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How to interpret an insurance policy: 9 points that you should check

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insurance policy

Do you know how to interpret an insurance policy, understand its content?

Are you one of those who take out the insurance policy and then don’t read it?

Well, you are making a mistake.

It is a contract and you run the risk that when the time comes you will find yourself with the surprise that there is no coverage for that incident. More than 18% of those who take out insurance do not read the conditions, and 54% do so above.

An insurance policy is certainly not a ” best seller, ” although many copies are sometimes sold. It is not very entertaining to read and difficult to understand. Especially when you are faced with long and cumbersome texts and terminology only for the initiated.

Don’t mess around!

In this article, I am going to tell you how to interpret an insurance contract. I will mark what content is essential that you review to facilitate the reading of the fine print. And by the way, you can clear those doubts that you did not dare to ask.

What is an insurance policy?

Before breaking down what an insurance contract is made of, it is important to remember what it is and what it is for.

The insurance contract is the one by which the insurer undertakes, by charging a premium and in the event that the event occurs whose risk is covered, to compensate, within the agreed limits, the damage caused to the insured, or to satisfy a capital, an income or other agreed benefits.

Article 1 Insurance Contract Law

An insurance contract can have any object of risk, as long as there is an insurable interest and it is not expressly prohibited by law.

The policy is the written instrument that regulates the conditions of the insurance contract. It is the private document that contains the rights and obligations of the parties that sign it. In addition, it is an adhesion contract so any modification must be made through expressly agreed clauses.

For this reason, when contracting insurance, together with the proposal, the application, or the policy itself, the insurer must give you: the general, particular, special conditions and any other complementary document that you have to subscribe.

The booklet of the General Conditions

For the same type of insurance, there are clauses that are common to all contracts, which is why insurers have printed or pre-printed conditions, the so-called General Conditions.

You can request that the insurance policy be drawn up in any of the official languages. Also that it is done in a different language in accordance with Directive 92/96 of the EU Council.

Computer digitalization has also reached the policies obliterating the book of general conditions.

Whatever the format in which they are delivered to you, the exclusions or limitations to the coverage of the contract, they must be highlighted typographically.

These are the contents that you must find in the general conditions, pay attention to the priority ones:

The rules that regulate the contract

List of the legislation to which the contract is subject. Basically, they refer to the Insurance Contract Law, Data Protection Law, Management and Supervision of Private Insurance, CCS legal statute, or the Mediation Law.

The contract persons and definitions

This section refers to the persons who may intervene, their function, or the definitions of the terms of the insurance contract.

The object of the insurance and the excluded goods.

They refer to the coverage assumed by the insurer, defined in the particular conditions. Those assets that are not covered are also described. You should not confuse it with uncovered risks that we will talk about later.

The risks covered.

In this section, you will find all the coverages offered by this type of insurance. But this does not mean that all of them are the ones you have hired, so you should go to the particular conditions to see which ones you have included in your policy and what are the insured limits or the excesses that affect each one.

Risks and Damages Not Covered.

If everything is relevant, I especially recommend reading this section, because in it you will find the list of risks not covered. It will depend on the type of insurance that this list is more or less extensive because it contains all the exclusions that affect the contract.

An optional form of assurance.

This is a section that you will find in the damage policies (SME, industry, etc.). It defines those forms of insurance whose acceptance is optional for the company. Normally it refers to the fixed and floating capital of the insurance of inventories or extension of the coverage in the valuation in case of loss.

The basis of the contract.

It defines the documents that together with the policy are part of the contract, such as the application or the insurance proposal. They also regulate the rights and obligations of the parties regarding the declaration of risk, its inaccuracy, the aggravation, reduction, disappearance, or transmission of risk.

The formalization of the contract, its duration, the payment of premiums, and the payment address is also part of this section.

Other aspects that are important in the long run are those related to the termination or nullity of the contract and the prescription of the actions derived from it.

Claims and their processing.

It is important that you know what duties you have to communicate the loss, rescue, and reduce the consequences. It is also important that you know how the damages are assessed, the compensation is determined and they pay you.

Conflict resolution.

Do you know who you can go to in case of conflict? This section of the insurance policy explains to whom you can direct your claim in case of conflict with the insurer. Of course, knowing how to do it can solve more than one setback.

You should also find two very special clauses:

Indemnification clause by the Insurance Compensation Consortium.

It establishes the extraordinary events that are covered, the risks excluded, the applicable franchise, or the procedure for action in the event of a claim.

Data protection clause.

It collects everything related to the treatment of your data and its use by the company. The address where to go should appear in case you decide to exercise the rights of access, rectification, cancellation, and opposition.

And something very important that you should keep in mind about your data. The legislation allows them to be assigned or part of them, and those generated in the event of a claim, to public and private organizations related to the insurance sector for statistical purposes and fraud prevention, in the selection of risks and settlement of claims.

Any modification that is established in the coverage, exclusions, or limitations must be inserted in the particular conditions, partially or totally repealing what is indicated in the general conditions.

The 9 points that you must review, yes or yes, in the Particular Conditions

But an insurance policy is an individual contract so it has to be personalized, this is done through the Particular Conditions.

They contain the data and specific clauses that identify and regulate the contract and so that you have no doubts about its content, these are the 9 points that you have to check yes or yes.

#1. The contracting parties

It must contain the name and surname or company name of the contracting parties and their address, as well as the designation of the insured and beneficiary, if applicable. Above all, check that the personal data is correct and does not contain any errors.

