How you should act when an insured event with a covered risk occurs, how to file a claim for compensation, and what to expect afterwards—these are important questions that every consumer should be informed about. The terms, procedures, and deadlines in this process are detailed in the General Terms and Conditions of your insurance contract. Additionally, every insurance company has adopted Internal Rules for the handling of claims under insurance contracts, which are also submitted to the Financial Supervision Commission. These rules are published on the official websites of the companies and are available in their offices.

Regardless of the specific features of the different types of insurance, the following main stages can be summarized:

 

Actions immediately after the occurrence of the insured event

If the nature of the insured event so requires, you should immediately notify the competent authorities (Fire Safety and Civil Protection Service, police, electricity distribution company, hospital), and/or call emergency number 112. Take action to mitigate the damage, where applicable or possible—for example, in the case of a plumbing accident, shut off the water supply to the property.

If the insured event occurred during the validity of the insurance contract and is covered under the general terms of your policy, you should notify your insurer to receive instructions for further actions.

 

Filing a claim for compensation / Notification of damage

It is clear that just talking to your insurer is not enough to receive compensation. This is done by submitting a claim for compensation in accordance with certain requirements under the contract. What does this involve?

-          The claim must be submitted in written form within the timeframes indicated in the insurance contract. You can choose how to submit your claim—in person at the insurer’s office, by registered mail with return receipt, or via the email address provided by your insurer. Most companies offer the option to report damage online via their official websites or through their mobile applications for certain types of insurance and/or covered risks. It is important to do this within the specified period—i.e. to comply with the contract terms. For example, under property insurance in case of theft, it is usually required to notify the insurer within 24 hours, while for other types of risks the deadline may range from 3 to 7 days. For life insurance, the notification period for a risk occurred — accident or death — may be 7 or more days from the event.

-          The claim should include your personal information, bank account details to which the compensation should be transferred, a detailed description of the event, and evidence certifying its occurrence and the amount of the damages caused. The insurer must inform you which proofs — documents, photographs, and others — you are required to provide. These depend on the type and specifics of the insured event. To assist their clients, insurers publish detailed information on their official websites about the procedures and required documents by insurance type and covered risks. The insurer may also request the submission of additional evidence, with maximum deadlines for doing so. For property insurance or Motor Third Party Liability insurance, this deadline is no more than 45 days from the date of filling the claim with the necessary supporting documentation (required evidence) according to the insurance contract.

 

Determining and assessing damages resulting from the insured event

The documents and other supporting materials you provide in your claim are used by the insurer’s experts and specialists to analyse and assess the damages, which in turn determines the compensation amount. For minor claims, this documentation is sufficient to make a decision on compensation, while in more significant or specific cases, inspections, assessments, and other expert evaluations may be carried out. For instance, if under your health insurance you have bought new glasses for office work, it is sufficient to provide the relevant documents to have the expenses reimbursed. However, in the event of a fire in your home, an inspection will be conducted.

 

Insurer’s decision regarding the submitted claim for compensation

For most types of insurance—excluding those for major risks—the deadline for the insurer to issue a decision is 15 days from the submission of the last required piece of evidence related to your claim. There are two possible outcomes:

-          The insurer determines the amount of compensation you are entitled to and pays it into the bank account you have provided. The amount of compensation reflects the actual damages caused and the insured sum under the specific risk in your policy. When determining it, certain conditions applicable to the case that may be included in the insurance contract are also taken into account such as “first risk,” deductibles, etc.

-          The insurer justifiably refuses to pay compensation. If you disagree with the decision, you may submit a written complaint to the insurer. The deadline for response is no longer than one month.

-          If you have objections regarding the compensation amount, you have the right to request, in writing, a factual and legal justification from the insurer for how the amount was determined. The insurer is obligated to respond with a reasoned explanation within 7 days. You may also request to conclude an agreement with the insurer, specifying the amount of the insurance compensation due.

 

On the website of the Financial Supervision Commission, under the Complaints section, you can review the conditions under which you may file a complaint against an insurer.

In any case, if you disagree with the amount of compensation or with the insurer's refusal to pay it, you have the option to seek protection of your rights through legal proceedings, in accordance with the Civil Procedure Code.

To protect your rights, apart from legal proceedings, you may also seek resolution of the issue through review by a sector-specific conciliation commission. For this purpose, you need to submit a completed application form in writing to the Commission for Consumer Protection.

 

Useful links:

Financial Supervision Commission

Consumer Protection Commission

Insurance Code

Civil Procedure Code