Your insurer pays you, but it also decides how much
In road traffic accidents, compensation is generally paid by the insurer of the person at fault. By contrast, when you have a problem with your home or your health, or when a relative dies, it is your own insurer that has to pay.
If you call the company or go to the branch, they will tell you whether the incident is covered and what the limit is. But the information is coming from the party that has to pay, and its profit is higher the less it pays out in claims. It may tell you something is not covered, or value it at an amount you know is not enough to fix it. That is when you need to know exactly what you signed and what the small print means.
The small print: what the Insurance Contract Act says
Protection for policyholders has improved over the years, but many insurance contracts are still hard to understand. Often only the specific terms (condiciones particulares) are handed over, when most of the rules that apply are in the general terms (condiciones generales). Ley 50/1980, de Contrato de Seguro (the Spanish Insurance Contract Act) sets out several rules in your favour:
- The insurer must give you both the general and the specific terms of the policy.
- Clauses that limit your rights must be specially highlighted and accepted in writing. If they are not, they may not apply.
- Before taking out the policy, the company must ask you, usually through a questionnaire, what it needs to know to assess the risk. If it did not ask, it will find it hard to refuse to pay later on the grounds that you concealed something.
- The insurer must pay within a reasonable time. If it delays without good reason, the law imposes particularly high late-payment interest.
Beyond the general law, each type of insurance has its own rules and court case law. Knowing them is what tells you whether a refusal stands up.
Life insurance: how to find out whether a policy existed
If a relative has died and you do not know whether they had life insurance, you can request a certificate from the Registro de Contratos de Seguros de Cobertura de Fallecimiento (the register of insurance policies covering death), which comes under the Ministerio de Justicia (Ministry of Justice). It tells you whether the person had life or accident insurance and with which company. If the policy was linked to a mortgage, the payout is usually used to repay the outstanding debt, and it is worth checking that the company does so. If you are dealing with the estate, you may find the page on inheritance, succession and gifts useful.
How and when to claim
The first step is a written complaint to the insurer’s customer service department or customer ombudsman. If it does not respond or rejects the complaint, you can go to the complaints service of the insurance supervisor. In parallel or afterwards, you can go to court, always after attempting to negotiate first, as generally required by Ley Orgánica 1/2025 (the 2025 law on the efficiency of the justice system).
As a general rule, claims under an insurance contract become time-barred after two years for property insurance, such as home insurance, and after five years for personal insurance, such as life or health insurance. Do not let time pass while you wait for the company to reply. You can start by telling me about your case through the online consultation.
