¿Qué normas deberían modificarse para que las malas aseguradoras se comportaran como las buenas?
Hay mucha gente que se queja de que las malas aseguradoras, que no las buenas, se dedican a timar a la gente de manera masiva y desenfrenada. Y algunos nos preguntan: ¿Qué debería hacerse para que las malas se comportaran como las buenas?
Quien tiene la solución y puede para resolver esto es la Dirección General de Seguros y Fondos de Pensiones (DGSFP) puesto es el Regulador y Supervisor del mercado, y ¿qué debería hacer para resolverlo?
Modificación del punto 5 del artículo 196 de la ley 20/2015
De este artículo que reza como infracción por parte de la aseguradora «El incumplimiento por la entidad aseguradora de las normas imperativas de la legislación específica sobre contrato de seguro», debería quedarse hasta aquí. Y por tanto debería eliminarse el periodo de gracia que se brinda a la mala aseguradora a rectificar su infracción a la condición, puesto sólo se puede sancionar a la aseguradora, «si no atendiera en el plazo de un mes el requerimiento que al efecto le formule la Dirección General de Seguros y Fondos de Pensiones cuando entendiese fundadas las quejas y reclamaciones planteadas en el procedimiento de protección administrativa de los clientes de servicios financieros.»
Actualmente este segundo párrafo da la oportunidad al infractor (la mala aseguradora) a poder rectificar después que el asegurador se haya saltado la Ley y el usuario haya debido realizar una reclamación al SAC o al Defensor del Asegurado. Luego, el usuario, deberá haber tenido que esperar un mes como mínimo para que le contesten. Después el usuario deberá poner una segunda reclamación o queja a la DGSFP y, yendo todo bien y al cabo de más de 1 año, la aseguradora remita a la DGSFP su rectificación a requerimiento del Supervisor. Y sólo si el seguro no cumple, la DGSFP podrá sancionarle, que puede quedarse con una simple amonestación. Este procedimiento no hace más que penalizar al usuario y beneficiar a las aseguradoras malas ya que sólo corregirán su actuación ante aquellos usuarios que hayan tenido más paciencia que un Santo. Del resto de usuarios que hayan desistido agotados, el mal seguro se habrá quedado su dinero enriqueciéndose ilegítimamente a costa del ciudadano.
Si la DGSFP sancionara automáticamente al infractor como nos sucede a todos cuando superamos el límite de velocidad por una carretera por poner un ejemplo, «otro gallo cantaría». ¿O es que el policía que nos «atrapa» con exceso de velocidad nos da un mes de gracia para rectificar nuestra conducta y dado el caso que no rectifiquemos sólo nos amonesta verbalmente? ¿Alguien cree que ese sistema sería efectivo y reduciría el exceso de velocidad?
Modificación del artículo 200 de la ley 20/2015
Este artículo dice que por cada infracción considerada «leve» la aseguradora podrá recibir una «multa» que va desde la «amonestación privada» hasta 60.000 €. La sanción debería ser de 60.000 € fija. De este modo las malas aseguradoras corregirían su actitud. Es obvio que las buenas aseguradoras no deben preocuparse de nada puesto que, como cumplen con sus obligaciones, jamás serían sancionadas. Para una aseguradora mala, ¿alguien cree que una «amonestación privada» le duele? No seamos cándidos.
Modificación del artículo 20 de la ley 50/1980 por intereses de demora
Cuando se publicó esta Ley el artículo rezaba que, «Si en el plazo de tres meses desde la producción del siniestro el asegurador no hubiere realizado la reparación del daño o indemnizado su importe en metálico por causa no justificada o que le fuere imputable, la indemnización se incrementará en un 20 por 100 anual». En el año 1995 se modificó este artículo para favorecer a las malas aseguradoras, se bajaron los intereses y así favorecerlas. Hoy en día los intereses de demora están a al tipo de interés legal más un 50%, que resulta un 4,5% los dos primeros años. La verdad es que el texto no debería haberse cambiado jamás puesto sería un incentivo para el asegurador el pagar lo que toca cuando toca.
Incorporar la obligación de la oferta motivada en el artículo 18 de la ley 50/1980
En la actualidad, tanto si se trata de seguros de daños como de RC, las aseguradoras no tienen por qué justificar su oferta económica al usuario.
