parties involved if these four requirements
are met. This agreement must adhere to the principle of consensualism
(principle of agreement), the principle of binding force of agreements or
contracts (principle of contractual bond), and the principle of freedom of
contract (principle of freedom to contract)
The rapid
development of modern insurance law is an essential area of study, especially regarding
legal certainty and consumer protection in contractual relationships. Recent
studies have emphasized the critical role of clear regulations in mitigating
disputes and enhancing transparency in insurance practices. For example,
research by Levantesi et al.
In the Indonesian legal system, insurance law does not stand alone but
is part of the national legal system, both internally and externally.
Internally, insurance law integrates with the entire legal order (including
constitutional, administrative, private, property, family, inheritance,
criminal, and procedural law). Insurance law is connected with various social,
political, economic, cultural, health, and other aspects. This entire legal
system can be used to develop legal theory and practice
The
urgency of addressing the legal issues surrounding standard clauses in
insurance agreements cannot be overstated, particularly given their significant
implications for consumer protection and trust in the insurance industry.
Standard clauses often create imbalances in rights and obligations,
disproportionately favoring insurers while leaving consumers vulnerable to
unfair terms and limited recourse in disputes. Recent studies, such as those by
Levantesi and Piscopo (2022) on mutual peer-to-peer insurance and Li and Khan
(2024) on exemption clauses in fishery mutual insurance, have highlighted how
ambiguous clauses can lead to consumer distrust and dissatisfaction. These
findings underscore the necessity for more transparent and equitable
contractual practices.
Furthermore,
the broader societal impact of addressing these issues extends beyond
individual consumers. Enhanced consumer protection fosters greater public trust
in the insurance sector, encouraging broader participation and contributing to
the stability of financial systems. By reconstructing the legal framework
governing standard clauses, this research seeks to fill existing gaps in policy
and practice. Unlike previous studies that primarily focus on theoretical or
sector-specific aspects, this study offers a novel approach by integrating
consumer perspectives into the drafting process and proposing actionable
regulatory reforms to ensure legal certainty and fairness.
The
study’s contribution lies in its comprehensive analysis of the deficiencies in
current insurance regulations and its innovative recommendations to address
them. By emphasizing transparency, consumer involvement, and stricter
oversight, this research provides a pathway for developing a more balanced and
just insurance framework that protects consumers' rights while fostering a
competitive and trustworthy industry. This focus on bridging legal theory with
practical reforms highlights the study’s unique position in advancing academic
discourse and policy development.
This
research employs a qualitative normative juridical approach, focusing on analyzing
legal norms and their application in regulating standard clauses in insurance
agreements. The qualitative aspect emphasizes a detailed exploration of
theoretical and conceptual legal issues, while the normative juridical approach
involves a comprehensive review of legal texts, statutes, and academic
literature. Data was collected through document analysis, examining
primary legal sources such as Law Number 40 of 2014 concerning the Insurance
Business, the Commercial Code, and regulations issued by the Financial Services
Authority (OJK). Secondary sources, including scholarly articles and case
studies on insurance disputes, were also analyzed to contextualize the findings
and highlight practical challenges in implementing existing legal frameworks.
This methodological approach enables an in-depth examination of the weaknesses
in the current legal framework governing standard clauses, identifying areas
for reform to enhance consumer protection and legal certainty. The research
findings aim to provide actionable recommendations for policymakers and
stakeholders in the insurance industry.
Article
1 Paragraph 4, Law Number 40 of 2014 concerning Insurance states,
"Insurance business includes all activities related to risk management
services, reinsurance, marketing and distribution of insurance or sharia
insurance products, consultation, insurance intermediation, reinsurance, and
loss assessment for both conventional and sharia insurance." In
contractual relationships, insurance agreements are laid out in the form of a
policy, where the insurer agrees with the policyholder, whose substance is the
payment of premiums by the insured to cover the risk of loss experienced by the
party with an insurable interest. After a claim is submitted by the agreed
terms, particularly for unforeseen events in the future, the good faith of both
parties becomes essential to avoid insurance fraud that can potentially harm
both parties directly or indirectly.
Insurance
companies must uphold consumer protection principles, especially in the
financial services sector, such as fulfilling transparency in the products
offered, providing clear, complete, and easy-to-understand information, and
ensuring fairness for consumers. Insurance companies must protect their
consumers (insured parties) who use their products or services as a part of
financial services. Given that insurance pools public funds through premium
payments by the insured as compensation for the agreed-upon risk transfer, it
is vital for both insurers and insured parties to have balanced rights and
obligations.
