The insurers and insurance brokers must have by law a customer service department in order to channel the claims, complaints and queries of their customers. Also, they have the obligation to have a client defender, who will be responsible for dealing with and resolving the claims received.
The presentation of complaints and claims to insurance companies and brokerages may be made, personally or through legal representation, on paper or by computer, electronic or telematic means.
Regardless of the route, claims may be filed with the customer service departments or services, before the client’s ombudsman, at any office open to the public of the insurance company, as well as at the email address that each entity must enable for that purpose.
Who can claim
Complaints and claims may be filed by the insured, participants, beneficiaries, beneficiaries and injured third parties, arising from the insurance contracts or rights legally recognized by said contracts and the applicable regulations of the insurance sector.
How the claim should be?
The claimant must submit a document stating:
- Name, surnames and address of the interested party, together with the DNI number.
- Reason for the complaint or claim.
- Office, department or service where the facts of complaint or claim have occurred.
- Place, date and signature.
With this document, you must provide the documentary evidence on which the complaint or claim of the insurance company or, where appropriate, insurance broker.
What steps to follow?
1. Prepare the complaint or claim document
Whether you are directly or your legal representative who directly claims the company or insurance broker, you must prepare a written statement with the information and information that we have previously indicated.
2. Submission of the complaint or claim to the entity
You must send the document to the entity, be it an office on the street or through the email for that purpose, or to the client’s defender. In the policy you will find the information of the defender, but you can also find the contact on the website of the company or brokerage.
3. Processing of the entity
Once the complaint is filed, the insurance entities, brokers, brokerage or insurance intermediaries have the obligation to resolve the complaints and claims of their clients related to their interests and rights legally recognized within a maximum period of 2 months.
4. If the answer does not satisfy the insured
If the insured who claims does not agree with the resolution of the insurance company, or does not receive a response after 2 months, he / she may file the same complaint or claim with the General Directorate of Insurance and Pension Funds.
5. Claim to the DGSFP
In order to submit the claim to the General Directorate of Insurance and Pension Funds, such claim must have been previously filed with the insurance company.
The Claims service of the DGSFP will attend, process and issue a final report on the complaints and claims made by the users of the insurance entities. This body will issue the final report within a maximum period of 4 months.
The final report must have clear conclusions before the complaint presented by the user. These will be notified to the interested party and to the entity once it is published. But it is important to note that this report is informative, so no appeal can be filed. In other words, the insurance company is not obliged to comply with the conclusions of the DGSFP report.
6. If there is still controversy
They should be the parties involved, entity and client, who reach an agreement on the possible compensation. If it does not occur, the client may go to the Courts of Justice.