#2. The concept in which it is insured

It refers to the condition of each of the parties that grant the contract, the policyholder, and the insurer. Both are the ones obliged to comply with the agreed conditions.

#3. The nature of the hedged risk

It must describe in a clear and understandable way, the guarantees and coverage granted in the contract, as well as with respect to each one of them, the exclusions and limitations that affect them highlighted typographically.

#4. Designation of the insured objects and their location

It will contain information related to the insured object, its characteristics, and the situation where it is located or the radius of action. For example, in car insurance, the data is the identifiers of the vehicle, characteristics, and habitual driver. In a home, the elements of the property, the location, or prevention and protection measures.

#5. The sum insured or the scope of coverage

You have to check that the insurance sum assigned to each of the coverages is clearly stated. You must also make sure that the insurance method or the amount of the franchise is listed if any.

#6. Amount of premium, surcharges, and taxes

The price of the insurance must be itemized. For this, the policy will state the net insurance premium, the taxes and surcharges that are levied on it, and the total premium for the initial period according to the chosen payment method.

In the case of a policy with floating capital, the way in which the payment will be made must be established.

#7. Maturity of premiums, place, and method of payment

Check that the expiration of the insurance corresponds to the agreed date. There are insurers that offer you the possibility of changing the date by anticipating it to the first day of the month or delaying it to the first day of the following month.

Another element that should appear in the form and place or means of payment of the premium. To learn more about this, I advise you to read this post: What form of payment am I most interested in insurance to save money?

#8. Duration of the contract

If you have read the article that I recommended in the previous point, you will have read about the duration of the contract. Well, the policy should indicate the day and time when your coverage begins and ends.

#9. The contract mediator

Regarding the mediator, in addition to the identification data, it must contain the type of mediator in question. The amount you receive for your work should be reported shortly.

With all this, we have already written between 30 and 40 pages of an insurance contract, but something else is still missing. Read on to find out.

The Special Conditions of the policy

These are specific conditions that affect certain circumstances of the insurance contract. They are generally used to remove some exclusions or to include new ones.

Do you have a mortgage and the bank requires a transfer of rights in the insurance?

Well, the clause that is included in the insurance policy for the loan will be a special clause.

The risk ratio in a damage policy or the nominal ratio of the insured in an accident group is special clauses.

The coverages or exclusions referring to the health status of an insured are also special clauses in a medical insurance policy.

Clauses based on international treaty coverage are also part of these special conditions.

Why is it necessary to pay attention to the content of the policy?

Well, because you have one month from the delivery of the policy to claim the insurer to remedy those clauses that do not conform to the agreement or the insurance proposal.

After that period without claiming, you will have to comply with the provisions of the policy. By the way, this clause must also be included in any insurance policy.

conclusion

Spending a few minutes reviewing the insurance policy means saving time because you can rectify it if it does not conform to what was agreed. But also, in the event of a claim, if it is well done, it will avoid unnecessary conflicts. Knowing what it covers, what it excludes, or who to turn to in case of conflict will make your effort not wasted.

But in addition, the conditions of the contract cannot be harmful to the insured. They must be written clearly and precisely, highlighting especially the limiting clauses of the rights of the insured.

Especially relevant is that they must be governed by the mandatory provisions of the LCS unless it provides otherwise or there is specific legislation for this type of insurance.

Attention! It is very important that you know that the insurance contract will be void, except in the cases provided for in the Law, if at the time of contracting the risk does not exist or the loss had occurred.

Have you ever read your insurance policy, was it easy for you to understand its content?
I wait for you in the comments and if you have any questions about your policy, raise it to answer it.

The definitive guide not to lose your mind if you have to make an insurance claim

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insurance claim

you want to make an insurance claim. And you want your complaint to be solved as soon as possible. You also don’t want to spend a lot of money.

As an insurance consumer, you have the right to complain if something has not gone well or to complain about deficiencies in the service.

Choosing the most appropriate route for an insurance claim, start by reading this guide so as not to lose patience.

Where can I complain and how can I complain?

In my case, most of the time, I advise giving priority to the extrajudicial route before the judicial one. I have always thought that insurance can solve many issues in a negotiated way.

To go to court, you have time.

There are different ways to make your claim, and so that you do not get confused, I bring you this little guide.

The freeways to claim insurance.

If you do not agree with the resolution given by the insurer to a certain matter, you can exercise your right to claim. You have two ways to do it, the judicial one, with an uncertain result, and at a cost to your pocket.

And the extrajudicial claim, with which you can obtain the same result, but cheaper. Free!

As a preliminary step to claiming your insurer, I recommend that you read the policy and everything related to conflict resolution measures. There you will find the different instances that you can go to.

In case you do not have the policy at hand, I leave you these brief notes about the tour of the different services. It will help you.

Step # 1: Customer Service.

Each entity names it in one way: customer service, claims. It is the administrative unit that is in charge of receiving and resolving the complaints or claims that come to them.

Once you have submitted the claim, the service has to respond within two months. Before resolving, the department affected by the complaint or claim will ask for the background, information, and allegations.

The decision of the attention service must be motivated, the conclusions will be clear and they must notify you within 10 days after taking it.

If the answer leaves you satisfied, you can now abandon reading the article. If not, and your company has it, this is the second step.

Step # 2: The Defender of the insured.

Has the insurance company’s response not convinced you? Well, I present to you the Defender of the Insured.