Si resulta que el perjudicado o el asegurado deben justificar y acreditar su reclamación al asegurador, tal y como dice la Ley 50/1980, pues debería ser obvio que el asegurador debiera tener la misma obligación de justificar, motivar y acreditar su oferta al usuario. ¿No es una cosa normal? Los dos deberían estar obligados a justificarlo todo a la otra parte. Es un ejercicio de transparencia y, por eso la Ley 35/2015 en su artículo 7, obliga al asegurador a realizar esta oferta motivada al perjudicado. ¿Por qué no se modifica el artículo 18 de la Ley 50/1980 incorporando, junto con el pago, la obligación de motivar la oferta? Con esta obligación se despejarían muchas dudas y los usuarios sabríamos el porqué de muchas resoluciones de la aseguradora que a día de hoy no se entienden. El artículo 18 de la Ley 50/1980 debería incorporar la obligatoriedad de la oferta motivada tal como reza el artículo 7 de la Ley 35/2015.
Regulación y supervisión de la actividad pericial
Que cualquier persona que cumpla con unos requisitos mínimos pueda desarrollar la actividad de perito no es un inconveniente. El problema está en erradicar a los peritos sesgados, parciales y que faltan a la verdad, tanto de la banda de los asegurados como de las aseguradoras. El único modo que existe para erradicar este gravísimo problema es regular y supervisar su actividad a modo de sancionar de manera ejemplar con multas elevadísimas e inhabilitaciones para ejercicio de la profesión a aquellos peritos que no actúen de acuerdo a los preceptos de las Leyes y normas en materia de seguros, actuando con el debido rigor, honestidad y profesionalidad que se requiere para el ejercicio de su profesión.
Si no es así siempre habrá un grupo elevado de peritos corruptos que seguirán actuando bajo las instrucciones de las malas aseguradoras para ayudarlas a timar al usuario, y de peritos de asegurado que intentarán enriquecer a su cliente de manera ilícita.
Si a la vista de una reclamación u oferta motivada de la aseguradora se viera que un informe pericial es un auténtico disparate, debería poderse denunciar y el ente supervisor actuar de manera contundente contra ese profesional.
Modificación del trámite pericial del artículo 38 de la ley 50/1980
El trámite pericial es un proceso largo, caro, engorroso e ineficiente. Si el perito fuera riguroso, profesional, honesto e imparcial jamás se necesitaría más de un perito. Tanto si lo contrata una como la otra parte se resolvería todo correctamente.
La no resolución de los temas tratados en los puntos anteriores hace que deba existir el trámite pericial, que sigue siendo un desastre y que dilata y encarece el tema de la resolución del siniestro, y acaba desesperando al asegurado.
¿Cómo valorarias a tu aseguradora?Comparte tu opinión con otros usuarios en RankiSeguros. |
Pero el otro problema surge con el tercer perito cuando no hay acuerdo entre los dos peritos ya que ninguna parte, ni la aseguradora ni el asegurado, se fían de los peritos propuestos como terceros. Esto sucede porque cada uno cree que el perito propuesto por la otra parte será tan poco profesional como el que contrataron. Y claro está, se va a la designación judicial y/o notarial que es una auténtica lotería puesto pueden resultar unos peritos que, por norma general, son un auténtico desastre. Y lo bueno del tema es que, una vez se llega a una mayoría por una u otra parte con el tercer perito, no hay quien impugne eso todo y que el acuerdo sea una auténtica barbaridad.
El procedimiento pericial debería derogarse y proceder cada uno con su perito y, si no existe acuerdo, proceder a una reclamación judicial normal y corriente.
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Soy perjudicada por un siniestro ocurrido a raíz de unas obras realizadas en casa, dañando con hormigón (de una subcontrata) la pintura de la casa, carpintería de aluminio (las ventanas de aluminio anodizado, puertas, etc), y mobiliario exterior ( luminarias, mesa de comedor con tratamiento epoxi, césped y valla de madera, césped artificial, estructura de madera de una pérgola). Le he reclamado a la contrata que contratamos su seguro y no a la subcontrata, ya que es con quien tengo el contrato vinculante y son los que permitieron que se aplicara, un material de forma incorrecta.
La aseguradora no nos ha informado de nada desde que se comunicó el siniestro, hasta que recibimos un documento «finiquito» por un importe irrisorio en relación a los daños causados y el cual prácticamente era como firmar un papel en blanco, ni siquiera indicaban qué siniestro había ocurrido.
He reclamado que no estoy de acuerdo con el importe, la redacción del finiquito y la ausencia de información por parte de la aseguradora y la tramitadora, supongo que después de agotar todos los plazos existentes se ha puesto en contacto conmigo y opta a negociar la indemnización, aportándome datos por e-mail con partidas incompresibles donde les aplica depreciaciones (10-30%), además de indicarme sutilmente que en juicio tendría las de perder.
