What can I do in case of disagreement with the resolution of my claim?

What can I do in case of disagreement with the resolution of my claim?

WHAT CAN I DO TO GET PAID WHAT IS FAIR?

What if I disagree with the offer made by the insurance company?

How can I claim or enforce my rights in the event that the insurer does not want to pay me what I think is my due?

What are the ways to claim our insurer ?

The most important moment in an insurance contract is when it has to proceed to compensate me for the damages I have suffered. At that time, the insurer must be liable for the coverage that I have contracted and, therefore, must, after assessing the damages, proceed to compensate me in the best way allowed by the signed contract.

At that time, the insurer must send me an offer of compensation, which I must accept.

In most cases this happens automatically and with the full satisfaction of the insured, but…. Sometimes not. Sometimes, I will not agree with the compensation that the insurer proposes to me.

What can I do in those cases?

In principle, “those cases” can be reduced to 3 situations:

  • The claim is not covered : the insurer rejects your compensation and, therefore, does not offer any amount of money, or repair of the damages incurred.
  • The loss is covered, but…: The capital we have insured is not enough to cover the value of the damaged goods. The insurer offers us partial compensation for the damages.
  • The claim is covered, but…. The declaration of the insured assets does not adjust to reality: the activity, the situation, the protections or other risk factors that the insurer asked us about when contracting the policy, do not adjust to reality. The insurer offers us partial compensation for the damages.

Okay okay, but what do I do?

First verify that our disagreement has a basis and that this basis indicates that we are right. That the errors invoked by the insurer are not such, or that they are attributable to it. Your Insurance Broker has the obligation to help you in this step. It is one of its fundamental duties, to advise the insured in the processing of the claim.

The first possibility that we can go to is the judicial route , but it is not recommended due to the time and money it costs.

The other possibilities are mainly 3:

  • Apply the provisions of article 38 of the Insurance Contract Law, regarding the appointment of an expert who represents the insured and who, as such, defends our rights against the insurer. The same article establishes the appointment of a 3rd. expert in case of disagreement with the previous two. It is a mandatory procedure, before going to court, for disputes related to the amounts or limits of coverage of the policy.
  • The second possibility is to go to the Customer Service Department or to the Insured’s Ombudsman that the insurance companies have, and whose resolution is binding for them, but not for the insured.
  • Finally, you can go to the General Directorate of Insurance and Pension Funds DGSFP ) , which has a mechanism to defend the interests of the insured. This instance cannot be accessed without having previously tried the arrangement through the Customer Service department of the corresponding insurer.

Meanwhile our claim is being developed, the Insurance Contract Law is placed next to the insured, forcing the insurer to advance the payment of the “minimum known amount” of the claim, within 40 days after knowing that amount. (Art. 18 LCS 50/80)

Also the same Insurance Contract Law, in its article 20, indicates that, in case of unjustified delay by the insurer, after the 40 days mentioned in article 18, with respect to the minimum amount, or three months from production of the claim with respect to the global benefit, provision is made for the surcharge of interest on this benefit in favor of the insured, the beneficiary or the injured third party. Surcharge that we must include in our claim, judicial, with appointment of an expert or with assistance to the customer service departments of the insurer or the DGSFP .