As
an agreement, the drafting of insurance policies must comply with the
provisions of Article 1320 of the Civil Code and Article 251 of the Commercial
Code. The Civil Code stipulates that agreement is one of the valid
requirements, while the Commercial Code mandates notification of the object and
subject of insurance in the policy clause. The legal principles in these
regulations must be followed by the insurer (insurance company) and the insured
(policyholder), ensuring that the insurance agreement is valid and binding,
creating a legal relationship between both parties, provided they agree to be
subject to the agreement's provisions.
In
general agreement drafting, both parties play a role in establishing and
agreeing on the terms included in the agreement. However, this differs when
drafting insurance policies with standardized characteristics and similar
substantive content. Insurance companies often draft standard agreements
(standardized contracts) with exemption clauses for practical and efficient
reasons, leaving the insured only the choice to accept or reject the insurance
policy that the company has unilaterally drawn up. If the insured agrees to the
policy, it is considered a binding acceptance, and they are subject to all
terms stated in the insurance policy.
Standard
agreements are often exploited by parties with higher authority and bargaining
power to benefit from others who need such agreements, thus eliminating
principles of balance or proportionality in the agreements. The implications of
using such agreements can harm one party due to their limited bargaining power,
even to the extent of losing substantive elements of the agreement.
Nevertheless, the party in need must still accept these conditions due to
urgent necessities. Insurance companies (insurers) generally draft standard
agreements unilaterally in contractual relationships. The restrictions on the
terms of the agreement often diminish the rights of one party while emphasizing
the restrictions on the obligations of the insurer. Exemption clauses are
commonly found in insurance agreements, yet the insured party has no option to
refuse such terms, ultimately leading to potential harm for the insured.
It
should be noted that the freedom to formulate and draft standard clauses in any
standardized agreement or documents prepared by businesses is part of
contractual law. Respect for and acknowledgment of individuals' rights to
contract freely are guaranteed by statutory regulations as long as they do not
contravene morals, public order, and existing laws. Article 18 of Law Number 8
of 1999 concerning Consumer Protection (UUPK) stipulates:
1. Business
actors are prohibited from including or making standard clauses in documents or
agreements if they:
a. Regulate the transfer of liability of the business
actor;
b. Grant the business actor the right to refuse the
return of goods purchased by consumers;
c. Grant the business actor the right to refuse the
refund of money for goods and/or services purchased by the consumer;
d. Grant authority to the business actor, directly or
indirectly, to act unilaterally regarding goods purchased in installments by
the consumer;
e. Regulate proof of loss of utility of items or
utilization of services purchased by consumers;
f. Give the business actor the right to reduce service
benefits or reduce the wealth of consumers that constitute the buying object;
g. State that consumers are subject to new, additional,
follow-on, and/or changes that are unilaterally set by the business actor while
consumers utilize the purchased services;
h. Grant authority to the business actor to create
collateral, mortgage, or guarantee rights over goods purchased by consumers in
installments.
2.
Business actors are also
prohibited from including standard clauses that are in hard-to-see locations,
illegible formats, or difficult to understand. Any standard clause that does
not meet the provisions of paragraph (1) and paragraph (2) is declared null and
void. Business actors are required to amend standard clauses that violate the
provisions of this law (UUPK).
In
addition to being declared null and void, business actors who do not comply
with the provisions of Article 18 of the UUPK may face criminal penalties of up
to five years in prison or fines of up to two billion rupiah, as regulated in
Article 62 paragraph (1) of the UUPK. Standard clauses can be formulated in
detail using specific numbers or articles or briefly in the form of clauses
containing certain meanings. Regarding signing insurance agreement documents,
such documents must fully and thoroughly contain standardized clauses. These
documents must be handed over to the insured as consumers for signing,
including documents such as requests for insurance, the insurance policy and
its attachments, such as general and special terms of the policy, and lists of
benefits that have been agreed upon by both the insured and the insurer.
Standard
clauses contained in standard insurance policy agreements can legally provide
assurance of certainty and legal protection to all parties, both the insured
and the insurer. This is because standard clauses in insurance agreements are
based on aspects of demand, offer, and acceptance undertaken by each party and
are fully carried out in accordance with the principles of contractual freedom
and good faith until an agreement is reached. This is not solely based on the
principle of "take it or leave it." The insured (consumer) is not
left with just two options: to accept or decline. Instead, there is a process
of negotiation and bargaining between the parties before reaching consensus. If
there is no agreement in that negotiation process, then the insurance agreement
will not materialize.
