¿Cómo presentar una reclamación o una queja a una compañía de seguros?
¿Sabes la diferencia entre una queja y una reclamación al seguro? ¿Qué norma regula estos tramites?
¿Qué es una reclamación?
Una reclamación consiste en pedir o exigir por escrito al asegurador que restituya un derecho o interés concreto derivado de presuntos incumplimientos por su parte. Sería el caso de reclamar el pago de la indemnización al seguro de responsabilidad civil del automóvil culpable, que no ha pagado a los familiares de la víctima de un accidente de circulación tras 4 meses de haber fallecido atropellado en un paso de peatones.
Al reclamar, en teoría, la aseguradora mira el asunto y justifica su postura, resolviendo el tema a favor del usuario o en su contra.
¿Qué es una queja?
Una queja no es más que denunciar las desatenciones, demoras, incumplimientos o cualquier otro tipo de actuación deficiente de la aseguradora hacia el usuario, sea asegurado o perjudicado. Las quejas no tienen como finalidad restituir ningún derecho, pero son la fase “previa” para presentar una denuncia a la DGSFP (Dirección General de Seguros y Fondos de Pensiones) y que, de este modo, la aseguradora sea “sancionada”.
La diferencia entre queja o reclamación
La reclamación tiene como finalidad última restituir los legítimos derechos o intereses del usuario, mientras que la queja tiene como finalidad denunciar el hecho o anomalía para ponerla en conocimiento del asegurador y, en otra instancia superior, solicitar una sanción a la DGSFP para que la conducta no se repita.
Pero cabe destacar que si la reclamación al seguro no es atendida correctamente y la DGSFP resuelve a favor del usuario en una segunda fase, la misma DGSFP puede, “de oficio”, instar una sanción administrativa a la aseguradora como si se hubiera tratado de una queja-denuncia.
¿Qué dice la norma? La obligación de pasar por el SAC de la aseguradora.
Hay dos normas: la Orden ECO/734/2004, que regula las funciones, requisitos y otros aspectos del Servicio de Atención al Cliente de las aseguradoras para atender las quejas y reclamaciones de los usuarios; y la Orden ECC/2502/2012, que regula el procedimiento de presentación de reclamaciones y quejas ante la DGSFP si resulta que la aseguradora no ha hecho ni caso al usuario, o la aseguradora ha contestado «tonterías».
Básicamente la norma dice lo siguiente:
- El usuario, sea asegurado o perjudicado, podrá presentar reclamaciones o quejas a la aseguradora, quien obligatoriamente deberá tener un departamento habilitado para tal fin (el SAC) el cual deberá tener una dirección de correo electrónico habilitada, una dirección postal y un responsable de ese departamento que deberá cumplir los requisitos de persona honesta, con conocimientos, experiencia,…
- El plazo máximo que tiene la aseguradora para contestar y resolver la reclamación es de 2 meses.
- La decisión de la aseguradora será siempre motivada y contendrá unas conclusiones claras sobre la solicitud planteada en cada queja o reclamación, fundándose en las cláusulas contractuales, las normas de transparencia y protección de la clientela aplicables, así como las buenas prácticas y usos financieros. Ello quiere decir que el asegurador deberá acreditar su resolución con pruebas y evidencias objetivas.
¿Con qué te encontrarás?
Te darás cuenta que los SAC de las malas aseguradoras van descaradamente a favor del seguro, no te acreditarán, ni documentarán, ni motivarán nada. Te contestarán cosas que no tienen relación con el objeto de tu reclamación. No te resolverán nada concreto y un largo etcétera de situaciones variopintas con las que te puedes encontrar. Es un departamento que las malas aseguradoras se lo toman de manera muy poco seria. Sólo sirve para hacer perder el tiempo a la gente, pero piensa que su resolución es firme y por tanto te sirve de mucho si planteas una reclamación judicial, puesto esa contestación, con todas sus anomalías, es la postura oficial de la aseguradora. Atención porque la buenas aseguradoras te acreditarán y te responderán de manera profesional y motivada todo lo que les pides. Esas, las buenas aseguradoras, son profesionales, rigurosas, honestas y transparentes. Piensa que existen aseguradoras que esta labor se la toman muy en serio y lo hacen muy bien, al contrario de las malas.
