What are the remedies against the insurance that does not pay?

Are you worried about not receiving the appropriate reimbursements from your insurance in the event of a claim? Before any signature, it is important to read your contract carefully to avoid conflicts. After a road accident, you do not receive compensation, or do you consider your allowance insufficient? Do not panic! Several solutions are possible. Does the insurer have the right to refuse to compensate you? How to contest a refusal of compensation from the insurance? To help you, contact a lawyer who specializes in insurance law. This professional can guide you through the formalities. Update on recourse against the insurance that does not pay.

TO REMEMBER:

• Before taking out car insurance, health insurance, or home insurance, it is essential to read the contract carefully to ensure that the guarantees offered provide sufficient coverage in the event of a claim.
• The insurer must compensate the insured for any loss mentioned in the insurance contract.
• In return, the insured must respect the conditions of cover, and must report the claim in time.
• If the insurance company refuses to pay, there are several ways to resolve the problem amicably.
• As a last resort, the insured can file a complaint against the insurer.

Can the insurer refuse compensation?

Whether you have taken out car insurance, health insurance, or multi-risk home insurance, the rules are the same. The law obliges the insurer to compensate the insured person if the loss in question is mentioned in the insurance contract and the company is notified within the agreed period.

However, the insurance company is released from any obligation if the insured does not comply with the conditions of the guarantee. The same applies if the situation is included in the warranty exclusions. Here is the list of reasons why the insurance is entitled to refuse compensation.

● Forfeiture of guarantees

Also called “non-compliance with the guarantee conditions”, the forfeiture of the guarantees is mentioned when the insured has respected not the guarantee conditions mentioned in the insurance contract.

● Late statement

The insured is required to report the claim within a limited time if one of the cases mentioned in the list below occurs:

• 2 working days for a flight;
• 10 days for a natural disaster declared in the Official Journal;
• 5 days for other claims.

● The omission of information

If you have omitted to declare important information or a change in circumstances that could increase the risk of a claim, the insurance company is entitled to refuse coverage.

● Warranty exclusions

Some warranty exclusions are imposed by insurance companies, while others are required by law. They are mentioned in the insurance contract.

Good to know:

The exclusions are particularly numerous when you opt for the least expensive insurance formulas.

Key points to remember:

• The insurer must indemnify an insured for any loss mentioned in the insurance contract signed by both parties;
• The insurance is entitled to refuse compensation in the event of non-compliance with the conditions of guarantee by the insured.

Dispute refusal of insurance compensation: how to proceed?

Before starting any procedure, start by re-reading your insurance contract. Pay attention to every detail.

Then, ask for an appointment with your advisor. An amicable agreement is often beneficial for both parties.

If, after this interview, the results are still unsatisfactory, ask for an interview with the director of the agency.

Following these interviews, do you feel that your rights are still not respected? A written complaint is required. To do this, send a registered letter with acknowledgment of receipt addressed to the “Litigation” department of the insurance company. You will find the contact details of the latter in your contract. This letter must be sent before the end of the limitation period (2 years). In addition to the letter of complaint, the file must include other documents such as the insurance policy number and supporting documents for the claim.

After looking for a solution internally, you can ask for outside help, without necessarily going to court. The insurance mediator is the competent person.

Here is a simple definition to better understand what the insurance mediator is.

It is an authority independent of insurance companies. This outside arbitrator intervenes in the dispute to help the two parties reach mutual consent.

Since 2015, La Médiation de l’assurance has been the only competent interlocutor to settle disputes between insurers and policyholders. To benefit from the assistance of the insurance mediator, the person concerned must meet two conditions: He has already sought to conclude an amicable agreement with his insurer. Then he hasn’t gone to court yet. Following your request, the mediator has a period of 3 to 6 days to give his opinion.

Master Benjamin Equin brings you more advice on what to do in the face of a refusal of insurance compensation.

Key points to remember:

• There are several amicable remedies to challenge a refusal of compensation by the insurance;
• You can appeal to an insurance mediator, without necessarily going to court.

How do I file a complaint against an insurance company?

The last resort is referred to the competent court. You have a period of 2 years after the date of the dispute to file a complaint. The competent court is different depending on the amount of compensation claimed:

Here is the list of competent jurisdictions:

• Local jurisdiction is recommended if the amount claimed is less than €4,000;
• The court deals with claims for amounts exceeding €4,000. In the latter case, the assistance of a lawyer is mandatory.

Good to know:

The legal limitation period is extended by 4 years if the referral is made by the mediator or the insurer, using a letter with acknowledgment of receipt. It is extended up to 10 years if the dispute relates to bodily injury or if the person concerned benefits from life insurance.

Key points to remember:

• The insured can file a complaint against the insurance;
• The competent court varies according to the amount of compensation.

To conclude, an amicable appeal is the most beneficial for both the insured and the insurance company. Whenever possible, it is recommended to seek an agreement by mutual consent.