There
is a fundamental difference between conventional insurance and social
insurance. Conventional insurance is voluntary, whether in the form of property
or life insurance, which essentially fulfills secondary needs for the insured
once primary needs have been met. Therefore, the insured has demanded that more
reflect fairness (fairness) and better service. Thus, insurance companies must
refrain from indiscriminately drafting standard clauses in policies. In
contrast, social insurance is mandatory and aimed at helping the insured meet
unmet primary needs. While conventional insurance companies are expected to
compete continually, social insurance reflects the state’s duty to fulfill citizens'
basic needs and rights who have not yet achieved prosperity.
Exemption
clauses are clauses found in a contractual relationship aimed at avoiding
obligations in the form of compensation for damages, either wholly or
partially, arising from the breach of the agreement. Several experts suggest
that exemption clauses release liability in contractual relationships, which
should not be permitted to exempt responsibilities stipulated in the agreement.
The transferred obligations aim to protect the interests of one party through
the transfer of responsibilities. To achieve equality of rights and obligations
for all parties in insurance agreements and to prevent losses to one party, an
agreement must include elements of consent. Such agreements must not misuse
circumstances, as this constitutes a defect of will. The Civil Code does not
recognize the concept of abuse of circumstances or imbalance of bargaining
power in any given agreement. However, in practice, abuse of circumstances can
be regarded as a form of defect of will in the agreement.
Article
251 of the Commercial Code (KUHD) asserts that the insured must provide
information regarding all conditions known to them related to the object being
insured. This action is an effort to mitigate risks that may arise from that
object, which belongs to and is controlled by the insured. To avoid losses arising
from exemption clauses when agreeing, besides adhering to Article 1320 of the
Civil Code governing subjective requirements, Article 251 of the KUHD must also
be included as a guideline. This aims to create equality of rights and
obligations between the parties.
The
inclusion of exemption clauses that burden the insured party can be seen as a
limitation on the principle of freedom to contract, as stipulated in Article
1338 of the Civil Code. This freedom is often dominated by one party with more
substantial bargaining power, meaning exemption clauses in standard agreements
are typically determined unilaterally by the insurer without involving the
insured. This situation permits the insurer to abuse such circumstances. Consequently,
the losses that might arise from exemption clauses will be felt by the insured.
One of the common problems the insured faces is the difficulty in obtaining
compensation payment when an insured event occurs.
The
juridical construction of contractual liability in forming a standard insurance
policy agreement begins with an understanding or knowledge regarding the
agreement to be made. This understanding is obtained through a request for an insurance
form, which must be filled out entirely by the insured before the agreement is
made. Following the request document, the insurer or business actor will
prepare the agreement draft for signing. Therefore, the standard insurance
policy agreements prepared by business actors reference the insured's request
documents. If the standard clauses in the insurance policy agreement do not
align with the insured's wishes, the insured has the right to refuse to sign
that agreement. There are three important aspects that prospective insureds
should consider before signing the standard insurance policy agreement:
3.
Understanding the
Agreement's Content, the prospective insured must comprehend the terms or
provisions of the agreement to be signed, both before and at the time the
agreement is signed (Contemporaneous Doctrine).
4.
Reduction or Limitation of
Liability: Prospective insureds need to be aware of reductions, limitations, or
eliminations of obligations or responsibilities placed upon the business actor
(insurer), as well as the creation of obligations placed upon the insured as
consumers (Exoneration Clause). Types of exoneration clauses to note include a)
reductions or eliminations of liability towards legal repercussions, such as
damages due to the breach of contract; b) limitations or eliminations of
obligations from the business actor; c) creation of obligations directed at one
party, for example, obligations to compensate third parties who suffer losses.
5.
Abuse of Circumstances: Prospective
insureds should be wary of potential abuse of circumstances (weakness, doubt,
or pressing conditions) that could influence their decisions, thus diminishing
their freedom to act. Abuse of circumstances (Undue Influence) can benefit the
insurer and harm consumers (insured). Indicators of abuse of circumstance
include:
a. Agreement content that is unreasonable, inappropriate,
or contrary to humanitarian principles (unfair contract terms);
b. The prospective insured is under pressure;
c. The prospective insured lacks alternative options but
to accept the agreement's terms, even if deemed burdensome;
d. An imbalance of rights and obligations between the
parties.
