¿Por qué algunas aseguradoras no pagan lo que toca cuando toca?
Imaginemos que circulando a 200 Km/h por una autopista cuyo límite son 120 Km/h nos detiene la policía. Ésta nos advierte que debemos circular como máximo a 120 Km/h y nos deja seguir tranquilamente ya que la Ley impide que nos sancionen y nos quiten puntos de la licencia de conducir, ¿qué haría la mayoría de gente? ¡Volver a circular a 200 Km/h!
Si las “reglas del juego” cambian, o sea, cambia la Ley y permite a la policía sancionarnos con 10.000€, nos sacan 6 puntos del carné de conducir y nos caen 2 años de cárcel, a nadie se le ocurrirá sobrepasar los 120 Km/h ni en sueños.
Por tanto ¿qué sucede?
- Las reglas del juego (Leyes y demás normas del ordenamiento jurídico) deben ser claras y justas.
- Que las reglas del juego deben ser lo suficientemente coercitivas para quienes las incumplen. Debe ser muy caro incumplirlas
¿Qué sucede cuando algún usuario intenta engañar a una aseguradora para enriquecerse?
Pues que las reglas del juego permiten que la aseguradora pueda denunciarlo o querellarse por intento de estafa, falsedad de documento y un sinfín de delitos a modo que a poca gente se le ocurra hacer trampas para enriquecerse a costa del seguro. Pero además, si la aseguradora se entera que el usuario está haciendo trampas, simplemente no paga y al usuario le costará mucho reclamar algo que no es cierto, y por tanto, la carga de la prueba para justificar una mentira será casi nula. Por ello las aseguradoras lo tienen relativamente fácil para evitar que los usuarios hagan trampas, más aun cuando el dinero está en el “bolsillo” de la aseguradora.
¿Por qué es tan fácil que las malas aseguradoras timen y se enriquezcan a costa del usuario?
Lo cierto es que las malas aseguradoras lo tienen bastante más fácil a la hora de timar a los usuarios que no al contrario, y por eso hay malas aseguradoras en el mercado que son auténticas profesionales del timo masivo. Y ¿por qué lo hacen? Pues porque las reglas del juego se lo permiten, o sea, sale muy rentable timar a los usuarios.
Si una aseguradora intenta timar a un usuario dejando de pagar lo que justamente le debe, ¿qué coste tiene para la aseguradora realizar tal fechoría? Muy poco. Parece que la Ley “incentive” el timo al usuario. Por lo tanto es un milagro que en España haya buenas aseguradoras que paguen lo que toca puesto la Ley, al contrario de penalizar a las timadoras, parece que las premie. Ciertamente, si hay buenas aseguradoras es porque hay una conciencia colectiva a nivel empresarial por hacer las cosas bien, ya que si todas actuaran al límite de la Ley, no pagarían a nadie, porque dejar de pagar tiene premio.
El accidente o el siniestro: un gasto.
Para una aseguradora un accidente es un gasto, y cuantos menos gastos mayores beneficios. Por tanto, a las aseguradoras no les interesa pagar siniestros sino al contrario, no pagarlos les representa un beneficio para ellas. Otra cosa es que haya aseguradoras buenas, que hacen las cosas bien, y malas, que no pagan lo que toca.
¿Cuánto cuesta dejar de pagar al usuario?
El artículo 20 de la Ley 50/1980 dice que el coste de aquello que el seguro deja de pagar al usuario tendrá la penalización del interés legal más un 50% durante los dos primeros años, o sea, un 4,5% de interés en el año 2017. Un 4,5% de penalización por dejar de pagar es irrisorio y perfectamente asumible, por tanto, sale muy a cuenta dejar de pagar. ¡Lo extraño es que paguen!
Imagina un caso donde hay 10 accidentes donde el seguro debe indemnizar 1.000€ a cada usuario y sólo paga 400€. Por tanto el timo es de 600€ ¿Cuál será el beneficio ilegítimo a costa de los usuarios? 6.000€ (600€ de timo de cada accidente * 10 usuarios timados = 6.000€)
¿Cuántos usuarios van a reclamar sus 600€ timados? Pongamos que sea 1 usuario valiente quien reclame.