It is a figure that all insurers are obliged to have, in case they do not have the service of the previous step, that all pay and of which they must be independent. Its decisions are binding on the company, but not on the claimant. If he agrees with you, the company will have to address your complaint or claim in the terms established by the Ombudsman.

The operation is similar to customer service. The response time is also for two months. If the decision does not satisfy you or you have not had a response, the next step is to go to the supervisory body of the administration. In insurance, the General Directorate of Insurance and Pension Funds.

Step # 3: The General Directorate of Insurance.

Your insurance claim can be made through any of the claims offices of the different supervisory bodies: The Bank of Spain, the National Securities Market Commission, and the General Directorate of Insurance, the latter being the one who will resolve your complaint.

Once the claim file is opened, before ten days, it will request the insurer to present any allegations it deems appropriate within fifteen business days. Their answer will be transferred to you so that in the same period you can show your disagreement with it. After this, the report will be issued within four months of the complaint.

The report, like the previous ones, will be motivated and clear in its conclusions and will state whether the actions comply with the rules of transparency and protection or with good financial practices.

But it will not deal with complaints or claims when the user is obliged to go to an arbitration body or when the matter is submitted to any administrative or judicial instance.

One piece of information: In 2014, the resolutions in favor of the claimant were 25% of the total. In favor of the insurer, 39%.

Ah! Two very important things:

  1. Before going to the DGSFP with your insurance claim, you have to prove that you have claimed through the Claims Attention Service or the Insured Ombudsman.
  2. The report you issue is not binding on you or the insurer.

Yes, yes, I know … then what is it for? This time I let you answer.

You are impatient and prefer shortcuts, so you can jump from the starting square to the next point.

The alternative of the arbitration system.

You have other alternatives that you can go to without having to take the previous steps. It is a specific system for consumers and users where conflicts can be resolved through mediation and arbitration. There are two types, the so-called ordinary arbitration, and the consumer.

Ordinary arbitration

Its operation is simple, in case of disagreement between the parties, both will choose an arbitrator who will be the one to decide and resolve the conflict. Its resolution is binding on both parties.

Consumer arbitration

It is under the umbrella of the Administration. It is a voluntary means for the resolution of conflicts where if the insurer is attached, it will submit to arbitration of the claim and if it is not, it can accept it as a solution.

Either of these options will make your insurance claim go less, but will not always reduce the time to resolution.

Conclusion

When you don’t like the insurance decision, you have a number of alternatives at your fingertips before going to court.

But you have to earn it and it is not always an easy task. At each instance you go you will have to do it with arguments, and for that, this is the place to find them.

If your plan is to claim insurance, you will need an extra reserve of patience and a pinch of optimism.

In summary … I have given you the alternatives so that you can make your insurance claim, without costing you one euro.

Did you know about the existence of these services? Have you had to use any?

7 keys to choosing the best roadside assistance insurance

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roadside assistance insurance

Can you imagine that you are left lying with the car at the doors of the house and the roadside assistance insurance does not serve you?

What about that contract you were going to sign or the doctor’s appointment that cost you so much to get?

After the monumental anger of the first moment, it’s time to find a solution in case it happens again.

Roadside assistance has become an essential coverage to have it included in your car insurance. Or to contract it in individual insurance. Be that as it may, my advice is that if you use the car, take out this type of insurance.

But not just anyone, in my case I seek that assistance is not only for the car but also for people. Give me solutions to circumstances in which the car, due to breakdown, accident, or any other, cannot circulate.

These are some of the keys with which I value which roadside assistance insurance suits me, and why.

1. What coverage does roadside assistance provide me?

I like to make the assessment thinking about who can suffer the consequences of being stranded on the road. Along with the vehicle assistance, I also consider what benefits people who travel in the car will receive, or if the coverage is extended when they do not.

For me, it is very important to know that if my car is stolen (warning: it is only worth what its tires are worth), the people who travel with me will have the means to return home, or the accommodation paid while they repair that untimely breakdown.

2. On-site repair

But things don’t always have to go that far. I also want to be sure that if I puncture a wheel or the car runs out of battery, I will receive the necessary assistance to continue the journey. Also, as I am a bit clueless, it will not hurt either, that they attend to me if I lose the keys or the car runs out of gas.

Getting your problem fixed on the fly can save you a lot of trouble. That is why it is important for me to have a helpdesk that can make a quick repair at the scene of the incident.

3. Assistance from kilometer «0»

The last roadside assistance I had to request was for a clutch cable break. It happened to me just 2 kilometers from home. This time he was alone and was not in a hurry. The car began its journey to the workshop on the crane platform, while I, taking a walk, returned home.

What would have happened if I was accompanied and it happened 10 kilometers from home? Well, the fact of having to pay the tow truck, we would also have had to face the costs of a taxi to return. In my case, the roadside assistance coverage starts at kilometer “zero”.

It is worth reviewing this point because more than one assistance insurance provides coverage from 25 kilometers.

4. Replacement vehicle

You have had a breakdown or an accident and the repair involves having the car immobilized for a couple of days. You are on vacation or work. Goodbye to that beautiful place they told you about or to that important interview for your business. You have been stranded at the most inopportune moment and you have no way of getting there.

For me, it is very important, and I suppose for you too, to be able to maintain the autonomy that having a replacement car gives if something like this happens.

Everything good has a cost, and if you want it, you have to pay for it.

5. Repatriation of the car and people

Having an accident is already a problem, but having it many miles from home is even worse. Therefore, one of the things that I value the most is that, if I have a breakdown, accident, or my car is stolen while outside of my province or country, it will be repatriated when it is repaired or found.

