Report damage quickly
It is also important that policyholders react correctly in the event of an accident. So you have to register with some insurance companies. report in a few days. If there is damage to the house, you should only hire craftsmen afterwards, as insurers usually want to see the damage beforehand. But nothing speaks against a cost estimate.
In addition, consumers should make sure that the damage does not increase. For example, if it rains through the roof, you should place a bucket under the leak to prevent the water from seeping into the apartment below. The insured can also carry out or commission emergency work that cannot be postponed. The costs of this are usually covered later by the insurance company.
When do you have to pay the insurance?
The average time that insurance companies can take your time depends on the type of insurance and the terms of the contract. Especially when it comes to higher amounts, such as residential building or liability insurance, many consumers sometimes wait several weeks or even months in payment.
This is because insurers want to know more about the larger sums and examine the facts particularly closely. While that is your right, there are limits.
Insurance companies have to pay for damages caused by the delay
If the insurance companies cannot show that the time for fact checking was really necessary, the payment is considered late. Experts also talk about slow regulation. If this is the case, the insurers are required to pay for the damage caused by the delay.
If you have hired a lawyer, the insurer may also have to pay their fees. However, you should not rely on this and only seek legal assistance if you can essentially bear the legal costs yourself.
What to do if the insurance does not pay?
You do not have to tolerate your insurance company delaying the processing time, or reducing or completely denying the benefit if the reasons for this are not understandable. Depending on the phase in which you want to intervene, you enter differently. Our guide shows you how.
- Reminder of the next completion: If the insurance company has not yet sent you a final letter refusing to settle the claim, you need to remind them to process your case soon. You can already make it clear in your letter that you will otherwise be in financial trouble if the insurance company doesn’t pay quickly. It is best to set a deadline.
- File a complaint or file an objection: If you still don’t get a response, write to the insurance company’s complaints management or directory. From there, the complaint must be passed on to the responsible department heads. You do not have to follow a specific form for reporting. If the insurance company denies your application after the reminder or only grants reduced benefits, you should carefully examine the reasons. If it is not valid, object to the denial by certified mail, explaining the reasons for the denial and attaching the relevant documents.
- Check the HIS entries: Insurers use the German insurance industry’s notification and information system (HIS) to verify information on insurance applications to prevent fraud. However, it may happen that incorrect or unjustified entries are listed. Check it out using the self-assessment.
- Claim before the Ombudsman: The Ombudsman is the extrajudicial arbitration board for insurance companies, before which you can also file a claim. However, he is often very busy, so it can take several months for your application to be processed.
- Complain to Bafin: You can also address your complaint to the Federal Financial Supervision Authority (Bafin). He then checks to see if his insurance company has behaved correctly and asks the board for an opinion. Your case will then be re-examined.
- Check financial aid: If you have legal protection insurance, you should consult the insurance certificate to see how you can use it. Alternatively, free legal aid could also be considered. Read here what requirements you have to meet.
- Claim default interest: If insurance companies delay payment, they earn interest at the customer’s expense. You can take action against this by asserting your right to default interest.
- Hire an attorney: If all else fails, you can file a lawsuit as a last resort. Ideally, you should retain an attorney for this. If the amount in dispute is greater than 5,000 euros, this is even mandatory.
Good to know: A comparison can avoid a lengthy legal dispute and save the insured time and nerves. An option to reach an amicable agreement with the insurance company is, for example, the so-called fictitious billing in the event of material damage. You will then quickly receive the estimated net amount of the repair. The rest flows after presenting the invoice. Alternatively, you can repair the damage yourself with the amount paid. Net instead of gross may be cheaper than arguing over the full amount.
Are there special cases?
Yes. the compulsory health insurance it is a special case because you should receive benefits from it even if you are behind on your contributions. If the health insurance company does not respond to your request for benefits in writing within three weeks, it is considered to have been approved.
If she refuses a service, she must appeal if the action is medically necessary and financially justified. If this is also unsuccessful, she can still file a complaint with the Social Court. Policyholders do not incur any costs for the opposition and the legal proceedings themselves. You only have to pay the attorney’s fees yourself, unless you win, in which case the health insurance company will pay the fees.
Keep a care diary and see your family doctor
Another special case is the care insurance. If your application for benefits is denied, the first thing you should do is discuss the reasons with your health insurance company. You can then counter this by, for example, creating a detailed care diary, asking for an opinion from your GP, or listing your care desk services if you already use one.
You must appeal within one month of receiving the denial. Unless the right to appeal is lacking, then you can give your objection for one year. If your objection is also rejected, the only option is to file a complaint with the social court.