El coste de reclamar del usuario: Para reclamar los 600€ el usuario deberá contratar como mínimo a un perito, y muy probablemente hacer frente a la mitad de los honorarios de otro (un perito tercero), más a un abogado y un procurador, y después de todo esto, ¿qué beneficio hay para el usuario, además de conseguir lo que en derecho le corresponde? Un 4,5% anual de 600€, que si el tema ha durado 1 año, resultarán 27€. ¿Quién, en su sano juicio, va a reclamar 600€ que le intentan timar y gastarse en contratar abogados, procuradores y peritos por esa cantidad con un incentivo de 27€ anual? ¡Nadie! Por tanto ese dinero va directo a beneficios de la aseguradora.
El coste de la mala aseguradora de perder la reclamación frente al usuario: ¿Qué coste tiene para la aseguradora perder la legítima reclamación del usuario? 27€ de penalización ya que los 600€ no son del asegurador sino del usuario. El seguro sabe a ciencia cierta que esos 600€ no son suyos, y por tanto, el riesgo de perder la reclamación son 27€. Y ¿cuál es el premio de timar? 600€. Por tanto es evidente que timar al usuario es un negocio muy lucrativo. Es una apuesta de ganar 600€ frente a perder 27€.
Y si además añadimos que cuando el usuario quiere timar al seguro puede cometer un delito e ir directo a la cárcel, y cuando la aseguradora tima al usuario nadie comete ningún delito ya que una aseguradora que no paga lo que toca no está tipificado como delito en el código penal, ya que no se considera ninguna estafa, delito ni nada por el estilo, pues así va la cosa.
Conclusión
Que un usuario time a la aseguradora es carísimo. En cambio, que una aseguradora time a un usuario tiene premio. Por tanto, ¿cómo puede ser que existan aseguradoras honestas, que las hay? Supongo que será porque hay directivos de compañías que están concienciados que hacer las cosas bien significa prestar un servicio social, aportar valor a la ciudadanía o algo similar, a parte de ganar dinero.
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Buenos días. Tengo un problema con la compañía de seguros con el pago de la pérdida de beneficios que tenemos contratada. El problema radica en el cálculo de los días indemnizables. El siniestro sucedio un día 5 de julio por la noche, y no fue hasta el día 6 que dimos apertura del mismo por la mañana a primera hora. Una semana más tarde vino una empresa reparadora, pero viendo el siniestro comento que daría parte para que acudiese un perito. Pasando los días volví a ponerme en contacto con la compañía y me comentan que no tienen constancia para enviar un perito pero que se realizara en menos de 48 horas. Desde el inicio 2 semanas mas tarde acude un perito y me comenta que tiene que venir una segunda vez, cosa que realiza desde el inicio cerca de los 20 días. Viendo la falta de rápidez de respuesta por la compañía les comunico que deseo reparar por mi cuenta en cuanto realicen el pago, solicitan presupuesto…etc que tardo 8 días. Según la fecha de envio del cheque fue un 20 de agosto, que pagaban para hacer la reparación, peo no la pérdida de benficios, que sería un mes más tarde, cuando pagaron una parte, y tres meses más tarde otra parte. En el cálculo de los días, aún solicitando el informe pericial, el cual no han facilitado, ellos estiman que son 10 días, más los días de repación, comentando que los días que ellos estiman es hasta que acude el perito por primera vez.
Contrariamente a lo que la inmensa mayoría de gente cree, seguramente por la información que dan algunas aseguradoras, éstas sólo tienen la obligación de indemnizar; y quien tiene la obligación de actuar activamente es el asegurado o el perjudicado.
En su caso y sin haber podido estudiarlo detenidamente a modo de analizar las circunstancias y consecuencias del siniestro, así como el contrato de seguro, usted tiene el deber de informar al asegurador y obrar activamente para resolver diligentemente sus daños y perjuicios.
Una vez realizadas esas actuaciones el asegurador tiene la obligación de indemnizar.
En resumen y lo que dice la Ley es: Cuando uno tiene un accidente tiene un problema que lo tiene que resolver él, y la aseguradora sólo debe pagar lo reflejado en el contrato, en caso de seguros de daños propios, o lo que refleje el Código Civil en cuanto a los daños y perjuicios que deriven de la culpa y negligencia en caso de daños a terceros.
Es cierto que las aseguradoras dan a entender, por criterios estrictamente económicos a su favor, que el asegurado o perjudicado actúe de manera pasiva en pos de la aseguradora que adoptará una actitud activa pero no es cierto, y en su caso y en situación de conflicto la Ley 50/1980 no le dará la razón.
Su caso debería estudiarse con detenimiento para poder evaluar qué puede reclamarse y qué no, pero no nos atrevemos a formular un veredicto riguroso sin analizarlo.