And above what can happen to the car, is knowing that, if the injured or sick are the passengers, we can be repatriated by roadside assistance insurance.

6. Assistance abroad

Breakdowns, accidents do not happen only in, also when you go abroad.

It is not only important to have repatriation. Sometimes the need is to spend a few hours in a medical emergency. Or have at your disposal a hotel room, where you can keep the prescribed rest before resuming the trip, or in case your companions have to wait for your discharge from the hospital. Other times, for the shipment of medicines or stolen or lost objects.

The situation can be worse and you have the need to return due to illness, accident, or death of a close family member. Or on the contrary, you are the one who needs a relative to travel because you are going to spend a short time in the hospital.

Having good coverage abroad is one of the keys that I value the most before choosing assistance insurance.

7. Financial advances during the trip

You have spent all the savings you had paid for the trip of your dreams. You have left the bank account with no balance and you have left with your credit cards and the little money you have left.

It is not too much, in those cases, that the assistance insurance can provide you if you need it, an advance of money if you suffer a serious mishap.

Having an amount of money to pay a lawyer or post a court bond can be vital. Remember that when you travel, you are subject to the laws of the country where you are going. But they all have something in common, the need to have money.

Conclusions

If there are several things that can go wrong, the one that causes the most damage will.

Murphy’s law
The battery that doesn’t work, that key you can’t find, the damn curb that has blown the wheel. They are little things that can bother your trip. And if you also do it in the company, the problem is even greater.

It is not the same to stay in the hotel because you have no way to move than to maintain the freedom to move by having a replacement vehicle.

With third-party car insurance, you can move, without any formality, through more than half of Europe. Roadside assistance coverage should, too. But not with any limit. Because it is not the same to have medical or lawyer expenses limited to 600 dollars than to have up to 6,000 dollars.

Sometimes knowing you are not alone is priceless, and roadside assistance can make you not.

Therefore, my conclusion is very clear:

Roadside assistance coverage, for me, has become a must.

And for you? Have you ever had to resort to roadside assistance?
Share your experience in the comments.

How can I know if I am a beneficiary of any life insurance?

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beneficiary of life insurance

Can you imagine that you have a small fortune as a beneficiary of life insurance, after the death of that relative, and you don’t know it?

How would that change your life?

Surely it would mean an economic relief or to be able to give yourself that whim delayed in time. Some extra funds never hurt, even if they have a sad origin for the loss of a loved one.

The truth is that it is increasingly common to have life insured. Sometimes voluntarily and we record it. Others, associated with certain contracts or services and we do not know they are there.

An example is life or accident insurance associated with the credit card. And who doesn’t have one?

Therefore, when a family member dies, even though it may be hard, it is advisable to make sure if they had any life insurance of which you can be the beneficiary without knowing it.

How can I know if I am a beneficiary of any life insurance?

If you already know your status as a beneficiary, the quickest thing to do is go to the insurance company with the documentation that accredits it and requests the payment of compensation.

But if you don’t know or have doubts as to whether that person had any insurance with death coverage, it is best to find out.

To find out if you are a beneficiary of life insurance, you must first find out if there is insurance and to do so it is best to ask the Administration through the Registry of Insurance Contracts with death coverage.

The purpose of the registry is to allow users to know if a certain person is the insured of an insurance contract with death coverage.

What information does the Registry provide?

Insurers are obliged to communicate the data of the contracts signed identifying the insured person and the insurance contract made.

Therefore, the insurance contracts on which it is possible to know this information are life and accident insurance with coverage of the insured’s death. It does not matter whether they are individual or group policies as long as the insured is nominated.

It will not provide information when it comes to:

  • The insurances that implement company pension commitments with workers and beneficiaries.
  • Insurance in which, in the event of the death of the insured, the policyholder and the beneficiary coincide.
  • The contracts are signed by mutual benefit societies that act as a corporate social security instrument.

The information is kept for 5 years following the death of the insured.

How can I request the data?

The Registry of Insurance Contracts with death coverage depends on the Ministry of Justice.

You can be certified on request via the Internet, by mail or so – face.

If you have an electronic signature, you can request it through the Electronic Headquarters of the Ministry of Justice. 

Whether you do it by mail or in person, you will have to present the 790 application form and proof of payment of the corresponding fee.

If the death is prior to April 2, 2009, you will also have to provide the literal death certificate, original or certified copy.

If you request it online, it will be the system itself that will retrieve the death registration data and allow you to pay the fee through the Tax Agency’s payment gateway.

Whichever means you choose, you will not be able to request the certificate until 15 business days after the death.

How long does the certificate take?

The deadline for issuing it is 7 business days from the date the request is submitted. In the case of a telematic request, it is normal for you to have it available within 24 hours.

In the request form, you can provide an email address to notify you when it is available.

The validity of the certificate is 90 days, so after that, you must request a new one.

If the certificate has to take effect abroad, it needs to be legalized, so you must indicate it in the application.

I already have the certificate, what do I do now?

You have confirmed that the deceased person had insurance with death coverage and where they are insured. Well, the next step is to find out if you are the beneficiary of the insurance. Go to the insurance company where they will inform you if they appear as a beneficiary in the policy.

If you are, the procedures to collect the corresponding compensation according to the insurance contract begin.

In case you are not expressly so, you will have to prove your status as a beneficiary. To do this, the insurer will ask you to provide the will – if any – of the declaration of heirs.

conclusion

This is the objective:

That no insurance with death coverage remains uncollected when the death of the insured occurs.

