Claims against insurance companies

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Claims against insurance companies
Car (automobile) insurance and collision damage waiver concepts. Businessman with protective gesture and icon of car.

Many people argue that insurers are in the business of not paying. In many cases, they deny the payment of compensation or put obstacles for reasons that seem to be incomprehensible. However, in other cases, they only protect your assets against requests that leave many doubts about their fidelity and legality.

However, with the corresponding legal advice, it is possible to successfully advance a claim process before an insurer or even withdraw unfounded claims due to the existence of prescription, evident lack of coverage, or other reasons that make it unfeasible.

In this writing, we explain seven facts that you should know and consider when filing a claim with an insurer.

1. You must know which insurance contract benefits you

You must know which insurance contract helps you and on which you will base your claim. For example, in the case of traffic accidents, you should know if the person responsible for the accident had one or more civil liability policies that could benefit him. You can ask this directly at the time of the accident.

To obtain this information, you must fill out the proposed form, send the request and wait for a response for about fifteen business days.

In any case, it is convenient to know the number of the policy, the insurer that issued it, and to have, at least, the title page.

2. How to obtain the policy?

It is convenient to have the policy in your possession before initiating legal action to know to what extent the insurer’s responsibility reaches or if conditions reduce the amount of money you can receive as compensation.

This is not always possible because, in some instances, the insurers refuse to deliver the policies, and due to time pressure, it is necessary to claim and even sue without knowing with certainty what the general and particular conditions of the contract are for sure. However, it is convenient to learn and study the policy in most cases to know what points there may be a discussion about and evaluate the claim’s viability.

In most cases, the policy can be obtained by filing a right of the petition with the insurer.

3. How do you know if you are on time to file the claim?

The prescription

In commercial legislation, the prescription of the actions derived from the insurance contract is foreseen. These are terms of time in which the interested party must exercise the actions against the insurer, under penalty of extinction of the same.

The issue of prescription in the auto insurance contract is complicated and is still subject to debate in jurisprudence and legal academia. In some cases, the five-year particular statute of limitations may apply and, in others, the ordinary two-year statute of limitations.

The temporary limitation of coverage

It is possible that the claim must be presented within a certain period in the policy to be covered due to the incorporation of clauses that limit coverage, depending on the date of presentation of the claim.

These clauses are known as claims made and sunset clauses. 

4. Why is it essential to file a formal claim?

In most cases, it is convenient to present a formal and direct claim against the insurer, in which all the available evidence that proves the loss and the amount is given. Why surprise the insurer with a lawsuit if a good claim can facilitate preliminary settlements and speed up the process?

A good claim facilitates preliminary settlement with the insurer and must provide the claim and the amount. The proof of the claim and the amount of the loss makes it possible to legally request the recognition of default interest, at the maximum legal rate, on the value of the proven compensation if the insurer does not honor the obligations it assumed.

Interest is calculated on the value of the proven compensation against the insurer and begins to run once a month has elapsed since the claim is filed with all the supports that prove the claim’s existence and the amount of the loss.

This will make the litigation much more interesting for the claimant and create more pressure for the insurer. In practice, the presentation of a reasonable claim allows the value requested by the claimant to increase with the passing of days due to default interest provided for in Colombian law.

Therefore, filing a formal and direct claim with the insurer is always a good idea, even if it means disclosing all the cards to the insurer from the start.

5. What should a formal claim contain?

The formal claim must contain the identification of the claimants, the facts on which it is based, the compensation claims. The grounds of law and proper legal argumentation in each case, the contact information and notifications, the power of attorney if acting through a proxy, and, most importantly, all the evidence that proves the claim and the amount of the loss.

Before the law, the procedures were the same, and, in most cases, there are no limits or requirements on the evidence that can be asserted. However, certain proofs are required in some cases, such as civil marriage registration, marriage or civil birth registration, to prove the relationship.

The insurer may have designed a particular procedure and requested certain documents.

For this reason, it is convenient to follow the procedure provided by the insurer, provided that this does not imply unnecessary obstacles and delays in the compensation payment process.

6. What to do if the insurer refuses to pay or does not respond to the claim?

In Colombia, the administrative process is enshrined and regulated based on the insurance policy. The insurance company does not object to the claim within the month following the support or evidence that proves the claim and the amount.

However, we believe that the enforcement process is very complicated for the claimant since it involves formal discussions about the enforceable title and its requirements that distract attention from substantive discussions regarding the facts constituting the insurer’s liability. For this reason, except in specific cases, we believe it is always more convenient to initiate a declaratory process. If you want to know more about the executive function, click here based on an insurance policy for untimely objection.

If the insurer objects to the claim, the reasons for the objection must be evaluated to determine if it is well-founded. This is an evaluation of the feasibility of a judicial process against the insurer.

In addition, in this phase of the claim, the negotiation steps that the interested party can carry out are precious to obtain a preliminary settlement. If the agreement is not reached and there is evidence and arguments to demonstrate the insurer’s responsibility in court, the interested party must promote legal action.

Extrajudicial conciliation

You can summon to reconcile the insurer to reach a preliminary agreement. The conciliation is carried out before a third party –conciliator-who will propose settlement formulas and will have as an objective that the parties put an end to the controversy, by themselves, without the need for them to go to the administration of justice.

If you have filed the claim before, the insurer will already know your case and may affirm your position at the conciliation hearing.

In civil matters, conciliation is a procedural requirement to sue. However, it is unnecessary when the interested party requests preventive measures in the lawsuit, according to the civil procedural law.

Promote judicial process

Suppose a preliminary agreement with the insurer is not reached. In that case, all that remains is to promote a judicial process, with the objective that the judge resolves the controversy and declares the insurer’s obligation. With the judicial process, it is sought that the competent judicial authority, through a sentence, orders the insurer to comply with the commitments that it acquired, with the issuance of the policy.

Depending on the evidence collected throughout the process, it is possible to build a case with such a force that it facilitates a settlement or conciliation agreement before the judge ruled in the first or second instance.

7. Do I need a lawyer to advance the claim?

It is unnecessary to have a lawyer to claim directly from the insurer. For this, it is enough to ask the insurer what documents it requires and deliver them, leaving proof of delivery.

In small claims, an attorney may not be required. However, it is good to consult an attorney to prepare your suit in most cases.

If the lawyer knows insurance law and civil liability, he will analyze your case to determine the viability of the claim. In addition, she will support his claims of her much better and help him during the negotiation periods.

To present the request for conciliation in civil matters, it is not necessary to hire a lawyer, although it may be convenient. If, in addition to the insurer, you will summon a public entity to conciliate, the conciliation must be carried out at the Attorney General’s Office, and you will necessarily require a lawyer.

To start the judicial process against the insurer, you will require a lawyer, unless it is a claim before a civil judge and the value of the claim is equal to or less than 40 SMMLV (article 25 of the General Code of Procedure under article 28 of Decree 196 of 1971). In this case, the interested party may litigate on their behalf.

How can we help you if you want to file a claim with an insurer?

We evaluate your case and tell you how to claim your rights against an insurer. We offer advice and legal representation in claims and lawsuits against insurers. We defend the rights and interests of policyholders and beneficiaries in all types of insurance.

  • Damage insurance.
  • People insurance.
  • Private and public service vehicle insurance.
  • Life insurance.
  • Debtors group life insurance.
  • Compliance insurance.
  • Property insurance.
  • Fire insurance.