How to make a claim against an insurance?

Insurance companies and policyholders are frequently associated on a day-to-day basis. The law requires that we have car insurance and many people choose to take out home insurance, health insurance or travel insurance, among others, and as in any other relationship, conflicts may arise as a result of a problem or customer complaint with the company.

Conflicts with insurers are more common than it seems but, when it comes down to it, we don’t really know how to proceed when filing a complaint or claim. In this article we are going to tell you what to do in case of conflict with the insurer? and How to make a claim against an insurer?

Have you ever wondered what you should do if you want to appeal or claim your insurer? The most important thing is to read the policy in detail to understand exactly what each party is obliged to do. It will be the policyholder, the insured, the beneficiary or even an injured third party who have the possibility of claiming.

There are several ways to make this claim:

  • Insurance mediator or broker
  • The insured’s advocate and customer services
  • consumer associations
  • Arbitration route
  • judicial route

Claim the insurer: Mediator or insurance broker

The first thing we have to do in any situation of conflict with the insurance is to contact our insured and go to our insurance mediator or broker, since he will be the one who best knows our situation and who can best advise us.

If we have not contracted the insurance through an insurance mediator or broker, we can go directly to the insurer to present our problem or our complaint.

It is essential to read the fine print of insurance contracts, even if they are difficult to understand.

If even so, it is not resolved, the next claim route will be the insured’s defender and customer service.

Claim the insurer: The insured’s defender

Each insurer has a defender, but he acts independently and his resolutions are only enforceable by the insurer, not by the client.

The steps you must follow to go to this claim route are the following:

  • File a claim in writing with the Ombudsman for the Insured (appointed by the Insurer itself) or, failing that, with Customer Service. First of all, the document must be sent by certified mail with acknowledgment of receipt, burofax or a means that allows having proof of its presentation.
  • If two months have passed since the claim was filed, it has still not been resolved, admission has been denied or the request we required has not been accepted, we can go to a second channel, the General Directorate of Insurance.

There is also the Commissioner for the Defense of the Insured and the Participant in Pension Plans. This figure is regulated in the Regulation of the commissioners for the defense of the financial services client (Royal Decree 303/204 of February 20).

It is a body belonging to the General Directorate of Insurance and Pension Funds, which aims to make it easier for users for their complaints, claims and queries to reach the corresponding authorities of insurance companies and to protect the rights of users insurance and pension plans.

Claim the insurer: Consumer associations

Consumer associations aim to protect users or clients from companies, and in these associations we can obtain information and they can help us on the possible options we have against insurers.

Claim the insurer: Arbitration route

The arbitration route is an extrajudicial route that allows conflicts between insurer and insurer to be resolved quickly, efficiently and, above all, economically. It is usually the most favorable option for the insured, since they do not have to face the high legal costs that may derive from the judicial process.

  • To resort to this route, the insured must submit the request for arbitration in writing to:
  • Community consumer information offices.
  • User consumer associations adhered to the arbitration system.
  • Personally at the Regional Consumer Arbitration Board.

Claim the insurer: Judicial route

All those conflicts that have not been able to be resolved by any of the above means, may be brought before the courts of justice.

The competent judges to resolve all kinds of conflicts with insurers are the judges and courts of the domicile of the insured, without the possibility of making an agreement to the contrary.

There are two types of claims to make through the courts:

  • Claim for material damage.
  • Claim for accidents with injuries.

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