El siguiente paso: Acudir a la DGSFP
Cuando te encuentres con la situación de que no te han resuelto nada, transcurridos dos meses sin respuesta o tras la respuesta negativa del SAC del seguro, podrás presentar una queja o reclamación de la aseguradora ante la DGSFP. En la próxima publicación te contaremos cómo hacerlo.
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Hola. Hoy recibí la compensación del seguro de vida y me dí cuenta de que mi edad esta alterada. Dice que tengo 48, pero en realidad tengo 43, lo que significa que he estado pagando una póliza más alta de lo que corresponde. ¿Qué puedo hacer para reclamar esta situación?
Buenas tardes, a primeros de año, dejé el coche aparcado en la calle una noche, por norma general duerme en garaje, la cuestión es que a la mañana siguiente al ir a buscarlo, lo habían rallado prácticamente entero, le habían dado un pequeño golpe en una puerta y roto el espejo retrovisor del conductor.
Llamé a la compañía y pasó un perito a ver los desperfectos del vehículo, el coche estaba asegurado en ése momento a todo riesgo con franquicia de 380 euros, pago el coche a plazos, lo que significa que no puede pisar otro taller más que el oficial (tiene garantía de 7 años), hablando con la aseguradora pregunté por vehículo de sustitución,(si no es mecánica el taller oficial no ofrece éste servicio) y me dicen que si no elijo «talleres de confianza» no me pueden ofrecer coche de sustitución pero tampoco me dice que al no elegir ese tipo de talleres mi franquicia pasa de 380 euros a 475 euros, lo cuál supone una sorpresa mayúscula cuando hablo con el taller oficial donde han pintado y arreglado el vehículo.
He hablado con la que fue mi aseguradora (me fui porque me subieron el seguro 80 euros por presentar 1 sólo parte en más de 10 años) y según ellos, esto viene estipulado en una página de la póliza y digo yo, al igual que me comentó que no había vehículo de sustitución, no podría haberme dicho esa cláusula?, talvez podría haber hablado con el taller y podría haber llegado a un acuerdo o haber tenido alguna otra opción y no desembolsar casi 100 euros más.
¿Puedo poner una reclamación o queja a la compañía?, me siento estafada, gracias por todo.
Respecto al tema del vehículo de sustitución, le queda cubierto dado el caso que el responsable de los daños sea un tercero y esté perfectamente identificado para reclamarle. Si usted reclama el siniestro a su aseguradora de daños propios, el vehículo de substitución será una garantía opcional que deberá estar específicamente contratada.
Respecto al tema del aumento de la franquicia dependiendo del taller que usted acuda a reparar su vehículo, puede entenderse como una cláusula abusiva. Este tema puede ser planteado al Servicio de Atención al Cliente de la Aseguradora, que no sirve absolutamente para nada, pero que es un paso necesario y previo que dura 30 días antes de presentar la reclamación a la Dirección General de Seguros y Fondos de Pensiones.
Si te ha servido nuestra respuesta, te agradeceríamos que nos pusieras una reseña en google. Gracias
Hola!:
Mi caso es una situación que se han dado de todo!:
Tengo seguros de hogar y de vida contratados con el banco por el tema de la hipoteca, en fecha diciembre 2019 se procede a la firma de carta de no renovación del seguro de vida que vencía para septiembre del 2020, al haber comunicado que no me iba a producir bonificación.
