Société

Êtes-vous bien assurés en cas de problèmes en vacances ?

C’est la période des vacances et chacun de nous se pose la question de savoir quelles assurances à souscrire avant son départ. Car, sur votre lieu de vacances, un simple accident peut devenir très vite un véritable cauchemar. Pour des vacances sereines, vos contrats d’assistance vous couvrent afin que vous soyez à l’abri de tous soucis.


Si dans la pratique et pour la majorité des clients non avisés, l’assistance s’apparente à un dépanneur occasionnel ou, pour les demandeurs de visas auprès de consulats étrangers, à un simple document obligatoire souscrit à contre cœur, dans l’espoir d’obtenir le fameux sésame et voyager en «outre-mer», cet état d’esprit est loin de refléter les réalités d’un secteur où les assisteurs innovent, réinventent leur métier et cherchent de nouveaux débouchés pour des prestations d’un haut niveau de professionnalisme. Cette vérité porte ses fruits, à en juger par la croissance continue d’un jeune secteur – qui a moins d’une trentaine d’années d’existence en tant qu’activité réglementée – et par la multitude des prestations conçues pour un public en situation de détresse.

La réglementation marocaine ne donne pas de définition précise de l’opération d’assistance, mais on peut s’en référer aux Directives européennes -dont s’inspirent largement le Code marocain des assurances– et en particulier celle du 10 décembre 1984 qui contient les éléments essentiels résumant les spécificités de ce métier : « L’activité d’assistance concerne l’assistance fournie aux personnes en difficulté au cours de leur déplacement ou d’absence de domicile ou de lieu de résidence permanente. Elle consiste à prendre, moyennant le paiement préalable d’une prime, l’engagement de mettre immédiatement une aide à la disposition du bénéficiaire du contrat d’assistance, lorsque celui-ci se trouve en difficulté par suite d’un événement fortuit, dans le cas et les conditions prévus par le contrat ».

Une assistance technique au quotidien liée au véhicule
C’est le produit phare du marché de l’assistance. Cela paraît évident tant que le but avoué d’un assisteur est de garantir une mobilité totale aux clients si celle-ci venait à être compromise par la survenance d’un événement qui pourrait la compromettre. L’assistance au véhicule et à ses occupants est, sans doute la forme d’assistance pour laquelle les centrales sont les plus sollicitées. Une des forces d’une compagnie d’assistance réside dans sa capacité à créer et à entretenir des réseaux qualitatifs et suffisamment denses géographiquement, de dépanneurs-remorqueurs pour pouvoir répondre à la demande de ses assurés. Le dépanneur dépêché sur place sera dans la plupart des cas un mécanicien à qui il sera possible d’effectuer une réparation fût-elle provisoire, qui permettra au client de poursuivre sa route jusqu’à son domicile ou jusqu’à un garage si nécessaire.
En cas d’impossibilité de réparation du véhicule sur place, la plus commode des solutions est sans conteste la mise à disposition d’un véhicule de remplacement pendant la durée des réparations avec toutefois certaines limites (en général 5 ou 7 jours maximum). Une autre solution est de permettre aux assurés de rejoindre leur destination, leur domicile ou leur lieu de séjour.

L’assistance médicale
L’assistance médicale est sans conteste la plus spectaculaire et la plus complexe des formes d’assistance existantes. Dès les premiers contacts pris à la déclaration d’un accident ou d’une maladie, le chargé d’assistance doit faire montre de beaucoup de psychologie. Il lui faut en effet recueillir un maximum d’informations sur d’une part, l’état de l’assuré, le contexte dans lequel est survenu le sinistre (maladie ou blessure), dans quel environnement il se trouve (voyage-t-il seul ou accompagné?). Ces quelques questions permettront d’entamer au mieux une prise en charge médicale. Dans les cas les plus graves, il faut parfois procéder à un rapatriement. Bien souvent, le grand public retient de l’assistance l’image d’un avion sanitaire spécialement équipé qui surgit pour sauver un patient abandonné au milieu de nulle part.
L’assisteur prend parfois le rôle d’un assureur, notamment lorsqu’il se substitue à lui et qu’il propose la « prise en charge » des frais d’hospitalisation de son assuré. La raison en est simple et pratique, c’est qu’il est généralement le premier prévenu de la survenance d’un problème médical. Actuellement, les montants de prise en charge sont plafonnés et varient, en fonction des contrats, mais peuvent être illimités pour les formules les plus performantes du marché.

L’assistance : vous êtes servis à partir d’un plateau
Quelles que soient les garanties, les sociétés d’assistance ont toutes plusieurs atouts qui font la spécificité du métier : le savoir-faire des hommes, un réseau national et international de prestataires de services et de contacts et un support technique qui leur permet de gérer des milliers de dossiers et des millions de communications téléphoniques par an, de régler les problèmes de logistique pour les interventions : hôtels, remorquage, avions.
Le téléphone et l’informatique sont les deux outils de base. Les sociétés organisent en général leur siège en trois plateaux. Le plateau technique gère les demandes de clients en difficulté avec leur voiture ou leurs moyens de locomotion. Le plateau médical prend en charge les soins, hospitalisations et rapatriements sanitaires. Le troisième plateau est consacré aux conseils pratiques et aux services à domicile. Les chargés d’assistance, qui réceptionnent les appels sur les différents plateaux, sont équipés de standards numériques sophistiqués.

Le casse-tête des exclusions de garanties
Les contrats d’assistance, comme tous les autres contrats d’assurance, n’échappent pas aux « exclusions de garantie ». Il est donc utile de bien lire son contrat d’assistance avant de s’engager car, c’est malheureusement à l’occasion d’un problème technique ou d’un souci de santé qu’on peut vous opposer ces exclusions qui sont de deux sortes : des exclusions communes à toutes les garanties et dans le cas des garanties de base : par votre fait intentionnel, ou votre complicité ; accidents résultant de la pratique de sport dans le cadre d’une compétition officielle organisée ou par le fait d’une guerre civile, actes de terrorisme ou de sabotage, etc. Et des exclusions particulières telles : les voyages entrepris dans le but de diagnostic et/ou de traitement; les maladies préexistantes diagnostiquées et/ou traitées, ayant fait l’objet d’une hospitalisation dans les six mois précédant la demande d’assistance; des hospitalisations pour des maladies pouvant être traitées localement ( une exclusion abusive souvent avancée par les sociétés d’assistance les frais engagés après le retour du voyage ou l’expiration de la garantie ; les frais de restauration, d’hôtel, de route, de péage, de carburant, de taxi ou de douane, sauf ceux prévus au titre de la garantie.


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