To do so, if you think you can be a beneficiary of one of this insurance, you only have to ask for a certificate of the insurance with death coverage that the deceased may have.

You can request it through the Internet or through traditional means.

Remember, you will have to wait at least 15 days from death to do it. And you will have it within a maximum period of 7 days from when you request it.

Ah! And if you are interested in knowing in which insurance contracts, with death coverage, figures as insured, you can also request it, free of charge, in the same way, and at any time.

Are you processing the inheritance, are you a beneficiary of death insurance?

5 Things to keep in mind before canceling health insurance

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canceling health insurance

Are you thinking of changing your insurance company but you don’t know how to cancel your health insurance, or what the consequences are?

Your birthday and the insurance premium skyrocket in the price?

Have they made you an offer for better and cheaper insurance?

In this article, you will find an answer to how to cancel health insurance, if you prefer to live without it or decide to change your insurance company.

We take out insurance with the intention that it lasts over time. Sometimes for one reason or another, we think that the time has come to change. They have raised the price, the service has not been what we expected or they have offered us better coverage. In short, we want to cancel health insurance and do it well so as not to have problems.

Like any other contract, its cancellation is subject to the stipulations established by law or by one of the parties. Therefore, to cancel it, you must do it correctly, acting according to the established procedure.

But also, if you plan to take out other insurance, you must take into account a series of circumstances so as not to have unpleasant surprises.

Are you starting to have doubts about how to do it? To solve them, I will tell you the 5 things that I would do before canceling health insurance.

How to cancel health insurance to avoid problems.

The first thing you should know is that health insurers establish that, in a generalized way, the contract ends on December 31. The duration of the insurance contract is usually 12 months, in the case of health, it is from its signing until the end of the calendar year. On this date, the insurance is automatically extended for one year and so on until its conclusion.

Once we know the date on which the insurance contract expires, these are the 5 things you should take into account before canceling it.

1. The contract cannot be terminated after it has been extended.

Once the insurance has been renewed for one more year, it cannot be terminated. You have to wait until the next expiration to be able to cancel it.

Only in certain cases is it possible to do so in advance: when the insurer, during the current period, modifies the conditions of the contract.

An unjustified increase in the price of insurance, modification of benefits, or a change in healthcare services are grounds for early termination.

If your company has you insured in a group health policy, terminate the employment relationship.

After informing the insurer of a decrease in risk and it does not lower the renewal premium.

2. The insurer has two months to report the new conditions.

Health insurers review the insurance premium every year. This review is carried out taking into account 3 factors: the age of the insured, the profitability of the policy, and the increase in the cost of services.

The health insurance premium is established by age group. Therefore, it should only increase when you go from one age group to another. Serving years in insurance usually means having to pay more.

The more medical care you need, the lower the profitability of the insurance. And the companies are not an NGO, so they try to correct losses immediately by raising the insurance premium. If your contract is also part of a group, you are subject to the accident rate that the group has, with which premiums can skyrocket from one year to the next.

Finally, there is an increase in the CPI (health), the increase in the cost of medical assistance. In recent years this has been around 2%, while insurance companies increased premiums by 4.6%.

The insurer is obliged to notify the policyholder two months in advance of any change in the conditions of the contract. Non-compliance does not exempt you from complying with the rule, but it does give you the possibility of canceling the insurance when it expires.

3. Notify the cancellation at least one month before the renewal.

We have seen how the insurer is obliged to communicate any variation of the contract two months in advance of expiration. You also have two months if you want to rescind it.

And the policyholder or the insured?

Article 22.2 establishes that you must communicate at least one month in advance of the conclusion of the current insurance period, your desire to cancel the contract. And you must do it in writing.

A special mention deserves online recruitment. If this is your case and after purchase to change your mind, you have 14 calendar days to withdraw.

When your relationship with the insurer is through group insurance, where the policyholder anticipates the payment of the premium, you should only communicate your desire to cancel the contract.

Communicate the cancellation through a means of which you have a record. Try to avoid doing it through the customer service phone or the contact form on the web.

4. The beginning of a grace period.

One of the conditions that health insurance has is the establishment of deficiencies when it is contracted. The grace period is the period of time between contracting and the entry into force of certain insurance coverage. I recommend reading How to choose good health insurance: 15 tips to do it right.

When you change your insurance company, it can include new grace periods in your policy that you have already passed. It is very important that you take this into account before making the decision to cancel the insurance.

5. What happens with preexistence or if I am in treatment?

Surely when you first purchased health insurance, you had to fill out health questions. In it, you informed the insurer of your medical history. Now, when you change companies, you will be subjected to a new evaluation with which diagnosed pathologies or illnesses can be excluded from coverage. It is also possible that you will be excluded from the assistance that may be related to pathologies that have already been cured.

Currently, insurers, when it comes to group insurance or in certain commercial promotions, do not include deficiencies or preexistence in their proposals. But be careful, don’t trust the large print on commercial brochures.

Conclusions

If you want to change your insurance policy or do without it, you just have to follow a few simple steps to cancel health insurance.

Inform you of the new conditions that they offer you. Analyze the coverage, the limitations, if you have grace periods or how many years the price is guaranteed.

After the decision is made, the next step is to inform the company that you are canceling the contract. I remind you that you must do it at least one month before the expiration date of the policy, that is, before November 30.

And finally, leave us your answer in the comments to the question:

Are you happy with your health insurer or have you thought about switching to another?