En fecha 28/07/2020 se pone en contacto telefónico con el banco para solicitar información acerca primero de la fecha de vencimiento de los seguros mencionados (no sabía la fecha de vencimiento) y preguntar una serie de dudas para trámites que me encontraba efectuando de contratación de seguro externo de vida, en dicha comunicación me afirman que el seguro de vida actualmente vigente si bonificaba finalmente y procedo entonces a solicitar que se procediera a los trámites de solicitud de renovación de los seguros incluyendo el de vida que hubo carta de desestimiento. Dicho trámite no fue atendido en su día, no me tramitaron por parte del banco aún habiendo solicitado por escrito al mismo en las reiteradas comunicaciones efectuadas por escrito y tomas de contacto solicitando información acerca de que subida en la prima tendría en la renovación, luego antes de la fecha de vencimiento presento en fecha 01/09/2020 una reclamación con lo siguiente:
«Por medio de la presente les informo, en relación con las pólizas de referencia y cuyo vencimiento y renovación es efectivo el 08/09/2020, que no se me ha comunicado tanto en el plazo previsto por la ley, ni en las distintas solicitudes efectuadas personalmente del aumento de prima anual que he requerido antes del vencimiento de la misma. Para su mejor conocimiento, adjunto las solicitudes realizadas por escrito requiriendo la información que por ley del asegurado debe de tener la información con la antelación mínima de 1 mes natural. Por lo tanto, solicito prorroguen las pólizas mencionadas en las mismas condiciones establecidas para la anualidad anterior.»
El caso es que se produjo primero vencimiento del seguro de vida y actualmente me encuentro sin seguro de vida(esto error del banco y las gestoras que no atendieron a las reiteradas solicitudes de renovación) y finalmente después de más de 1 mes no hubo respuesta de la aseguradora a la reclamación arriba efectuada.
Ahora el banco quiere remendar su error haciéndome un seguro nuevo de vida pero tiene una diferencia abismal de cuota respecto del que disponía 250€ de más en la prima (si hubiera habido renovación esto no podía haber aumentado más de 50€), luego quisiera saber si primero pueden restaurarme el seguro exactamente a las condiciones que tenia, y si ante la falta de respuesta en la reclamación (tengo entendido que por ley del asegurado en este caso concreto deberían de haberme dado una respuesta en el plazo de un mes) tengo derecho a que se ejecute la reclamación interpuesta.
Gracias por su atención y un saludo.
Para no quedar sin cobertura le aconsejamos que pague el seguro de vida, manifestando su disconformidad ante el Servicio de Atención al Cliente (SAC) de la aseguradora y, dado el caso que no resuelvan el tema que seguramente será así, presente reclamación ante la Dirección General de Seguros y Fondos de Pensiones (DGSFP).
Si te ha servido nuestra respuesta, te agradeceríamos que nos pusieras una reseña en google. Gracias
Buenas!
Mi compañía de seguros me ha dado de baja (seguro de vivienda) y yo me he enterado 10 meses después! y de casualidad. Me dicen que la causa de la baja es simplemente porque ellos también pueden elegir a sus clientes, aunque yo se que es porque abrí «muchos» partes el año pasado. El caso es que les pregunté si me habían enviado algun aviso sobre esto y me dicen que me habían enviado un burofax en octubre (estamos en Agosto), les digo que no he recibido nada y me responde que efectivamente allí lo tenía devuelto por dirección incorrecta. Después me pasa con dpto.de Bajas y les pregunto si me lo pueden enviar otra vez, aunque sea a mi e-mail para ver el contenido y me responde que no está autorizada. Total, estoy sin seguro ya 10 meses sin saberlo y llevo muchos años con esta compañía pagando puntualmente. Que debo hacer?
Un saludo y gracias.
Es cierto que del mismo modo que usted puede darse de baja del seguro cuando desee (no prorrogar el contrato), la aseguradora también lo puede hacer. No tiene que haber ninguna razón objetiva. La única restricción es que usted tiene un mes de antelación para comunicar la baja a la aseguradora y ésta tiene dos meses de plazo para comunicárselo antes de la fecha de vencimiento del contrato.
