When an Incident May Not be Covered by Insurance

Having an insurance is not always synonymous with that for any incident, the insurance company pays for all the damages. There are a number of occurrence specified in the insurance contract where companies can refuse to cover a claim.

According to the Insurance Association of Canada, a company can refuse if it is proved that the damage or loss arose from an event that was neither accidental nor unpredictable. That is, if they are background information that could have or anticipate and avoid the sinister hands of the person who contracted the insurance.

An example would be if a person takes out a life insurance and within the pre-existing or illnesses reported having had cancer, and months later dies of the disease.

But beware, there are also a number of instances in which the insured can claim.

One of them is going to administrative bodies which gives the Superintendency of Securities and Insurance. If this process is not successful, then it goes to an arbitration process, where the general conditions - that is the way to determine the arbitrator and the fees, among others, are described in the policy. If the insured are not satisfied with the decision of the referee, may apply to the Court of Appeals.

However, a new figure will be introduced in the insurance market. This is the “Defender of the Insured”, which seeks to improve customer service, analyze the problems that arise in the operation of companies and be an easier alternative to judicial solutions.

The figure would be funded by industry, but it would be an independent professional with no ties to the industry, basically, hear and settle in an objective and free individual complaints concerning possible breaches by any company.

As a starting point, the distinction is essential that when an insurance contract must consider the individual needs, ie to analyze the risks faced daily and within them, define which of them could cause greater damage or negative consequences.

These risks fall into personal risk, ie those that can cause accidents as they affect our physical capabilities and / or mental and economic risks, or those susceptible to claims that may affect the nature and initial conditions of insured property.