What to do when you do not agree with the decision of the insurer in a claim?

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decision of the insurer in a claim

Having a claim and going to insurance can be desperate, right?

The normal thing is to feel overwhelmed by circumstances, especially if at the first change they tell you that they do not take charge of its consequences. You look at the policy and you don’t understand how they can tell you that it doesn’t have coverage.

You look on the Internet and all you find are complaints.

Everything seems very complicated. You don’t know where to start or what the priority is, or even if the resolution is worth discussing.

However, not claiming what you consider to be yours causes discontent to grow in you. You think it is unfair but you do not see yourself with the capacity to manage the situation.

You would like someone to tell you what to do, how, and when, right?

You are not alone, I dare tell you that I know the way to act.

Therefore, this article is dedicated to what you can do when you are not satisfied with the resolution that the company has given to the claim.

1. How does the insurer act upon learning of the claim?

Before, I am going to tell you, briefly, what are the steps that an insurer takes when it becomes aware of the claim. This chronology, standard for most, is undergoing some changes that you should be aware of.

You have had an accident and you have communicated it to the insurer through your insurance broker or directly. From that moment on, a whole process is triggered that begins with:

1.1 Receipt of the claim declaration

The first step begins with the declaration that you have to make to the insurer once the claim has occurred. In it you must inform it in detail of the causes, circumstances, and consequences, known to you, that derive from it.

There are other channels through which the insurer can find out the occurrence of the claim, but will come to you to confirm it.

1.2 Opening of the file

Upon receipt of the declaration, the insurer will open a claim file to which it will incorporate all the information obtained during its processing.

1.3 The first checks and initial assessment of the claim

At the time the file is opened, the company makes a first check of whether or not the causes that motivate the claim are covered by the policy. Depending on its result, the insurer will adopt any of these decisions:

  • Refuse the consequences of the loss if it is not covered in the policy.
  • If there is clear coverage and enough information to indemnify the insured, he will indemnify him and archive the file.
  • If it is a complex claim or the necessary and sufficient information does not exist, the processing will continue.

In either case, the company will make a first assessment of the cost of the claim and reserve the estimated amount.

1.4 The intervention of the expert

The task of investigating, analyzing the possible causes of the loss, and assessing its consequences is entrusted by the insurer to the expert.

The expert is a professional expert in the matter under analysis and the acceptance of the claim by the company will depend on him.

1.5 Resolution of the claim

The last step, once the investigations are concluded and the claim has been assessed, will necessarily happen because of the insurer:

Pay the corresponding compensation or benefit. Once paid, the insurer may terminate the contract by voluntary decision or because the insured risk has ceased to exist as a result of the loss.

Deny payment of compensation. In this case, the insurer must inform the insured of the reasons for his decision, providing the evidence to verify it.

2. What do I do if I don’t agree with the resolution?

In recent times, insurers are replacing the “field” expert with more or less specialized teams of claims processors who resolve as if they were an expert.

The decisions they make, generally based on the information and documentation provided by the insured, are causing an increase in the number of rejected claims. They often lack the necessary evidence to adopt them and are carried out in the confidence that the insured will not claim.

The law establishes that the insurer must compensate the insured at the end of the investigations and expert opinions necessary to establish the existence of the claim and assess its consequences. And it establishes a period of 40 days, from the date of the claim, to make the payment of the minimum known amount.

If you agree with the established compensation, you only have to charge.

And if you are not, the next step is to carry out an expert opinion contradictory to that of the insurer.

3. The contradictory expert opinion in the claim to the insurer

If you do not reach an agreement with the insurer, within the period indicated above, you may appoint an expert to make a contradictory expert opinion.

You must inform the insurer of the appointment of the chosen professional. This will have a period of 8 days to designate yours. If I did not do so, I would be obliged to accept the opinion of your expert.

Once the experts are appointed and you accept the appointments, several results can be given:

That there is an agreement between the experts. In that case, the expert opinion will become a joint record stating: the causes of the loss, the assessment of the damage, and all those circumstances that influence the determination of compensation. It must also state the liquid amount of the compensation.

There are many claims where the insured gives up due to exhaustion or for not entering into legal claims for their cost. Also due to ignorance of their right to make an expert opinion on the part.

In my opinion, the only way you have to combat the dominant position of the insurer is by pulling legislation. And there it is to make use of the appointment of an expert by the insured.

But before going any further, I want to give you a good recommendation and that is that if you need to consult an expert.

And now, we are going to continue with the article that you still have things to know.

4. The appointment of the third expert

But it may happen that both experts do not reach an agreement, what to do in that case?

The solution is to appoint a third conformity expert between both parties. If there is no agreement on the appointment, you can promote a file as provided in the Law of Voluntary Jurisdiction.

Once the appointment is accepted, together with the other two experts, they will proceed to prepare a report that will be approved by unanimity or majority. This expert opinion is binding on the parties, without prejudice to the fact that it may be challenged in court. The insurer has 30 days to challenge it, while the insured has 180 days from notification.

If the report is contested, the insurer has 30 days to pay the insured the minimum amount referred to in art. 18 of the LCS. If the expert opinion is not contested, the amount determined by the experts will be paid within a period of five days.

5. The last step, the judicial claim

Sometimes it is better to go, after the resolution of the insurer, to court. In that case, you will have to use the evidence to try to make the company see reason.

The claim will be followed through a verbal trial in the courts of your domicile. When acting without a lawyer, the plaintiff will formulate a succinct demand in which he will state the data and circumstances that concur, will identify the defendant, fix precisely what he asks for, and will prove it documentary.