Standard
clauses in insurance agreements often become a source of weakness for consumer
protection, especially due to their unilateral nature, which provides no room
for negotiation. The insurer usually speculates these clauses considering their
interests, which can result in injustices within contractual relationships. In
many cases, consumers lack the ability to understand and negotiate every detail
of clauses that may contain restrictions or exclusions undermining their rights.
This can make consumers feel compelled to accept unfavorable terms, which may
affect their protection when filing claims.
Furthermore,
exemption clauses in insurance agreements can also lead to legal uncertainty
for consumers. These clauses often relieve the insurer of liability in certain
situations, making it difficult for consumers to obtain the compensation they
should receive when insured risks materialize. The lack of clarity or
complexity in the legal language within standard clauses can hinder consumers'
understanding of the insurer's
liabilities, thus increasing the risk of unexpected losses. Therefore, the
imbalance in the formulation of standard clauses can diminish the effectiveness
of the protection afforded to consumers and create situations in which their
rights are not fully respected.
The imbalance in the
formulation of standard clauses can diminish the effectiveness of the
protection afforded to consumers, creating a scenario in which their rights are
not fully respected. The nature of standard clauses, as standard provisions
predetermined by insurance companies in policy agreements, are typically
drafted without active participation or involvement from consumers. The
unilateral nature of these standard clauses poses the potential for injustice
since insurance companies, as the drafters of clauses possess greater
bargaining strength than consumers. As a result, consumers often feel compelled
to accept terms dictated without the ability to negotiate or request changes
more suited to their needs and interests. This injustice can harm consumers,
especially when standard clauses contain terms that absolve the insurer of
liability for losses or claims consumers might submit.
The absence of
consumer participation in drafting standard clauses not only creates injustice
but also leads to gaps in legal protection for consumers. Many consumers do not
fully understand the implications of the agreed-upon clauses, which can leave
them unaware of the risks they face. For instance, certain standard clauses may
contain exoneration provisions that reduce or eliminate the insurer’s
responsibilities in certain circumstances. This can leave consumers feeling
trapped in an unfair agreement where they do not receive the protection they
should obtain. The unilateral nature of standard clauses also fosters legal
uncertainty, causing consumers to hesitate when it comes to filing claims, as
they may not be sure whether the existing provisions will safeguard their
rights. The lack of clarity in standard clauses can lead to conflicts between
consumers and insurance companies, which may trigger potential legal disputes.
Lack of legal
knowledge about standard clauses in insurance agreements poses a significant
issue that can disadvantage consumers. Many consumers do not have enough
knowledge about legal terminology or the concepts that exist within standard
clauses. This limits their understanding of the rights and obligations they
agree to when signing insurance policies. This lack of understanding often
results in circumstances where consumers feel powerless and unaware of the risks they may face due to the provisions outlined in
standard clauses. For instance, if there is a clause limiting or eliminating
the insurer’s liability in certain situations, consumers may be unaware that
they have agreed to terms that could lead to financial losses when filing
claims.
This legal
misunderstanding also inhibits consumers from negotiating the terms within
insurance agreements. Consumers who do not comprehend standard clauses may feel
they lack the capacity or confidence to request changes or clarifications on
provisions they consider unfair. In such situations, consumers tend to accept
the terms as they are without questioning or negotiating the conditions
established by the insurance company. As a result, consumers not only lose the
opportunity to secure better protection but also risk being caught in
unfavorable agreements. This lack of understanding can create uncertainty and
dissatisfaction among consumers. When consumers encounter situations where they
must file claims, they may feel confused or frustrated when realizing that the
terms they agreed to do not provide the protection they anticipated. This can
lead to a loss of trust in insurance companies and the insurance system
overall.
Complex legal
language in insurance agreements represents one of the main obstacles hindering
consumers from understanding the content and meaning of the clauses contained
in the policy. Legal language often involves technical terminology, formal
phrases, and complicated sentence structures that can make it difficult for the
average person to comprehend. For example, terms like "exoneration,"
"liability release clauses," or even more general terms like
"default" can be obscure for consumers without a legal background.
Consequently, consumers may face challenges interpreting what they actually
agreed to, potentially causing legal uncertainty and confusion when they
encounter situations requiring claims.
This lack of clarity
often leads to serious misunderstandings concerning the rights and obligations
of consumers. Consumers may be unaware that certain clauses may limit their
rights to file claims or grant more authority to the insurance company to reject
claims under specific conditions. For example, if consumers are not fully aware
of provisions regarding "the obligation to provide accurate
information," they may inadvertently provide inaccurate or inadequate
information, which the insurance company could subsequently use to deny a
claim. This poses significant risks for consumers who may hope to receive
coverage but instead face detrimental complications.
