What steps do you have to follow to claim the insurance if you do not respond?

When you have verified that there was no reason for your insurer not to provide a service, it is time to file a claim. The first step you must take is to file your complaint with your company’s Customer Service (SAC) or with the Customer Ombudsman if there is one. Your company’s reply should arrive within two months. Below we give you all the information to make a claim to the most prominent insurers in the market:

Claims to Adeslas

To claim Adeslas health insurance, you can contact the company through its customer service number: 91 919 18 98 or 93 518 10 80. In addition, they also allow you to contact them through Twitter and Facebook.

According to the latest data from the OCU, Adeslas manages to resolve around 82% of the complaints received, for which it has a  response period of about 30 days. This is much more than the average of six days that companies usually respond to a claim. Therefore, the consumer organization gives Adeslas is  54 out of 100.

Claims to Sanitas

In the case of claiming Sanitas, the interested parties must send a document with the claim and the ID of the insured (or any other identity document) to the Sanitas Claims Department. You can do it by email ( reclamaciones@sanitas.es ) or by post (Calle Ribera del Loira No. 52, 28042 Madrid ). After this, the insurer will have two months to respond, as the law indicates.

The OCU marks the Sanitas claims service with 58 out of 100, with 69% satisfied. In addition, your response period is only four days.

Claims to AXA

If you want to claim the AXA insurance, you can do so through its website, in which it has enabled an online form so that the insured or third parties who want to make a claim can fill in the data of the same and send it electronically.

AXA manages to resolve 57% of the claims made by users. In addition, the response time is an average of eight days, so the OCU gives it a score of 60 out of 100. 

Claims to DKV

DKV also makes available to its clients two addresses, both e-mail and postal mail, so that they can claim the insurance: either by writing to Defensacliente@dkvseguros.es or Torre DKV. Avda. María Zambrano, 31 – 50018 – Zaragoza. They can also do so by going to one of the DKV offices.

According to the OCU, its score is the best value, with 75 out of 100. Resolve 65% of your complaints and, as a general rule, respond on the same day you receive the complaint.

Claims to Asisa

 Finally, in Asia, you can claim by filling in a form that the entity makes available to you on its website and through the private area of ​​its clients.

OCU scores a 59 out of 100 because it resolves 69% of the claims it receives and has a response period of five days.

If the insurers did not respond to your complaint, or if the solution they offered you did not satisfy you, the next step would be to complain to the  General Directorate of Insurance and Pension Funds  (DGSFP). When you file this complaint, you must indicate that you have already exhausted the first route without obtaining a good result. This procedure is always carried out in writing, either using paper support or electronic means. The DGSFP Claims Service has four months to issue a resolution that is not binding, although insurers usually respect it.

Once this option has been exhausted, you can always go to court or to some extrajudicial resolution system, such as the arbitration system, which is free. Its only drawback is that it is voluntary for both parties and, therefore,  requires the submission of the claimed company. The positive part of this method is that the decisions taken have the same validity as a court ruling.

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