After an incident, comes the time for the compensation process. From the detection of damage to the declaration to the insurer, including the persons to be notified and the delays to be respected, formalities to be accomplished are numerous. It is advisable to know them to avoid unpleasant surprises.
An insurance claim is an event (fire, death ...) which makes use of the guarantees of the contract: compensation, capital or annuity. In the context of civil liability insurance, there is a claim only if the third party files a request for compensation to the insured person (ref. article 51 of the CIMA Code).
The insurance claim is therefore the realization of the risk covered by the insurance contract.
- The damage report
Once the incident is under control, the priority is to make an inventory for availability of evidences. It is important to keep all damaged goods / materials and take pictures or even make a video before cleaning the premises. In case of burglary, it is necessary to start by an inventory of the missing objects along with their value.
A police or bailiff's report is recommended.
To justify the existence and the value of damaged goods/materials, all documents available should be gathered.
For personal insurance, documents provided by the medical staff attesting illness, disability or death of the insured will be required.
- The declaration of claim
First of all, it is important to check the guarantees covered by the insurance contract. Some damages could be excluded and therefore do not require a declaration.
In case of theft, a complaint should be filed with the police station before submitting a declaration.
Reporting deadlines to your broker / insurer depend on the nature of the claim. As a general rule, the declaration of the claim must be made within a minimum of five working days following the occurrence of the loss.
However, this period is sometimes reduced to two working days in case of theft.
It is important to read the General Terms of the Contract and to respect the prescribed reporting deadlines, failing which you could be deprived of the guarantees provided for in the contract.
- Do you need to support the refurbishment?
If the restoration of the assets is done by yourself, remember to keep bills for the purchase of materials or repair costs.
Warning ! You must first check with your broker / insurer that you are authorized to carry out the repairs yourself. In the event of important material damage, the insurer may require an expert report by an authorized professional, before any repair.
From the evidence gathered, you will be able to estimate the cost of the damage and compare it with the expert's assessment. In case of disagreement, you should inform your broker / insurer.
The form of claim reporting is not legally specified.
However, claim forms are available and can be provided by your broker / insurer and be completed with the assistance of an adviser.
The declaration must include:
- the contact details of the insured;
- the number of the insurance contract;
- the date of occurrence of the incident;
- a description of the incident;
- a description of the damages;
- any possible damages caused to third parties.
In case of theft, the insured must attach a copy of the complaint filed with the police.
Health claim forms provide information on disease nature and treatments.
Refer to your contract for more details on how to report claims.
- Declaration Form
- Accident report
- DCI Convention
- Declaration Form
- Third Party Payer Case
The third-party payment is a mechanism by which the insured is exempted from the advance of health expenses that are partially or wholly paid by his health insurer or mutual.
The insured person pays the hospital, the pharmacist or the practitioner the co-payment. He then signs a subrogative invoice for the unpaid portion of the cost which will be paid by his insurer.
The total third-party payment allows the insured to pay nothing (100% insurance coverage).
An insurance card that may or may not be biometric is sometimes provided to the insured and can only be used within a care network.
What is a co-payment?
The co-payment is the part of the expenses to be bored by the insured after deduction of the payment to be made by the insurer. It corresponds to the difference between the cost of the service and the cost guaranteed. its amount may vary according to several criteria:
- depending on the act or the treatment,
- depending on the type of medication,
- depending on the nature of the risk,
- depending on the duration of the illness,
What is the Health Insurance Card?
The health insurance card allows you to benefit from the services covered by health insurance. Only one card is issued per person and is valid for the duration of the contract. Among other things, it allows the identification of the insured and when it is biometric provides information relating to the guarantees covered by the contract.
What is the care network
A care network connect insured persons with health professionals approved by insurers or brokers and play an important role in the quality / price ratio of services.
- Theft Claim
- Declaration Form
Three key points determine the quality of the claim processing:
- The assistance and care delay
- The compensation delay
- The quality of the exchanges and clarity of information provided throughout the process