At this point, when you claim compensation from the insurer, it is essential to have a legitimate expert opinion that supports your claims.

The success of your claim increases if the opinion is defended before the judge by an expert. That is why I advise you to have the experience and knowledge of NPA to improve your position with the insurance company.

Conclusions

I have told you how the insurer acts when the occurrence of the claim is notified. And as it is more and more frequent that you find yourself with the refusal of its consequences. There are several reasons, but all of them justified in the knowledge that the majority will not be discussed by the insured.

The expert opinion by the insured’s expert is becoming increasingly necessary. Resorting to the second or third appraisal is a right guaranteed by article 38 of the LCS.

But you can also go to court, where having a good expert opinion is essential.

And if you wonder who pays the expenses, I will tell you that it will depend on the medium you use. But in most cases, your expert’s fees can be paid by your own insurer.

I can’t resist asking you:

How many times have you given up claiming the insurance after refusing the claim?

Don’t you think it is time to start discussing the resolutions of the insurance company without fear?

Leave your answers in the comments.

Can I cancel the insurance early if I have sold the car?

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cancel the insurance early

Are you thinking of selling your car and buy a new one?

And among the discounts and advantages of the offer, the dealer gives you car insurance for the first year. Of course, how you will miss the opportunity if also is safe all risks.

The offer no longer includes insurance, but you have found another one that is cheaper than the one offered by your insurer for the new car.

Immediately you begin to ask yourself, What do I do with the insurance on the car that I remove?

Can I cancel it early and get my money back?

Can I pass the policy on to the new buyer and have him pay for it?

Why am I going to have to pay if I no longer have the car?

In this article, I will answer your questions in case you are going to sell the car before the end of the current insurance.

How does the sale of the car affect the insurance contract?

Car insurance is a contract with a previously agreed duration and whose conditions must be met by the insurer and the insured. In the event that any of the parties wants to cancel it early, there will be a penalty.

As in insurance, the premium is paid in advance, the penalty will be economic for those who cancel the insurance early. If your policy has the payment of the premium divided, even if you sell the car, you are obliged to pay the full annuity.

When early cancellation is requested by the policyholder, the unconsumed premiums remain in favor of the insurer. If this is the one who cancels it, they will have to return the remaining premium to the policyholder.

As you can see, until now the disappearance of the risk from the sale of the car has not appeared, but do not be in a hurry that I will tell you about it.

But first, we are going to analyze what are the alternatives that exist after selling the car.

1. I sell the car with insurance to the buyer

If the car buyer agrees to transfer the insurance to him at the same time that you sell him the car, you should immediately notify your company. This will analyze if the conditions of the new policyholder and driver (age, experience, driving history) conform to its risk selection rules and will make its proposal.

If the risk profile is equal to or lower than that declared in the insurance, the transfer can be done without any problem. If the risk were greater than the original, the insurer could reject the application.

When this happens, solutions can go through:

  • The payment of an additional premium for the new policyholder
  • Reserve the unconsumed premium for you to use it later in other insurance. This possibility is exceptional and has an expiration date, depending on the company. Some carry it only until maturity, others extend it to 18 months.

Like any other request that can modify a contract, in the insurance one, it must also be made in writing.

It is essential that you set the date on which the changes should take effect. Remember that if you do not notify the insurer of the sale and from when you cease to be the owner of the car, in the event of a claim, the expenses will be charged to your policy and you will not be exonerated from the risks incurred by the new owner.

2. I want to keep the insurance for the remaining time after I sell the car

You have decided to sell the car but you want to take advantage of what remains for you because you are going to buy another. This is a situation with few complications, although it is not always without its setbacks.

The usual thing is to substitute one vehicle for another. In this case, if there is no delay between the withdrawal of one and the delivery of the other, the company will apply the price that corresponds to the chosen type of insurance, discounting the unused premiums.

The setback can arise if the delivery of the new vehicle is delayed and the old one has already been sold. In that case, you must inform the insurer so that they reserve the premium for you until the new car is delivered.

Before I was talking about this measure and its exceptional nature, so it is convenient for you to have it previously agreed.

3. I have sold the vehicle and do not want to continue with the insurance

It is possible that you know, from what I have told you, how likely you are to lose the unused premium.

Whether you sell the vehicle to a private individual, or if you sell it to a sale or take it to scrap, you are obliged to notify your insurance. In the first two cases, you should inform the buyer, in writing, of the existence of the insurance and its possible transfer.

Once the transmission is verified, you have 15 days to inform the insurer, who may terminate the contract in another fifteen days. If it does, it is obliged to return the unconsumed premium to you.

Ah! And of course, throughout this process, it helps not to have had claims, because if there were …

conclusion

If you plan to sell the car in the middle of the insurance period, get used to the idea that one of these exceptions must be met in order to return the premium for the time not consumed.

One happens because the insurer accepts the risk derived from the transmission of the vehicle. In that case, it is the buyer who can reimburse you for the remaining insurance time until the renewal.

The other exception is that the company itself decides to terminate the contract.

In all other cases, the best thing that can happen is that you reserve the premium to use it later.

These suggestions will help you and avoid setbacks:

Inform the buyer in writing of the existence of the insurance and then the insurer. Complying with this requirement established in the law can have a positive result for you.

All communications make them in writing in such a way that you can prove it at any time.

And to finish, tell me, did you notify the insurer about the sale of the car? What did you do with the unused premium?

