One of the problems you encounter is the calm with which insurers process claims.
It is clear that managing a claim takes time, because you have to open the part of it, verify the policy, send an expert, etc. Nor should we forget that some insurers have decentralized paperwork administration, which also lengthens the process.
As a result of this you have to spend a considerable time without a response from your insurance company.
To avoid such disappointment, below, we explain the three basic steps to make an insurance claim and avoid the eternal wait.
1. Initial notice to the insurer
If you have been involved in an accident you have to notify your insurer.
The normal thing is to inform the agent (the person who has sold you the policy), or communicate it by phone, fax or email to your insurance company.
It is significant that you do not forget to ask for the file number. Because this reference will be very useful for future procedures and will allow you to carry out any subsequent action.
2. Informal claim to the insurer
If your insurer does not respond to you within a reasonable period of time (approximately 1-2 weeks), it is highly recommended that you try to contact them and record your request.
It is vitally important that you leave a written record of this step.
Although it is not a formal insurance claim, it is good that this second communication is in writing, the most normal way is email.
We consider that this means is the most appropriate in this phase. It has no cost to you and allows you to record your request and claim. This is very attractive, if you do not reach an agreement with your insurer and you are forced to use a judicial procedure.
3. Formal insurance claim
If you have finished the previous phases without having a favorable response to your claims, either because they have not answered you or they have done so in a negative way, then it is time to consider making a written claim to your insurer.
For this claim we have several options.
3.1. Complaint in writing to the insurance company before the Department of the Ombudsman of the Insured.
The Insured Ombudsman is an independent body, which can be designated by one or more insurance companies. Its objective is to resolve the conflicts and claims that policyholders, insured persons, beneficiaries and injured third parties may present against said entities.
You can go to this organization if you believe that the insurer's response is not correct or when you do not even receive a response from it.
You must make this claim in writing and send it by certified mail or any other way that allows you to obtain an acknowledgment of receipt.
The address of the Insured Ombudsman must be provided by the insurance company, being published on numerous websites.
The maximum period with which it has to respond is 2 months. If after this time you do not receive a satisfactory response or your request is denied, the way to the next step is opened.
3.2. Claim before the Claims Service of the General Directorate of Insurance and Pension Funds.
This service attends to the queries, complaints and claims presented by the inhabitants through the procedure included in Order ECC/2502/2012, of November 16.
In this case, you have to submit a formal claim in writing, either through a written burofax or electronically.
To access the General Directorate of Insurance and Pension Funds where it explains the procedure to follow, click here.
You have to keep in mind that these two options are not mandatory, but simply a possibility that the law makes available to you.
If these two options do not give you a satisfactory result, there is also a third:
3.3. Formal insurance claim by burofax or electronic form with acknowledgment of receipt.
It consists of sending directly to the insurer a previous formal claim with acknowledgment of receipt. Remember that reception is essential.
This way of doing it has a double objective that is:
On the one hand, if your claim is strong, the insurance company may be scared enough to want to settle.
On the other hand, if you finally have to go to court, you can use this claim to interrupt the statute of limitations and it will serve to justify the existence of previous claims with the insurance.
When making an insurance claim, there is no mandatory structure that you have to use (except in the case of traffic injuries where there are certain nuances). What you should indicate is the following:
- Personal data of the claimant (name, surnames, DNI) and their status with respect to the company (insured, policyholder, injured party,)
- Details of the insurer, the policy number or its insured (if you have it) and the claim number.
- Justification of what you claim. This is the body of the claim. Here you will detail why you direct your claim to the insurance company. You will make your request and give your insurance a short period of time to attend to your request with the warning that, if you do not do so, you will initiate legal action.
- Signature, date and place.
As you can see, steps 1 and 2 are always convenient to carry out because they are common sense.
Then, when it comes to how to make a formal insurance claim, you have several options. So you will have to choose the one that suits you best.
Our advice is that you always try to reach an agreement with the insurance company. But if you see that they do not give you a favorable response within a reasonable period of time, then do not delay too much in procedures that may not lead to a satisfactory result.
When there is a blockage in the negotiations, it is usually best to seek the advice of an expert to shuffle the different possibilities.
If you want to stop worrying about all this hassle, call us.