Si has sufrido un accidente de tráfico con lesiones y daños materiales
¿Has tenido un accidente de tráfico y has resultado herido o con daños materiales? Tienes tus derechos y te decimos cómo ejercerlos.
Si has sufrido lesiones por accidente de tráfico, sean graves, moderadas o leves, tienes los siguientes derechos tanto si en el momento del siniestro eras peatón, ocupante, conductor del vehículo inocente, ciclista o transeúnte:
- Siempre tienes derecho a que la aseguradora del vehículo que ocupabas costee obligatoriamente tu asistencia sanitaria, que implica que directamente se hará cargo de todos los costes hospitalarios o ambulatorios en centros sanitarios públicos o privados hasta tu total recuperación, o hasta que tus secuelas se hayan estabilizado. En el caso que fueras peatón, transeúnte o ciclista, será la aseguradora del vehículo contrario la que se hará cargo de todos los costes.
- Derecho a percibir la indemnización como víctima por tus lesiones, días de baja y otros muchísimos conceptos que vienen recogidos en la Ley 35/2015 de reforma del sistema para la valoración de los daños y perjuicios causados a las personas en accidentes de circulación, de los cuales te hacemos mención más abajo.
¿Cómo tengo que reclamar un accidente de tráfico?
Como perjudicado y con pleno derecho a reclamar directamente todos los conceptos a la aseguradora del vehículo “culpable” (Art. 7 Ley 35/2015), te indicamos la manera de proceder para tener los mínimos problemas en cuanto a percibir la indemnización:
Primero precisarías a uno o varios peritos de seguros, especialistas en distintas disciplinas (autos, diversos, médicos), para que valoren los siguientes conceptos:
- Valoración de los daños materiales en vehículos afectados como son tu coche, moto o vehículo accidentado.
- Valoración de daños materiales como bicicletas y ajuar personal (ropa, teléfonos móviles y resto de cosas afectadas).
- En caso de grandes lesionados, se deberán valorarán las reformas de la adecuación de la vivienda del lesionado.
- Los gastos del funeral, traslado, repatriación, entierro de la víctima si ésta hubiera fallecido. De igual modo se procedería si fuera un gran lesionado.
- Los daños morales y psicofísicos.
- Los daños y perjuicios de circunstancias económicas, incluyendo las que afectan a la capacidad de trabajo, pérdida de ingresos de la víctima o lucro cesante.
- La indemnización por muerte
- La indemnización por lesiones permanentes o secuelas
- La indemnización por lesiones temporales
- Las indemnizaciones a cónyuges, ascendientes o descendientes con dependencia de la víctima.
- Gastos por asistencia sanitaria futura; prótesis y órtesis previendo sus substituciones futuras por desgaste.
- Gastos de rehabilitación domiciliaria y relacionados con la pérdida de autonomía personal
- Costes de ayudas técnicas y de apoyo.
- Gastos por adecuación de vehículos.
- Gastos de ayudas de terceras personas
- Gastos que impliquen ocuparse de menores por la imposibilidad de las lesiones así como las pérdidas de capacidad de las tareas del hogar
- Otros conceptos que deban tenerse en cuenta en cuanto a las circunstancias propias de la víctima.
Antes de que haya transcurrido un año desde la fecha del accidente, ya que sino “caduca” (prescribe) tu derecho a reclamar, hay que realizar una reclamación a la aseguradora “culpable” indicando lo siguiente:
- Comunicar del siniestro pidiendo la indemnización que te corresponda.
- Antes de que transcurran 3 meses de haber entregado la reclamación con el máximo de información, la aseguradora “culpable” debe realizar una oferta motivada. Una oferta motivada significa que junto con la oferta de indemnización debe, obligatoriamente, acompañar los informes periciales y restos de pruebas, acreditaciones o evidencias objetivas sobre las que se basa para ofrecerte esa cantidad de dinero determinada.
- Si la oferta es insuficiente, tu reclamación es rechazada o no hay contestación por parte de la aseguradora “culpable”, podrás iniciar un proceso de reclamación civil.
Como afectado podrías ahorrarte los peritos si, como dice el Art, 7 de la Ley 35/2015, desde el momento del acaecimiento del accidente y tras tener conocimiento del hecho, la aseguradora del conductor “culpable” procediera a observar una conducta diligente en la cuantificación del daño y la liquidación de la indemnización.
Ten en cuenta que la misma Ley 35/2015 prohíbe a la aseguradora condicionar el pago de la indemnización a que firmes una renuncia a futuras reclamaciones. Esto significa que, si la aseguradora hubiera obviado algo y posteriormente a haber recibido la indemnización te dieras cuenta que tienes derecho a más dinero, puedes reclamarlo siempre y cuando no haya transcurrido más de un año desde tu última reclamación ya que habría prescrito.
«La Ley prohíbe a la aseguradora condicionar el pago de la indemnización a que firmes una renuncia»
Es cierto que podrías esperar los tres meses a ver qué hace la aseguradora y acudir al Instituto de Medicina Legal (IML) de manera gratuita para ti, pero dado el caso de que NO obtengas respuesta, con o sin motivación, o ésta fuera desestimatoria por falta de “nexo causal”, no estarías facultado para ser asistido por el IML, por lo que podrías quedar muy desamparado y sin demasiadas posibilidades de obtener resultados favorables. En caso que no estuvieras de acuerdo, podrías iniciar un proceso de reclamación de demanda civil, o penal dependiendo de las circunstancias del accidente.
Finalmente recomendarte, para tu tranquilidad, que siempre seas asistido por profesionales expertos en la materia, ya que, aunque no todas las aseguradoras son malas, hay que estar atento con alguna de ellas porque en ocasiones pueden tener “extraños intereses”.
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