Model letter of contestation to an insurer for the management of a claim

Model letter of contestation to an insurer for the management of a claim.

Litigation with insurance

A dispute or disagreement with his insurer is something quite common. But in the majority of cases, it is a misunderstanding or misinterpretation of the insured about his contract.

The first thing to do is to re-read your contract, including the terms of exclusions of guarantees and special conditions and do not hesitate to contact his adviser in case of doubt.

Disputes with his insurer generally involve a refusal to compensate for a claim, an insufficient amount of compensation, a late declaration, the non-reimbursement of a broken object, a change in an undeclared situation or because of a claim. too long processing time for example.

How to make an amicable remedy with his insurer?

In a letter of "mis en cause" you will show that you have informed the insurer of the loss within the legal deadlines and that the latter is covered by the contract while demonstrating that the guarantee conditions have been met (no intentional fault or exclusions). Attention, the limitation period is 2 years, beyond no action will be possible!

It is not always easy to express your grievances in writing, that is why we propose below models of letter of complaint to the insurer for different reasons and insurers (Maif, MMA, Matmut, Axa, Allianz , Macif, Gan, Groupama, Maaf, GMF, etc.). It is important to send your letter by registered mail with AR in order to keep track of your steps if, subsequently, you have to request the Ombudsman's intervention. This procedure will allow you to obtain an informed and external opinion on the dispute between you and your insurer, when it does not succeed.

Similar letters: Referral to the BCT after a refusal of compulsory insurance, Make a request for arbitration, Request a conciliation.

These letters can be useful to you:

Request an information statement from the insurer Request a copy of a certificate of insurance

 Examples of mail to settle a dispute over an insurance contract

Subject: Claim compensation.

Example for an automobile insurance contract (refusal of assumption of responsibility)

Dear,

I acknowledge receipt of your registered mail dated [date] in which you inform me that you refuse to compensate the theft of my GPS in London that I declared [date] on the grounds that it falls under the exclusion of guarantee.

However, there is obviously a contradiction between the general conditions and the particular conditions of our contract. Indeed, Article 3 provides for the compensation of objects broken into my vehicle at the European level, but the special clause B provides for exclusion outside France.

Referring to the case law, I ask you to review your position and make my compensation as soon as possible.

In the meantime, please accept, Madam, Sir, my best regards.

Example for a home insurance contract (insufficient amount)

Dear,

On [date], I declared a water damage / fire that occurred on [date] at my home [address] and for which I had taken out a multi-risk insurance policy with your agency.

After the arrival of the expert you appointed, you sent me a compensation proposal in the amount of [amount]. However, as evidenced by the various estimates attached, the work is estimated at more than [amount] by the various professionals.

Therefore, I ask you to increase the amount of compensation or to extend a new expertise. In the absence of a response from you within 15 days, I will ask the intervention of the mediator of insurance, which I hope will allow us to find common ground.

In the meantime, please accept, Madam, Sir, my best regards.

Example for too long compensation periods

Dear,

By registered letter of [date], I declared to you a claim concerning [specify] and for which you confirmed to me a support in the amount of [amount].

However, to date you still have not made the settlement that is due to me. I remind you, as provided by Article R.112-1 of the Insurance Code, that the insurance contract that binds us indicates that the compensation must be paid no later than within a period of [specify].

As of [date], you will therefore be liable for late payment interest under article 1153 of the Civil Code. If you do not answer within 15 days, I will go to the insurance mediator.

Hoping to be able to count on a fast settlement, I beg you to believe, Madam, Sir, in my sincere greetings.

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