Who is he and how can he help you?

A song says that there is a man in Spain who does everything, because in insurance matters the Ombudsman of the insured pays attention to this song. An important figure that is a prior resource before going to the General Directorate of Insurance and that precisely ensures that the rights of the insured are clear and crystalline for all parties.

We are going to delve into this figure that is at our disposal whenever we ask our insurance company for it.

Who is the insured’s Ombudsman?

The Policyholder Ombudsman assumes a role designated by insurance companies to to intervene in disagreements and complaints of insurance holders. They are independent experts who enjoy complete autonomy with respect to the management bodies of the insurance company to which they are linked. This figure, often little recognized, is similar to the Customer Ombudsman in the banking field.

If the answer provided by your insurance company does not meet your expectationsthe next step to consider is to file a claim with the company’s Insured Ombudsman.

The Insured Ombudsman will act as the body in charge of receiving, analyzing and responding to claims and complaints from clients on various aspects of the content, application and effects of the insurance contract that they maintain with the company.

Duties of the insured’s defender

  • Address complaints: The Insured Ombudsman is responsible for receiving and managing claims from policyholders in relation to the services provided by the insurance company.
  • Mediation and conflict resolution: Acts as a mediator in cases of disagreement between the insured and the insurance company, seeking a fair solution for both parties.
  • Advice: Provides advice to policyholders on their rights and obligations in relation to the insurance policy.
  • Monitoring of ethical practices: Ensures that the insurance company complies with regulations and ethical practices, ensuring the rights of the insured.

What defines an insured advocate?

  • Independence: It is crucial that the Insured Ombudsman is independent of the insurance company to ensure an impartial assessment of claims.
  • Accessibility: It must be accessible to policyholders, providing efficient channels to lodge complaints and obtain advice.
  • Transparency: Transparency in the dispute resolution process is essential to gain the trust of policyholders.
  • Legal Knowledge: The Insured Advocate must have legal knowledge and insurance experience to understand the complexities of the claims.

How to request your intervention

The first step is that as an insured request intervention from the Insured Ombudsman through your company, once you have registered your disagreement with the resolution, you can do this electronically, although in a face-to-face office they will give you a physical copy.

This procedure is free and once the disagreement has been expressed you will have to present the following documentation to the defender himself:

  1. Complete contact details.
  2. Policy number and file number to be resolved.
  3. Complete description of the facts.
  4. Demand from the company to resolve the conflict.
  5. Copy of the current policy.

In short, you can trust that the Insured Advocate is there to safeguard your rights and offer clear answers to your concerns. If you are ever dissatisfied with your insurance company’s response, remember that you have this independent and reputable figure to address your claims fairly and equitably.

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