Leave your answer in the comments.

My insurance has been raised without warning

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when they raise the price, we react hastily without evaluating the result ...

My insurance has been raised again. I’m changing my company right now!

How many times have you said this phrase after seeing that the insurance receipt had been charged to your account?

I confess that I have also reacted like this on occasion. Because my insurance has also been raised, like most clients of insurance companies.

If I have not reported any claim, why is the price raised? Can I change companies?

This article is about that, about answering these and other questions you can ask yourself.

Why has my insurance been raised if I have not given any part

We tend to see insurance individually when the contribution of the group premiums is necessary to bear the consequences of our risks.

This occurs both in traditional insurance and in the new formulas used in the collaborative economy.

Therefore, there is only one reason why insurers raise their prices: the insurance premiums must be sufficient to allow the insurer to satisfy all the obligations derived from the insurance contract. A compelling reason, in addition to a legal obligation.

The margins of the insurance business are becoming smaller and in certain lines they are negative. When the combined ratio (premium income – the sum of management costs and claims benefits) approaches 100%, the situation is not good. The quickest solution to correcting this is to increase your premium income.

A price increase has to meet the criteria of fairness and sufficiency and be based on actuarial calculations of costs and risk. From there, it can be done collectively, to all clients of a branch equally, or individualized according to the behavior of the policy or use both at the same time.

Can you raise my insurance without informing me first?

They can do it. In fact, it is the usual. Although this does not mean that it conforms to what the legal regulations established.

Insurers take advantage, in a generalized way, of the lack of insurance culture of their clients to act outside of what the law requires of them. When it comes to the price of insurance, they hide it until a few days before the expiration of the policy. In this way, your possibilities to compare in the market and change companies decrease.

The insurer must notify the policyholder, at least two months before the end of the current period, of any modification of the insurance contract.

Article 22.3 Insurance Contract Law

As you can see, insurers have the obligation to report any modifications they make to the contract. And the price is one of the most important conditions of insurance.

How does the insurance company have to notify me of the changes in the contract?

If you notice, the law only states that you must be notified of the changes but does not say how to do it. While the insured is required to provide a written communication to cancel the contract, the insurer is allowed to use any available means of those provided at the time of contracting the insurance.

If you have registered as a client on their website, access to your policy information enables them a means of contact. The same is true if you provided them with a mobile number or an email address. If you didn’t update the data and they sent the information to a number you don’t have or an account you canceled, they have done their part.

About the deadline to do it, I can tell you that I do not know an insurer that complies with it. In the best of cases, they will notify you 15 or 20 days in advance.

Exceptions must be stated in the policy

But as in any contract, there are also exceptions to the rule. If in the conditions of your policy it is already regulated that the premium may increase according to certain factors, they will not have the obligation to inform you if the price changes due to any of them.

You have a sample of this, surely, in your car policy. You should only look at the stipulations that regulate bonuses or surcharges for declared claims.

Many times this is the argument they use to hide that premiums have risen regardless of the number of claims you have had.

I return the receipt and change company

They have not communicated the price of the insurance or they have done it at the last moment and when you see it … you bounce. Don’t worry, it has happened to all of us.

But this should not be a reason for hasty decisions. First of all, you must assess what options you have and which one suits you according to the circumstances.

Perhaps the time has come to review the capitals insured and the coverage of the policy. To compare what you pay for your insurance with what others pay for the same coverage. Now is the time to assess the alternatives or negotiate more favorable conditions

The renewal date has not yet arrived

You know how much the insurance is going to cost you and the renewal date has not yet arrived and you have decided to change companies. In that case, you are in time to notify the insurer that you want to cancel the contract.

If you have more than a month until expiration, you have no problems. Communicate it according to the requirements established by law and you can now easily contract your new insurance.

But you may have less than a month left. In that case, act as if you lack more time, and to solve your doubts, download this practical guide that will help you effectively.

The insurance has already expired and they have passed it to me to collect

Returning the insurance receipt is not the best solution, and even less if it is compulsory insurance such as that of the car. If you do, you run the risk that the insurer will demand payment from you, and may go to court to do so.

If this happens and they claim payment from you in court, you have a point in your favor if they breached the rule and did not notify you two months in advance.

3 powerful reasons why you shouldn’t lose your cool

My insurance has been raised without notifying me,,,

This is a statement that is often heard. Insurers ignore the provisions of the law and do not inform the policyholder within the established deadlines.

Acting calmly will help you get a better result, especially if you think about:

1. Review the risk conditions and the insured capital.

We do not pay attention to insurance until we need it and many times we are surprised that it is out of date.

The renewal can be a good time to give a return to the insured capital. To check if the characteristics and conditions of the risk have changed.

2. Improve coverage and the price of insurance

It is also the time to review the guarantees contracted. They must evolve according to our needs, including new guarantees or discarding some of the contracted ones.

All these changes will modify the insurance premium adapting it to the new conditions.

3. Failure to comply with the law by the insurer favors you

If they raise the price, they are substantially modifying the conditions of the insurance contract. And the fact that they do not notify you gives you a favorable position to defend because you asked for the cancellation after the deadline or because you have returned the receipt if they demand payment.

Remember, staying calm to make the right decision has enormous power. It allows you to engage in a one-to-one negotiation when you master the resources you have.

Knowing that the company has broken the law can make it more willing to connect with you as a customer, making it more receptive to your claims.

And now, tell me. Does your insurer inform you of the price increase or does it pass you if you don’t ask?

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