Por otro lado la aseguradora tiene que acreditar que le comunicó la baja. Si es cierto que la aseguradora le mandó un Burofax notificándole que NO le prorrogaba el contrato de seguro antes de los dos meses de la fecha de vencimiento, aunque usted no recogiera el Burofax ya es suficiente.
Hay gente que cree que por no recoger un burofax cuando se mandó a su dirección postal es como si no le hubieran avisado y están totalmente equivocados. Si la aseguradora le envió un Burofax comunicándole la anulación del seguro dentro del plazo, la aseguradora tiene razón y usted NO aunque «no se hubiera enterado». Ahora bien, asegúrese que el seguro le mandó ese Burofax. Piense que del mismo modo que hay asegurados que mienten y estafan a los seguros, también hay aseguradoras que estafan y mienten descaradamente a los usuarios. No se fíe de nadie.
Si te ha servido nuestra respuesta, te agradeceríamos que nos pusiéras una reseña en google. Gracias
Buenas, os agradezco mucho vuestra respuesta! pero aún me queda la duda de
¿que debo hacer para asegurarme de que me enviaron el burofax? ya os comenté que le solicité a la compañía el envío de una copia a mi correo, o como ellos quisieran, y no aceptaron.
Un saludo.
Puede plantear usted un requerimiento judicial a la aseguradora para que aporte esa prueba justificando el porqué del requerimiento. Si al requerimiento la aseguradora no aportara copia del burofax significaría que le habría engañado todo este tiempo.
Si te ha servido nuestra respuesta, te agradeceríamos que nos pusiéras una reseña en google. Gracias
Buenas tardes.
Hemos abierto un parte en el 2018 por una fuga de agua en la cocina. Vinieron varias personas del seguro (una de ellas nos quiso estafar queriendonos vender un calentador fuera del seguro) a reparar la fuga pero dejaron la pared hecha un desastre, los muebles dañados, la vitro a punto de caer y todos los demas problemas derivados al tiempo que tardaron en reparar la fuga. Ah, tambien nos dejaron casi dos meses sin calentador y por ende sin agua caliente en casa!
El tema esta en que estamos en julio 2020 y todavia NO han terminado de acomodar el desastre de la pared ni los demas daños en la cocina.
Hemos perdido innumerables horas al telefono reclamando, en el banco, mandando emails, recibiendo en casa a incompetentes y todavia la repacacion ¨sigue el proceso¨. Cada vez que hablamos con una persona del seguro nos dice algo diferente y ya no podemos mas con esta situacion, hemos vivido dos años con la cocina hecha polvo por su poca profesionaliad.
No solo eso, en el 2018 pagabamos 250 euros al año, en el 2019 nos cobraron 380 y este año 530!!!! y todavia la cocina esta un desastre pero para cobrar y subir el precio del contrato si que son buenos!!
Quisiera tomar vias legales porque ha sido un infierno toda esta situacion.
Que me aconsejan? Gracias
-Es la aseguracion del banco sabadell- y ya ni el banco sabe que hacer con esa situacion.
Alessandra
En nuestro blog ya publicamos un post https://www.claimcenter.com/operarios-en-casa-o-indemnizacion-con-dinero/ donde alertábamos que los asegurados deben buscar a los operarios por su cuenta y reclamar la indemnización al seguro. Que debéis olvidaros de que las aseguradoras os envíen los operarios Low Cost a arreglar las cosas ya que en caso de reclamación por deficiencias se hace mucho más difícil reclamar esas incidencias.
Si hubieras obrado como recomendamos hubieras encargado los trabajos a industriales de tu confianza y remitido las facturas al seguro para su abono. En el presene caso deberás contratar un peritaje valorado y reclamar esas deficiencias al seguro, ya sea extrajudicial o judicialmente debiendo invertir dinero en peritos, abogados y procuradores con el riesgo de no recuperar el coste de los profesionales. Por eso decimos en nuestro post que la «comodidad» de los operarios de la aseguradora puede salir muy cara.
