Introduction to Insurance Contracts: Understanding the Basic Principles
An insurance contract is a key legal document that defines the relationship between the policyholder and the insurer. Under this contract, the policyholder agrees to pay the premium, while the insurer assumes the responsibility for paying the insurance benefit in the event of an insured incident. This type of contract serves as protection against the financial consequences of various risks that may arise in the future. The foundation of insurance lies in the insurer’s obligation to cover the damage or loss caused by an insured event, as detailed in the contract.
Process of Resolving Insurance Claims: Steps and Key Information
The resolution of insurance claims begins with the submission of a claim by the insured, which needs to be thoroughly explained and supported by relevant evidence. The insurer conducts an investigation and damage assessment, usually documented in a report, to determine the circumstances and amount of damage. The decision on the insurance claim is made by a body within the insurer, whose name varies from company to company. A well-explained and evidence-supported insurance claim greatly increases the likelihood that the damage assessment will be adequate and fair.
Legal provisions dictate that in situations where the basis of the insurance claim is undisputed, but more time is needed for detailed processing and determining the final amount of damage, or in cases where an agreement on the amount of damage with the claimant is not reached, the insurance companies are obliged to pay an undisputed part of the damage as an advance. This advance payment allows partial compensation to claimants while the complete processing is finished, especially in more complex cases where more time is needed to collect and analyze all relevant information. If the insurance companies fail to fulfill the payment obligation within legally prescribed deadlines, the claimant has the right to payment of the undisputed part with the addition of interest from the moment of submitting the claim or receiving notification of the insured event. The claimant also has the right to compensation for any additional damage caused by the delay in payment.
Objection to the Insurer’s Decision: How to Approach and What to Include
Insurance companies sometimes make final damage assessments that may seem illogical or unfair. In such situations, the first step for the insured is out-of-court dispute resolution, which is usually provided for in the insurance contract. The process involves submitting a written complaint to the insurer, which is detailed and well-explained. The complaint is a statement of dissatisfaction by the claimant in the process of resolving insurance claims arising from extra-contractual liability for damage.
The complaint should contain:
- Personal Details of the Complainant: State the name and address if the complainant is an individual. In the case of a legal entity, it is necessary to state the name of the company, the company’s headquarters, and the name of the responsible person.
- Reasons for the Complaint: A detailed explanation of the reasons for submitting the complaint, including specific requests or expectations from the process.
- Evidence Supporting the Complaint: It is necessary to attach all relevant evidence supporting the claims. This may include documents that were not considered in the initial process, as well as suggestions for new evidence that may be important for the case.
- Date of submission of the complaint and signature of the complainant or the person representing them
- Power of attorney for representation, if the complaint is submitted by a proxy.
The decision on the complaint regarding the resolution of the insurance claim is made by a secondary body of the insurer (within 15 days).
Importance of Legal Support: How a Lawyer Can Help You
To successfully resolve an insurance claim, it is crucial to have quality and professional legal support.
Contact us with confidence to quickly and efficiently claim the amount that belongs to you, with minimal stress and complications.