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Claims

General

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

The insured must give notice of the loss within three days after becoming aware of the loss, although this time limit may be extended in the insurance policy.

The insured must provide to the insurer, at its request, all information to verify the loss and may examine the administrative or judicial proceedings related to the claim. This request must be made within 30 days of the loss being reported. The beginning of the 30-day period within which the insurer must decide whether to accept or reject a claim is then postponed until either:

  • the insurer has received relevant information to reject the claim; or
  • the insured has provided all the information requested by the insurer.

Once the relevant information has been received, the insurer must decide on whether to cover or decline liability for the claim within 30 days (or 15 days for life and personal accident insurance). If the insurer does not reject the claim in a timely manner, it is deemed to have accepted the loss. 

Time bar

What is the time bar for filing claims?

General limitation period

The limitation period for claims brought under an insurance contract is one year from the date when the relevant obligation becomes payable.

In life insurance, the one-year limitation period starts from the date when the beneficiary becomes aware that he or she is a named beneficiary. This limitation period cannot be extended until three years from the date of death of the insured.

Reinsurance contracts There is no express legal provision concerning limitation periods in reinsurance contracts. The courts have generally applied a one-year limitation period, equating reinsurance to insurance. In the absence of a specific rule, the general limitation period is five years (Article 2560 of the Civil and Commercial Code).

Denial of claim

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

(Re)insurers may deny coverage:

  • when a loss is not within the risks covered by the policy;
  • if an event listed in the exclusions;
  • when the loss occurred while coverage was suspend for non-payment of the premium; or
  • for breach of a condition. 

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

Disputes between insurers and insureds are usually settled before the ordinary, civil or commercial courts, according to each jurisdiction.

In cases commenced under a consumer relationship, judges will usually apply the rules of summary proceedings.

Third-party actions

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

A non-life insurance contract can be made for the benefit of a third party. To enforce the contract, the third party will be required to produce the insurance policy or provide evidence of the policyholder's consent.

In life insurance, appointed beneficiaries can claim directly against the insurer once the event occurs.

In civil liability insurance, the victim of a tort is entitled to have the insurer join the proceedings.

Insureds have no action against reinsurers.

Punitive damages

Are punitive damages insurable?

There is no specific regulation regarding the insurability of punitive damages.

Subrogation

What regime governs (re)insurers’ subrogation rights?

The rights that correspond to the insured against a third party due to loss are transferred to the insurer up to the amount of the moneys paid. The insured is responsible for any act that prejudices this right of the insurer. Subrogation does not apply in life insurance.

Through subrogation, the insurer acquires a derived right, assuming the same position that the insured had with respect to the responsible third party. This implies that all rights, guarantees and actions of the insured are transferred to the insurer, and that the responsible third party can submit to the insurer all the defences that it has against the insurer, and those it had against the insured.

There is no specific regulation regarding rules of subrogation for reinsurance contracts, but this can be agreed by the parties.

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