What is the process for a insurance claim?

At the time of a claim, there is uncertainty, stress and a lot of concern, that is why we want to share with you in our article, a small guide so that you know what to do in case of suffering an event of this type.

1.The first thing you should do in order to collect the insurance is to report the claim to the insurance company so that they can make the settlement report.

2. If the policy was contracted through an insurance broker, you should contact him, as he should assist him in the settlement process.

3. Settlement can be done directly by the insurance company or through an independent external adjuster. The decision taken must be informed to the insured within a period of three business days from the date of the claim.

4. The insured may object to the settlement being carried out by the insurance company and in that case, the latter may request, within five business days, that an insurance adjuster be appointed (the insurer will have two business days to designate the liquidator.

5. To whom the settlement of the claim corresponds (insurer or liquidator), the insurer must inform about the steps to be taken and the background information that will be required to settle the claim.

6. The liquidator must issue his report within the shortest period of time, not to exceed 45 calendar days from the date of the complaint, except:

  • Individual insurance on risks of the first group in which the amount of the annual premium is higher than 100UF in 90 calendar days from the date of the claim.
  • Marine insurance, hulls or General average: 180 calendar days from the date of the claim.

It should be noted that these cases may be extended by the liquidator in founded cases for the same periods, which must be communicated to the insured and the Commission for the Financial Market, being able to nullify the extension and set a specific term for the delivery of the settlement.

7. The settlement report must be sent simultaneously to the insured and insurer on the same date, which must be composed of a technical opinion about the origin or non-payment of the compensation, the amount of this and finally the criteria and parameters used for its determination.

8. The insurance company and the insured will have a period of ten business days from receipt of the settlement report to challenge. In the event of a challenge, the liquidator will have six business days to respond to it.

9. In case of persisting differences regarding the origin of the coverage or amount of compensation, the insurers will have to inform within a period of five working days, the final resolution of the claim.

10. When there is an agreement between the insured and the insurer, the compensation must proceed within the following six days from the notified resolution.

Although the settlement process seems simple and fast, it is not. The traditionality of the insurance industry has conceived a notorious stagnation and the participation of many actors, which makes it more difficult and slow all the way.

Keeping policyholders satisfied has not been an easy task for insurers, which is why LISA’s promise is to guarantee an easy, fast and safe process in a few days, thanks to the use of cutting-edge technologies.

Contact us and request information about our products.

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