Hola he intentado ponerme en contacto con el seguro y no hay manera! Queria darlo de baja o congelarlo si se puede,como no he podido he devuelto el recibo. Me pueden obligar a pagarlo? Gracias un saludo
Para darlo de baja debe enviar un escrito fehaciente a la aseguradora con al menos 30 días antes del vencimiento oponiéndose a la prórroga del contrato.
Si ha hecho esta gestión y siguen contándole la prima, devuelva el recibo tranquilamente ya que estarán incurriendo en una ilegalidad.
Dado el caso que no haya avisado en el periodo enunciado, deberá pagar el seguro a no ser que el interés asegurable no existiese.
Tuve un accidente de tráfico en agosto del cuál fui víctima, he estado 4 meses aproximadamente en tratamiento rehabilitador, he cumplido estrictamente con mi parte de citas médicas y asistencia. Estando en tratamiento, me llamó una persona diciendo que mi compañía me había asignado este despacho de Abogados, en ese momento, desconfío porque estoy aún de baja, posteriormente me visitó a mí domicilio un médico enviado por la compañía contraria. Dado los hechos, pregunto a un intermediario de mi compañía de seguro, confirma la palabra del despacho de abogados. Al final, acabo enviando el documento firmado que ellos supuestamente necesitan para actuar en nuestro nombre y por el cual, nos han estado molestando mediante vía telefónica. A día de hoy y sin tener ninguna respuesta, llamo al despacho de este abogado, para mí sorpresa éstos han recibido hace 1 mes aproximadamente respuesta motivada de la compañía contraria, la cuál no he conseguido tener aún en mi poder, supuestamente, en esta carta dice que no existe indemnización alguna por parte de la compañía contraria, pues no ven nexo causal entre daños materiales, el coche, y daños personales, es decir, lesiones. Por las cuales sigo en tratamiento. La única solución que me facilitan desde este despacho, es que van a pedir a mi compañía ir a juicio, ya que la compañía contraria solicita una prueba biomecánica. Por mí parte, debo añadir que los partes médicos los tuve que solicitar a mí compañía, y que se me ha tenido desinformado en todo momento. Además viendo las clausulas de mi contrato, leo que tengo el derecho, pero no la obligación de asistencia jurídica, así pues, me siento estafado por estas personas y desgraciadamente mi compañía no está informándome de los pasos que se dan en mi nombre. Espero puedan ayudarme gracias de antemano
Parece que su seguro ha designado a unos abogados para que le hagan la reclamación de daños con cargo a la Garantía de Defensa Jurídica y Reclamación de Daños. Si usted quiere puede escoger libremente a los abogados que crea oportunos con cargo a esa garantía hasta el límite asegurado.
La aseguradora contraria tiene la obligación de responderle a usted, antes de los tres meses de solicitar la oferta motivada de indemnización, con su propuesta.
En caso que la aseguradora contraria haya optado por rechazar sus lesiones alegando el Nexo Causal, presente una demanda judicial rápidamente.
Le aconsejamos que busque a un buen perito médico con experiencia y honesto para soportar su reclamación por lesiones. De tener otros perjuicios como son ayudas, lucro cesante, etcétera, también deberá reclamarlos.
Han entrado unos caballos en mi jardín y lo han arrasado,el seguro me dice que valore los daños pero yo prefiero que sean ellos quien los valoren,deberían hacerlo ellos?
Si tiene identificado al propietario de los caballos (sus datos), mediante la garantía de «Defensa Jurídica y Reclamación de Daños» de su seguro del hogar puede imputar el coste de contratación de un perito experto en temas de jardines para que valore sus daños, y por la misma garantía contratar a un abogado para que reclame el importe de los daños.
Si no tiene esta garantía, se lo deberá costear usted a no ser que su seguro tenga una garantía denominada «todo riesgo accidental», «garantía amplia de daños», etcétera donde cubra este tipo de eventos. En este segundo caso, aporte usted el presupuesto de restitución del jardín hecho por un jardinero que servirá para cuantificar la indemnización que le corresponde.
