Tiempo de lectura: 2 minutosOne of the worst fears of those who have contracted insurance is that the insurer does not want to be responsible for the compensation for the incident. When someone contracts a service like this, the first thing they expect is that if they have to use it, the insurance company will take care of everything and they will be free of worries, but this is not always the case. That is why we will tell you how to make a claim for compensation.
So what to do if an insurance company does not want to pay?
The first thing you should know is that any type of refusal to pay on the part of the insurer must be communicated in writing. In this document the company must explain the reasons why they cannot make the compensation that you consider to be the corresponding one.
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Once received, the next step is to carefully study the arguments and counter them with the conditions described in the contract and to locate in the contract the parts that are being referred to.
It is important to detect all possible weaknesses in the contract, since any limitation or rejection of the indemnity that is made by an interpretation of the insurer and that presents a loophole or weakness can be used in favor of the insured.
When these weaknesses have been detected, a written response should be sent to the company to let it know the reasons for rejecting its first communication and the arguments for refuting the reasons for the rejection. This should be done within the time indicated by the company.
The next step is for the company to return with a written response, which may be positive for the insured or may reaffirm its initial decision. If this is the case and if there is evidence that the insurer is evading liability, a claim appeal can be filed where a neutral person is assigned to review the case, however, this person is appointed by the insurer itself.
In case of resorting to this point and the opinion continues to be negative you can proceed to sue the insurer for non-compliance. If this point is reached, it is important to have all the documents of the contracting of the service, as well as all the communications between both parties.
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In what situations can an insurer be sued?
- When the insurer fails to comply with the mandatory rules of the specific legislation on the insurance contract, for example, Law 50/1980.
- When the insurer fails to comply with the rules on market transparency and protection of users’ rights in the field of insurance.
- When the insurer’s customer service department does not exist or functions inadequately.
- When the insurer covering the civil liability arising from the traffic accident of the at-fault vehicle does not respect the reasoned offer, or does not give the reasoned response referred to in articles 7 and 22.3 of the revised text of Law 35/2015.
- When the decision issued by the customer ombudsman of an insurance company is not complied with, when it is favorable to the claim raised by a policyholder, insured, beneficiary or injured third party.
- When the insurer fails to comply with the precepts of obligatory observance for insurance companies, included in regulations with the rank of private insurance supervision law.
In Lex & Co we have the most qualified professionals to provide assistance and advice in any case concerning insurance collection matters.
Carlos Figueroa Rodríguez, attorney at law at Lex & Co. He has more than 10 years of experience in specialized cases involving insurance claims and medical malpractice. He is a graduate of the Universidad Anáhuac and has a Master’s Degree in Constitutional Law and Amparo from the National Bar Association. He also has a Doctorate in Juridical Sciences from the UCI Mexico. Professional license 6577215.
