RIGHTS OF THE INSURED

1. What to do in case of a dispute?

If you are dissatisfied with the conduct of the insurance company, or if you believe that the insurance company is not adhering to the provisions of the insurance contract (the policy), the first step should always be to file an objection with the insurance company, in writing.

Before taking any further action, you should wait to receive a written response from the insurance company, which is obliged to deliver it to you within 30 days of the date the objection was filed.

In accordance with the law, insurance companies are obliged to have an appropriate organizational unit (body) responsible for resolving disputes, and to have developed internal procedures for out-of-court dispute resolution.

2. Submitting a complaint to the Agency

If you do not receive a response from the insurance company, or if your objection is rejected by the company and you believe that the company is not acting in accordance with the provisions of the laws or the secondary legislation within the competence of the Insurance Supervision Agency (the Agency), you can submit a complaint to the Agency.

You can also submit a complaint to the Agency if you believe that any of the entities carrying out insurance agency or insurance brokerage activities is not acting in accordance with its obligations established in the legislation and secondary legislation.

The complaint can be submitted (in person or by mail) to the Agency or electronically (by email: [email protected]).

The complaint is submitted by completing a prescribed form, together with which you need to attach the documentation related to the specific complaint.

3. How the Agency handles the complaints it receives

The Agency IS NOT A BODY AUTHORIZED TO RESOLVE DISPUTES and is not authorized to arbitrate in matters related to property-law relations that may arise from an individual contractual relationship (a concluded insurance contract).

 

The Agency IS NOT AUTHORIZED to act on complaints that relate to:

– the basis of the claim for compensation (whether the company accepts that it has an obligation under the concluded insurance contract), and

– the amount of the claim for compensation (the amount of the damage that occurred).

 

Deciding on matters related to property-law relations in which the basis or the amount of the damage is disputed is within the competence of the judicial authorities.

 

The Agency IS AUTHORIZED to check for possible omissions, irregularities and non-compliance in the conduct of insurance companies, and if there are indications that insurance companies are acting contrary to the laws or secondary legislation, the Agency will conduct a supervision procedure, impose appropriate supervisory measures in accordance with the Law on Insurance Supervision and, if necessary, issue recommendations to the insurance companies aimed at preventing similar situations in the future.

The Agency does not consider complaints for which court proceedings are being conducted, for which a court decision has already been issued, or for which another procedure is under way. The Agency does not act on anonymous complaints.

If the Agency determines that the complaint relates to the basis and amount of the claim for compensation, the Agency does not act on the complaint received and informs the complainant of this, referring them to exercise their rights before the competent court.

If expert evaluation takes place in the proceedings between the client/insured/policyholder and the insurance company, the Agency is not competent to assess the findings and opinions of the experts, and the facts and circumstances established in these findings may be used only in court proceedings.

If it determines that it is authorized to act on the specific complaint, the Agency considers the complaints received in the procedure established in the Rulebook on the manner of handling complaints from the insured, insurance beneficiaries and injured third parties.

The Agency delivers a written response to the complainant within 30 days of the date the complaint was received.

The written response (notification) you receive from the Agency regarding your complaint is not an administrative act that decides on your rights, obligations and interests within the meaning of the Law on General Administrative Procedure.

The final way to exercise your rights by proving liability, the amount of the damage that occurred and the obligations of the insurer is to initiate and conduct court proceedings against the insurance company.

Any supervisory measures the Agency may take against the entities are not communicated to the complainant.

Additional Information