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What should the insurance claim contain?

What should the insurance claim contain?

What should the insurance claim contain? Below, we concisely list all the documents you must gather and the steps you must follow when claiming compensation from your insurance company. Knowing how to make a claim to the insurer is essential for your claim to be resolved satisfactorily. Processing a claim to the insurance company takes time, but you want to do your best so that the process bears fruit.

We indicate what your claim should contain:

  1. It is convenient to record the number of telephone calls made to the insurer, with the exact date, and the result of the same
  2. Record the date of the first refusal
  3. If there was physical damage, submit medical reports
  4. Accompany all kinds of related documents: photos, statements, etc.
  5. Always send the documentation by certified mail.
  6. Keep the file number.
  7. Request in writing, within one or two weeks, a resolution of your claim
  8. If there is no satisfactory response, make a formal complaint to the insurance through a burofax with acknowledgment of receipt, through the Insured Ombudsman Department, or through the Complaints Service of the General Directorate of Insurance and Pension Funds
  9. In case of not obtaining results, start the legal process, mediation, or arbitration

Does it cost anything to claim from the insurer?

Claiming against your insurer is free of charge. However, if the refusal is persistent, it is advisable to have a freely appointed lawyer, independent of the insurance company, who ensures that you get the maximum compensation and that will generate added expenses. The lawyer who is going to defend your case should be an expert in insurance claims. There are many lawyers who only charge if you charge since they go on commission.

Can an insurer refuse to pay a claim?

The insurance companies receive an amount of money from the insured so that, in the event of a claim, the agreed service is compensated or provided for the damage caused.
However, there are some occasions when insurers reject the payment, which generates a logical frustration in the insured, who does not know where to turn. Normally, this happens when insurance is contracted without knowing well the duties and rights that are acquired at the time of signing it.
What are the reasons a motor vehicle insurer may refuse to pay a claim? Here we point out some:

  1. The driver does not have the required driving documents in force at the time of the accident.
  2. The driver is under the influence of alcohol or drugs.
  3. The driver does not make the relevant report to the Police about the accident in case there are injuries or theft.
  4. The driver does not provide assistance to the victims in the event of a hit or similar accident, because failure to provide assistance constitutes a crime.
  5. If the insured stops paying the installments.
  6. If the company considers the veracity of the documentation or data provided by the insured to be inconsistent.

COMPARE CAR INSURANCE

For these reasons, it is advisable to read the entire text of the policy, in order to be very clear about the corresponding coverage and exclusions. It is also worth learning about the company’s reputation and the type of insurance you are purchasing.

ABSTRACT

  • If you are thinking of filing a complaint with your insurer, talk to your agent first before filing a written claim with the Insured Ombudsman department.
  • The last resort to resolve a dispute with your insurance company is the judicial route, but in this case, you will have to deal with the legal issues that are generated.
  • Sometimes companies refuse to pay a claim if the driver does not have valid driving documents or is under the influence of alcohol or drugs. Also if the statements are false or the policy premiums have not been paid.

FAQs – Frequently Asked Questions

How to claim damages to an insurer? It must be requested in writing and by certified mail through the Insured Ombudsman or through Customer Service.

How long does an insurer have to respond to a claim? There is a maximum period of two months to resolve the request in favor or against the insured and you have another 10 days to communicate the answer.

When can an insurer refuse to pay? When the driver does not have valid mandatory driving documents, when the insured’s declarations are false, when driving under the influence of alcohol or drugs or when the premiums of the contracted policy have not been paid.

Sources:

  • http://www.dgsfp.mineco.es/es/Consumidor/Reclamaciones/Paginas/InformacionProcedimiento.aspx
  • https://www.consorseguros.es/web/inicio

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