In claims against insurers it is crucial to review the complete policy and the risk questionnaire. Coverage is not automatic: it depends on the interpretation of the clauses and the fulfillment of obligations by both parties.
Common cases:
Coverage denial.
The denial is usually based on exclusions or time limits. It is essential to verify whether the clause is restrictive and whether it was expressly accepted; if not, it may be inapplicable.
Underinsurance.
If the insured amount is less than the actual value, the proportional rule applies. Before accepting a reduction, the valuation and possible automatic updates should be reviewed.
Claims in home, liability, life, health, or business insurance.
Each policy requires specific criteria and evidence: in home insurance the origin of the damage matters; in liability, the harm to third parties; in life/health, the medical report; and in business insurance, the loss of profits and the damage that can be proven.
Technical interpretation of the policy.
Concepts such as “covered risk” or “aggravation of risk” influence the indemnity. A technical review prevents interpretation from being left solely to the insurer.
Extrajudicial and judicial claim.
Before going to court a prior claim must be filed. If it is well-founded, it improves the negotiation; if there is no favorable response, the judicial procedure begins.
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