¿Cómo presentar una reclamación o una queja/denuncia de una aseguradora ante la DGSFP?
En el Post “¿Cómo presentar una reclamación o una queja a una compañía de seguros?” te explicábamos qué es una queja y qué es una reclamación a una aseguradora y te indicábamos que ésta debe ir dirigida, por correo electrónico, al SAC (Servicio de Atención al Cliente). Pero, ¿qué puedes hacer cuando el SAC de la aseguradora te responde “tonterías”, resuelve cosas que no son ciertas o que no se adecuan a la Ley? Puedes hacer una reclamación a la DGSFP o otras opciones:
Opción 1: Conformarte y aguantarte
Muchas personas que tienen toda la razón se quejan de la injusta resolución de su caso, pero al final se conforman con la decisión de la aseguradora y no reclaman ni se quejan formalmente. Es una opción que todos sabemos que ocurre y, por tanto, es dinero del usuario que la aseguradora se queda en forma de beneficios.
Opción 2: Plantear una reclamación o queja a la DGSFP
Si el Servicio de Atención al Cliente de la aseguradora ha determinado pagarte menos de lo que te corresponde, no te ha pagado el accidente, no ha resuelto tu queja de manera satisfactoria o alguna cosa similar, puedes acudir a la DGSFP (dirección general de seguros y fondos de pensiones) y plantear la misma reclamación o queja que planteaste al SAC. La DGSFP cogerá tu caso y puede resolver de varias maneras:
- A favor del usuario (asegurado o perjudicado). En estos casos la DGSFP notifica su resolución al seguro y al usuario. Piensa que el fallo de la DGSFP no es vinculante para el seguro (no debe cumplirlo de manera obligatoria), pero en el 100% de las ocasiones las aseguradoras hacen caso a su decisión.
- A favor del seguro. La DGSFP da la razón al seguro en contra de los intereses del usuario. En este caso puedes recurrir a la opción 3.
- A favor de nadie. Muchas veces la DGSFP resuelve el asunto sin dar razón a nadie. Unas veces porque no es competente en el tema y el usuario debía haber procedido a reclamar por otros cauces, como sería la vía judicial, el trámite pericial, etcétera. Otras veces porque el usuario ha cumplimentado mal algún dato o no ha aportado algún documento. Ya sabes que por temas burocráticos, si te olvidas de algún detalle al que obliga la norma, te desestiman tu recurso. Por eso es muy importante que antes de plantear la reclamación o queja a la DGSFP te leas detenidamente la Orden ECC/2502/2012 para no dejarte nada. Tranquilo, sólo son 10 páginas y se lee rápido.
Opción 3: Plantear una reclamación judicial
Plantear una demanda judicial, lo que puede conllevar costes de abogados, procuradores y peritos, si es que no has contratado, a parte, una póliza de seguros de “Defensa y reclamación” que incluya el máximo de garantías, la libre designación de peritos, abogados y procuradores y además tengas un capital asegurado mínimo de 6.000 € para ese concepto.
Seguimos con la reclamación o queja a la DGSFP
Para plantear una queja o reclamación a la DGSFP deberán cumplirse las siguientes condiciones, las cuales están recogidas en la Orden ECC/2502/2012, concretamente el artículo 2:
- Antes de presentar una queja o reclamación a la DGSFP, deberás haberla planteado al SAC de la aseguradora que presuntamente ha “violado” tus legítimos derechos.
- La aseguradora te deberá haber contestado o deberán haber transcurrido 2 meses o más desde que la presentaste sin que la aseguradora te haya contestado.
- No deberás estar de acuerdo con la resolución del SAC de la aseguradora.
- Atención, que hay una serie de situaciones donde la DGSFP no te admitirá tu queja o reclamación. Éstas situaciones vienen recogidas en el artículo 10 de la Orden ECC/2502/2012.
Plazo de respuesta de la DGSFP
Verás que la Orden ECC/2502/2012 establece un plazo de contestación de tu queja o reclamación de 4 meses, pero como en la DGSFP están colapsados de la cantidad brutal de reclamaciones y quejas que tienen, el promedio de respuesta es de entre 2 y 3 años. O sea, que cuando te responden ya ni te acordarás del tema.
Una buena noticia es que mientras lo tiene la DGSFP queda interrumpida la prescripción de tu asunto, por lo que de algo te sirve.
Pero así, reclamar al SAC y luego a la DGSFP ¿sirve para algo?
Aquí viene nuestra recomendación:
- Si tienes alguna reclamación, la planteas al SAC, y si la respuesta no te satisface la planteas por la vía judicial y acabas mucho antes.
- A parte de plantear la reclamación judicial y si quieres contribuir a la justicia social y a la solidaridad entre los ciudadanos de este país para que las malas aseguradoras no actúen de manera impune, puedes plantear, a parte de tu reclamación judicial y tras haber recibido la contestación de la aseguradora, una queja a la DGSFP con todos los incumplimientos, demoras, desatenciones o cualquier otro tipo de actuaciones deficientes que hayas observado en la actuación de la aseguradora, a modo que la DGSFP castigue severamente con sanciones económicas o de otra índole a esa aseguradora para que su conducta no se repita. Pero debes poner especial atención de no quejarte o reclamar algo a la DGSFP de lo que paralelamente estés reclamando judicialmente ya que anularía tu queja o reclamación a la DGSFP. Para esto pondremos un ejemplo:
Imagina que se trata de un tema de unas lesiones por accidente de tráfico y la aseguradora del causante no te los atiende alegando inexistencia de nexo causal, o sea, que finges la lesión. Tú puedes plantear la reclamación judicial de tus secuelas, días de baja, lucro cesante, etcétera, para cobrar la indemnización, pero podrías quejarte a la DGSFP, y previamente al SAC, por no haber recibido de la aseguradora la oferta motivada a la que hace referencia el artículo 7 de la Ley 35/2015 antes de los 3 meses desde tu primera reclamación. La queja a la DGSFP por el incumplimiento del artículo 7 de la Ley 35/2015 no es objeto de la demanda y por tanto, aunque sea del mismo accidente, una cosa es reclamar la indemnización a la aseguradora y otra distinta es no haber recibido en tiempo y forma la oferta motivada o no haber recibido la indemnización del pago mínimo antes de los 40 días de haber declarado el siniestro tal como indica el artículo 18 de la Ley 50/1980. Son cosas distintas. Una cosa es conducir a 200 Km/h y la otra es conducir sin carné de conducir aunque el mismo conductor sea el que comete las dos infracciones, que es conducir por encima de los límites de velocidad permitidos sin estar en posesión del correspondiente permiso de conducir.
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