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?
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:
- 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.
- 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.
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.
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.
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?