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Claims

General

What general rules, requirements and procedures govern the filing of insurance claims?

Italian law does not provide specific detailed procedures for filing insurance claims to insurance undertakings apart from the following general principles:

  • For non-life insurance contracts, the insured must inform the insurance undertaking of the occurrence of the insured loss no later than three days following the occurrence of the event or acquiring knowledge of the event; and
  • Following the notification to the insurer, the policyholder must file with the insurance undertaking the relevant documentation provided in the insurance contracts concerning the loss, and must take any measure to avoid any increase of such loss or damage.

Moreover, the general principle is that the policy must clearly provide the rules for filing claims, the documents that the insurer may require from the insured/beneficiary for the assessment of the risk and of the claim amount. In this regard, the insurance undertaking cannot oblige the policyholder to provide it with documents that are not necessary to assess the claim.

Regulation 35/2010 issued by IVASS (the insurance market regulator) on transparency requirements to be met by insurers vis-à-vis policyholders provides that insurance undertakings must define in the pre-contractual documentation the procedures for the filing of insurance claims and the relevant documentation needed.

A specific regime exists for filing insurance claims for mandatory motor liability insurance policies.    

Time bar

What is the time bar for filing claims?

The time bar for filling insurance claims is set out in the Civil Code.

For non-life insurance contracts and reinsurance contracts, the time bar for filing claims to the insurance undertaking is two years from the day on which the event occurred.

For life insurance contracts, the time bar is 10 years from the death of the insured.

Denial of claim

On what grounds can the (re)insurer deny coverage?

The ground on which insurers can deny coverage depends on the line of business and the type of insurance coverage. In general terms, insurance undertakings deny the indemnification of a claim or the payment of the insurance benefits when:

  • the insured did not regularly pay the premiums;
  • the event is not covered or is specifically excluded from the policy;
  • the claim is time-barred;
  • the claim is fraudulent or incomplete;
  • the insured made false or incomplete statements upon signing the policy (subject to certain conditions);
  • there is not enough evidence relating to the insured event;
  • the insured breached his or her duty either to inform the insurer of the occurrence of the loss or to take any measure to avoid to increase of such loss; or
  • the losses or event causing the damages claimed by the insured occurred before the insured period.

What rules and procedures govern the insured’s challenge of the denial of a claim?

There are no rules and procedures governing the insured's challenge of the denial of a claim.

General rules regarding civil proceedings apply.

Italian law provides for alternative dispute resolution systems that will/may be adopted before starting a civil action in court (ie, the mandatory mediation procedure and the assisted negotiation for all types of claim and the special arbitration procedure before the arbitrator for financial disputes that applies in certain cases of alleged breach by a financial intermediary of its conduct rules when distributing life insurance investment products).

The insured has the right to file complaints with IVASS; however, the definition expressly excludes complaints regarding the (denied) payment of a claim by the insurer or the amount of the same.

Third-party actions

On what grounds can a third party file a claim directly with the (re)insurer?

The Civil Code and the Insurance Code (Legislative Decree 209/2005) provide that third parties can file a claim directly with the insurance undertaking in the following cases:

  • In third-party liability contracts, the insurance undertaking is generally entitled to indemnify directly any third party damaged if the insured is notified first and the policyholder so requests;
  • In motor car insurance; and
  • In life insurance contracts in favour of a third party, the appointed beneficiary has the right to obtain the payment of the capital benefits deriving from the death of the insured.

Punitive damages

Are punitive damages insurable?

No, punitive damages are not insurable under Italian law since neither statute nor case law recognises the compensation for punitive damages in civil proceedings. Italian courts can order a party to indemnify the claimant only for material and non-material damages suffered, provided that they are the direct consequences of a certain event.

Consequently, insurance undertakings operating in Italy do not cover punitive damages risk.

However, a recent Supreme Court decision concerning the enforcement of a foreign judgment that ordered the payment of punitive damages seems to recognise the possibility of such damages to a certain extent.

Subrogation

What regime governs (re)insurers’ subrogation rights?

The Civil Code provides that the insurance undertaking that indemnifies the loss suffered by the insured can file a civil action against the third party liable for the damage that caused the loss to the insured.

This subrogation's right is subject to certain conditions established by law and limited to the same amount paid by the insurance undertaking to the insured.

The insurance undertaking remains liable for damages caused while exercising the subrogation's right. 

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