Based on these
challenges, several efforts need to be undertaken to create legal certainty,
including simplifying legal language in insurance agreements, which is a vital
step in enhancing consumers' understanding of standard clauses. Many consumers
struggle with understanding the complex legal terms and technical jargon often
present in insurance documents. By simplifying the language used, insurance
companies can make these documents more accessible to consumers without legal
backgrounds. For instance, companies could replace difficult terminology with
more common terms or provide clear definitions alongside technical terminology.
This would not only reduce confusion but also enable consumers to grasp better
the terms they are endorsing.
Using clear and
easily understood language also contributes to consumers' awareness of their
rights and obligations within insurance agreements. When consumers can
comprehend the contents and meanings of clauses better, they will be more
capable of evaluating the applicable terms and conditions. This empowers them
to make more informed and wise decisions regarding whether to proceed with or
negotiate particular clauses. Additionally, with better understanding,
consumers will be more prepared to ask questions or seek clarifications about
provisions that may seem detrimental or confusing to them.
Involving consumers
in the drafting of standard clauses is a crucial step in creating a balance in
the contractual relationship between insurance companies and consumers. By
engaging consumers in this process, insurance companies can ensure that their
interests and needs are adequately accommodated. One way to encourage this
involvement is by holding forums or discussions where consumers can provide
input or feedback regarding clauses that will be implemented. Through open
dialogue, consumers can express their views on clauses that may be deemed
detrimental or unfair, resulting in agreements that are more transparent and
equitable for all parties involved. This not only enhances fairness in the
agreements but can also strengthen consumers’ loyalty to the insurance company.
Furthermore,
involving consumers in the drafting of standard clauses can also enhance their
understanding of the content of the agreements. By participating directly,
consumers have the opportunity to ask for clarifications on provisions that may
be confusing or sound complicated. This process fosters greater awareness of
their rights and obligations as insured parties, as well as provides them with
the opportunity to adjust the terms of agreements to better align with their
situations and needs. When consumers feel heard and involved, they are more
likely to appreciate the agreements generated and feel more responsible for the
decisions made.
On the other hand,
stringent regulations are also critically needed to ensure consumer protection
in standard clauses of insurance agreements. The government and supervisory
authorities play essential roles in establishing provisions that require
insurance companies to clearly explain each clause that could absolve them of
liability. For example, regulations could include requirements for insurance
companies to provide clear and simple explanations of each clause that might
significantly affect consumer rights. With such regulations, consumers will be
better protected against harmful practices, and insurance companies will be
held more accountable for the drafting and communication of the clauses they
employ.
Insurance agreements
and standard clauses demonstrate that although insurance agreements serve to
transfer risk and provide protection to the insured, there are significant
challenges regarding the balance of rights and obligations between the insurer
and the insured, especially due to the use of standard clauses often drafted
unilaterally by the insurer. Exemption clauses, which relieve the insurer of
liability under specific conditions, can potentially harm the insured by
limiting their right to receive fair compensation when insured risks
materialize. Furthermore, the existing ambiguity in the contents and complexity
of the legal language in these clauses can hinder consumers from understanding
and negotiating the agreements they sign, thus increasing the risk of
injustice. Therefore, it is imperative for all parties to consider the
principles of consumer protection, transparency, and good faith in the
preparation and execution of insurance agreements so that a more just and
equitable contractual relationship can occur and enhance public trust in the
insurance industry as part of financial services.
The imbalance in the
drafting of standard clauses in insurance agreements can result in ineffective
protection for consumers, creating unfairness and legal uncertainty and
reducing consumers' understanding of their rights and obligations. With
standard clauses frequently drafted without active participation from
consumers, many feel compelled to accept unfavorable terms without being able
to negotiate changes that better suit their needs. The lack of legal
understanding regarding complex terminology, combined with the
unilateral nature of such clauses, can lead to serious misunderstandings, where
consumers remain oblivious to the risks they may encounter and ultimately lose
trust in insurance companies. Therefore, measures such as simplifying legal
language, involving consumers in the drafting of clauses, and implementing
stringent regulations are necessary to ensure transparency and fairness,
allowing consumers to comprehend and evaluate their rights and obligations more
effectively, thus fostering the establishment of a more balanced and mutually
beneficial contractual relationship.
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