What to do in case of disagreement with the refusal of my claim?

Refusal of my claim

What to do in case of disagreement with the refusal of my claim?

What should I do if I disagree with the refusal of my claim?

Cover claims. This is the goal of any insurer. However, this goal is not always achieved by insurance companies. There are several ways to get back to your insurer if you disagree with them. Apart from the judicial route, there are three possibilities which are regulated in Spanish law:

Appoint an independent expert

This will be done at your expense. Provisions of art. 38 of the Insurance Contract Law (Ley de contrato de seguros). The insured has 40 days to appoint his own independent expert when he does not agree with the expertise of his insurance company. Once appointed and communicated to the other party, the company has 8 days to appoint an expert. The 2 experts may reach an agreement, but if not, they may appoint a third expert by consensus who will have 30 days to issue his report. This procedure is considered mandatory when the dispute is about the amount or the form of the compensation.

As a general rule, your insurance company must compensate you for the minimum amount within 40 days of the claim being reported. The Insurance Contracts Law (Ley de contrato de seguros) establishes the said condition "to make payment of the minimum amount of what the insurer may owe, according to the circumstances of which it is aware". Therefore, even if the adjuster's decision has been challenged, your insurer must have paid you this minimum amount, within the time limit set. If the expert's decision is not contested, the insurer will pay the amount of compensation indicated by the experts within five days. If it is contested, it will be necessary to wait for the resolution of the third expert.

Possibility of contacting the claims department of the insurance company if my claim is denied.

In Spanish, the department is called "Defensor del asegurado". The department is totally independent from the insurance company. The legal deadline for a response is 2 months. Nevertheless, the insurance companies try to process all the requests they receive quickly. In fact, 86% of the industry is committed to processing them within 30 days.

Making a claim to the Claims Department of the Directorate General of Insurance and Pension Plans (DGSFP)

The DGSFP can be contacted by various means, including by telematics. In order to contact this service, it is necessary to demonstrate that you have previously contacted the insurance company's complaints department (point 2). The maximum response time is 4 months.

As a result of all this, it is very important to entrust your insurance contracts to an insurance broker who will be able to accompany you throughout the claim and the management of your contract. He will be able to defend your rights and interests because he is totally independent from the insurance company. You can consult our article on the role of a brokerage firm by clicking here.

In case of you do not have insurance, do not hesitate to ask us for a comparison of the best insurances here

There are many insurance companies and different contract options. For this reason, we recommend that you use the services of a specialist broker who will be able to guide you. If you have any questions, do not hesitate to contact us directly by telephone on +34 93 268 87 42 or through WhatsApp on +34 627 627 880 or by email: [email protected]

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