En la información que me pasan por email existen partidas donde se limitan a indemnizar reparando el daño pero de forma ilógica. Por ejemplo con la mesa de comedor exterior mancharon las patas y han dejado marcas por el hormigón, mi miedo es que es tratamiento epoxi de la mesa se haya deteriorado y con el tiempo se oxide y/o deteriore con el tiempo ¿Es lógico que a una mesa de aluminio con tratamiento epoxi con aportación de factura de 999€ le apliquen un valor por «limpieza zona inferior patas» por 33€, si no tiene ni un año de vida?
Al igual que la carpintería de aluminio anodizado (además que algunos de los cristales tienen picadas por la proyección del hormigón) los marcos se han quedado con marcas sutiles pero que me preocupan que hayan deteriorado la protección del anodizado. A estas partidas le practican una depreciación del 20%. ¿es lógico?
Muchísmas gracias. Un cordial saludo
Buenos días,
Tuve un siniestro de coche hace ya un año, en el que fui la última de una cadena con 3 vehículos implicados, sufriendo daños en el vehículo y también personales, y no produciendo yo daño a ningún vehículo ni persona. Pues después de un año y un mes, todavía ni siquiera me han dado el visto bueno para la reparación del coche, y de la indemnización ni te cuento. ¿A dónde debería reclamar?
Si usted fue la última de la cadena y fue la culpable del accidente, depende del contrato de seguro que usted tenga debería cobrar alguna indemnización, pero también es muy posible que no tenga derecho a ninguna percepción, ni por daños materiales ni por lesiones. Deberíamos analizar el accidente con mucho más detalle así como su contrato de seguro para salir de dudas.
Buenas tardes
He reclamado a mi seguro de hogar que cubran unas gafas que mi hijo rompió a un compañero de clase mientras jugaban al fútbol y esto es lo que me responden:
«Nos dirigimos a Vd. en relación con el expediente de referencia para indicarle que obrando en
nuestro poder toda la información relativa al mismo y después de haber procedido a su completo
estudio, entendemos que no existe responsabilidad que le pueda ser imputada por los hechos que
nos ocupan, ya que al estar los dos niños jugando hay un consentimiento por ambas partes y
carece de Responsabilidad Civil.»
Quisiera me orientaran para hacer una reclamación pues según una definición de responsabilidad civil:
«La Responsabilidad Civil es un término legal que se refiere a la obligación que tenemos de indemnizar a un tercero al que hemos provocado algún daño de forma involuntaria. Es decir, como responsables de los perjuicios causados, pagaremos a ese individuo o entidad cierta cantidad a modo de compensación.»
Muchas gracias por su atención,
Esperanza
Ciertamente la contestación de la aseguradora es imaginativa y pintoresca. Confundir el “jugar” con “consentir” que le hagan daño es, cuanto menos, inverosímil. De hecho, una de las exclusiones típicas en la garantía de responsabilidad civil es la de competiciones “oficiales” para evitar pagar daños y lesiones que se hagan entre los implicados. Quieren excluir los casos como que por ejemplo un defensa de un equipo de fútbol lesiona a otro en una “entrada” brusca.
Los artículos 1902 y 1903 del Código Civil español son claros. Los padres, los tutores o los titulares de los Centros docentes son responsables de los daños causados por los niños menores que se encuentren bajo su guarda, tanto los daños que se produjeran entre ellos como a otras personas. No existe ninguna limitación con respecto a que si el daño se lo hacen jugando, corriendo o comiendo.
La “traducción” a la contestación que le da su seguro es que “no queremos pagar las gafas al perjudicado, que sabemos que debemos pagar, porque nos queremos quedar el dinero de la indemnización para tener mayores beneficios a final de año. Por eso nos inventamos una excusa perfecta para ver si nos deja usted tranquilos”. En definitiva, que sea usted quien pague las gafas al afectado si quiere.
Lo que usted debe hacer es una reclamación al Servicio de Atención al Cliente de su compañía de seguros, asumiendo la responsabilidad de los daños y reclamando indemnizar al perjudicado, ya que su aseguradora es quien tiene la responsabilidad subsidiariamente. Y si transcurridos 30 días no obtiene respuesta o ésta no es de acuerdo a su contrato, formule una reclamación a la Dirección General de Seguros y Fondos de Pensiones reclamando que el asegurador no se hace cargo de una indemnización de Responsabilidad Civil.