When subscribing to an insurance contract, the insurer undertakes to indemnify the insured if the risk provided for in this contract is fulfilled. How to proceed if your insurer does not agree to pay you the compensation provided for in the contract?
What the law says: When an insurance contract is concluded between an insurance company and an individual, the insurer has the obligation to indemnify the insured in the cases stipulated in the contract and within the agreed period. However, the insurer may refuse to pay compensation if the loss is not covered by the contract or if it occurred in circumstances that preclude the assumption of responsibility.
Time limit to act: 2 years from the moment the incident occurred.
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An insurance contract contains several information, including the risks covered, but also the guarantee clauses. This part of the contract sets out the conditions and requirements to be met for the loss to be covered. The contract also specifies the exclusions of protection, that is to say the cases in which the insured is not protected. You also need to know how to find a personal injury lawyer.
The guarantee conditions specify the cases and circumstances in which the insurance will take place. They can also impose mandatory preventive measures on the insured in order to do everything possible to prevent a disaster from occurring.
These measures may consist in the installation of alarms in a house or for a car; a lock on a bike; smoke detectors in a dwelling; etc.
The insured must also be vigilant and, for example, lock his vehicle or house, do not put himself in danger voluntarily, or inform the insurance when his situation changes.
In addition, once the loss has occurred, the insured must:
- inform the insurer as soon as possible ( article 175-18 of the Insurance Code),
- prove the existence of the claim,
- show that the claim covered by the contract,
- Demonstrate that the warranty conditions have been met.
If these obligations are not respected, if the insured is negligent or if the conditions are not met, the insurance may refuse compensation.
In which cases can insurance refuse to compensate the insured?
The insurance must compensate you even if the accident was caused involuntarily by your fault.
However, the insurance contract may include an exclusion clause, which allows the insurer not to support certain defined events. In general, these events are excluded from protection because:
- the probability that they occur is important
- the law prohibits insurance companies from guaranteeing
- The fault is committed intentionally
This type of clause must describe and precisely identify the risk that is not covered by the insurance. Cases of exclusion must be limited and if they are not clear enough, the insurer cannot refuse compensation.
For example, are not supported by insurance: fines; accidents by a driver who did not hold a driver’s license; claims intentionally caused by the insured to obtain compensation. The insurer must prove that the claim is excluded from the guarantee. If he can provide this proof, he may refuse to indemnify the insured.