How to Resolve an Insurance Complaint? [Step by Step Guideline]
Buying car insurance should be the solution to almost any unexpected mishap with your car. From small damage and the need to tow it to compensation for partial or total theft.
However, we know that few things in life are perfect, and in the case of financial services, it is not unusual to experience a dispute. It may happen that you are not satisfied with the services offered by the insurance contract underwritten. And for this reason, you need to make intact insurance complaints explaining the reasons and conditions.
Let’s see together how to resolve an insurance complaint step by step (procedure valid for each type of insurance).
What Are The Main Issues Of Dispute?
Although each case is different, according to official statistics, there can be a trend of the main problems that the user faced with the insurer. Even only three causes had 65.2 percent of the total claims:
- Due to the refusal of the insurer to pay compensation
- For the request for cancellation of the contract and/or policy not attended
- For disagreement with the time for payment of compensation
Steps To Resolve Intact Insurance Complaints
Once you know the claims landscape and some statistics about it, you may feel identified. However, if you consider that you are the victim of injustice by the insurance company, you can claim your right. Even if you are not satisfied with the resolution, you will need to carry out a protocol to claim.
Since there is a financial relationship between both parties, we share the different resolution stages with you.
It is important to point out that an agreement could be so simple that it is solved in preliminary instances, without intermediaries. However, there is also the possibility that it will culminate after a lengthy court ruling.
1. Insurance advisor or insurer
The first instance to resolve any insurance complaint (such as to resolve a loan) is as simple as contacting your insurance advisor. As the direct link between the company and the user, this character could help mediate a conflict.
Sometimes, the reinterpretation of a conflict could open the way for a good agreement between both parties. This, without the need for another process and investing in representation expenses.
2. Defender vs. Insurance Company
Reaching this stage already implies wear and tear in the relationship between company and user. Therefore, it will be necessary to acquire the services of an advocate to handle the case.
The goal at this stage is a fair settlement. In it, the insured will fight for higher compensation, which covers his request and his lawyer’s fees.
If not reaching an agreement, the conflict will cease to be between individuals and pass to public order. There will be no guarantee that the result will be in favor of the client.
3. Consumer associations
This stage translates into the preamble to a legal conflict. However, it is possible to reach an agreement regularly for the benefit of the user. However, there is also the alternative of reaching the last resort.
For this process, the internal ombudsman or regulator has the possibility to intervene. Its purpose will be to reconcile the conflict.
Even if the user requests it, they could offer the Free Legal Defense service to financial services clients who request it.
As part of the requirements at this point, they are:
- Written presentation of clarification presented to the financial institution
- Claim filed with the internal ombudsman or regulator.
- Reconciliation hearing minutes and reports presented by the claimed Financial Institution
- Insurance policy cover
- General conditions
- Proof of premium payment
- Loss notice
- Invoices or receipts for fees
4. Arbitration route
Before reaching a judicial instance, arbitration is an extrajudicial route where the last possibility of conciliation will be sought. The insurance company will regularly try to compromise and invite the driver to do the same.
Between the evaluations of both parties, it will be the last opportunity between the insured and the company for a direct agreement. That is, once this resource has been exhausted, it will be a third party that will define and endorse one of the parties in an unappealable way.
It is one of the most advanced stages; the user must also assess his defense costs. If it continues, the complainant must absorb all expenses in the process hoping that it will be in their favor. Otherwise, it would be a severe financial blow for the insured.
5. Judicial way
At this point, the process has been unsolved for several months. None of the previous routes could unblock the conflict, so it will be a judge who will define sharply.
The possibility of making a pact is practically impossible, so the judge will analyze the arguments of the two parties. After studying the case, it will issue a final verdict and end the conflict. No guarantee that the customer will be favored.
Remember that if you have contracted legal defense coverage in your policy, your insurer will give you an amount of money so that you pay a lawyer you trust. But only if the cause of the loss is the third party and you have to claim from their company the payment of compensation.
To anticipate any split-up between a user and an insurance company, we recommend looking at the Law on the Insurance Contract. It establishes the regulations of commercial relationships between insurance institutions and policyholders. That is an x-ray between the rights and obligations of both that will save you from future intact insurance complaints.