Hace 2 meses he tenido una avería en una lavadora, no hacia absolutamente nada,llame a la aseguradora y vino un técnico, al sacar la lavadora , quitar la tapa de arriba y tocar los cables encendió y pusimos un programa que se ejecuto completamente, el técnico dio por acabada su labor volviendo a poner la tapa y colocarla en su sitio, al acabar el programa la lavadora, le dio al técnico por apagar y volver a encenderla y sorpresa ya no encendió.
Respuesta del técnico: es la placa madre (que bien es verdad que al verla tiene unas rallas que no deja mirar bien los programas) precio de la placa 470 euros.
yo por otro lado he llamado a otro técnico que he tenido que pagar de mi bolsillo y era simplemente un pieza que no hacia conexión.
Es la segunda vez que me pasa y estoy un poco cansada que no miren la lavadora como tendría que ser y yo tenga que solucionar los problemas por otro lado.
¿Puedo poner una queja o reclamar lo que me costo el otro técnico?
Muchas gracias por adelantado
Deberíamos mirar su contrato, pero en principio los seguros no cubren la reparación de las lavadoras a no ser que haya una causa externa, súbita, violenta, accidental e imprevisible que la dañe como sería el caso de un incendio, explosión, daños eléctricos, etcétera.
Entendemos que su caso particular no tiene mucho recorrido para presentar una reclamación pero insistimos, sin analizar su contrato ni saber qué incluye y qué no, no podemos dar un veredicto firme.
Tengo un seguro de decesos que cubre un subsidio diario de hospitalización de 30€. El caso es que después de haberle presentado a la aseguradora todos los informes médicos me pagan 8 días de los 26 que estuve hospitalizada. Cuando me pongo en contacto con el servicio de atención al cliente, me dice que han cerrado el expediente porque ya me enviaron una carta de pago con el ingreso en mi cuenta por el siniestro sufrido. Me dieron un correo electrónico para presentar la reclamación pero sigo esperando y ya empecé las conversaciones en Agosto
A falta de examinar su contrato, los límites y todas las circunstancias, parece que la aseguradora debería pagarle todos los días. Debería estudiarse detenidamente. Pero si usted tiene toda la razón, debe presentar una reclamación por escrito (correo electrónico) ante el Servicio de Atención al Cliente de su aseguradora. Si no ha recibido respuesta que resuelva en 30 días, puesto la valoración de los días está tasada por la fecha de baja y alta del hospital, puede usted presentar una reclamación ante la Dirección General de Seguros y Fondos de Pensiones (tardará unos 3 años en resolver) o bien una reclamación civil judicial (tardará entre 2 y 8 años en resolver).
Su póliza del hogar debe tener la garantía de «Defensa Jurídica y Reclamación de Daños» que le debe cubrir el realizar las labores de reclamación a su seguro de subsidio para que usted no le cueste dinero.
tengo una qeja sobre mi seguro
me puedes ayudar algo
Hola, contacta con nosotros en esta página https://www.claimcenter.com/defensor-del-asegurado/
Hace cinco meses contraté un seguro con alianz y hoy fui a pasar la itv y me dicen que no tengo seguro! Resulta que no le han dado de alta! Que puedo hacer como reclamarles
Deberíamos estudiar el caso detenidamente con documentación de su solicitud de seguro, propuesta, pago o no de prima, comunicaciones, aceptación del riesgo por parte del asegurador, etcétera. Si no le han cargado la prima siendo una solicitud de nueva contratación, es aventurado postularse.
quiero dejar mi testimonio y dar gracias a jose maria por la ayuda recivida hare todo lo que me a dicho en nuestra conversacion para el problema de mi seguro de vivienda.muchisimas gracias,un abrazo desde santander.
Muchas gracias por su comentario. Le estamos muy agradecidos por sus palabras, que nos animan a seguir ayudando a las personas a hacer valer sus derechos. Saludos,