Claims Procedure
CA Vida Assegurances SA
Article 1.- Purpose of this regulation.
This document regulates the procedure for attending to and resolving complaints and claims, as well as the mechanisms for resolving conflicts that may arise with policyholders, insured parties and persons holding rights and obligations (the Clients) deriving from insurance policies with CA Vida Assegurances SA (the Company), pursuant to the provisions of Articles 46 and 48 of Law 12/2017, of 22 June, on the organisation and supervision of insurance and reinsurance of the Principality of Andorra.
Article 2.- Purpose of complaints and claims
Clients may contact the Company when they believe that, in the context of a contract, operation or service provided by the Company, they have received treatment that was negligent, improper or not in compliance with the Law.
Article 3.- Form
The filing of complaints and claims may be carried out in person or through representation, on paper or via digital, electronic or telematic means, provided it is possible to read, print and store such documents.
The procedure is initiated through the submission of a document, which may be filled in at the time of the filing of the complaint, including the following information:
a) Name, surname and address of the interested party and, if applicable, of the representative (duly accredited); ID document number of the natural persons and the data held in the public registry for legal persons.
b) The reason for the complaint or claim, clearly specifying the issues on which a ruling is requested.
c) The office or offices, department or service where the events that are subject to the complaint or claim occurred.
d) That to the claimant’s knowledge the subject matter of the complaint or claim is not being investigated via administrative, arbitration or legal proceedings.
e) Place, date and signature.
The claimant must provide, in addition to the abovementioned document, the documentary evidence in his/ her possession on which the complaint or claim is based.
Complaints and claims may be submitted to the offices of the Company, on Avinguda Fiter i Rossell no. 22, AD400 Escaldes-Engordany, as well as via the email address (sac@creand.ad) that is enabled for this purpose and that appears on the Company’s website.
The filing and processing of claims is totally free of charge.
Article 4.- Term
The filing of a complaint or claim by a client must be undertaken within a period of two years from the date on which the Client was aware of the events that are the subject of the complaint or claim.
Complaints or claims filed after this term will be rejected.
Article 5.- Leave to proceed
1. Upon the Company receiving the complaint or claim, it will confirm receipt in writing and make a record of the date of the submission of the complaint or claim. The corresponding proceedings will then be opened.
The complaint or claim is filed once by the interested party, without reiterations being demanded before other bodies of the Company.
2. If the claimant’s identity is not sufficiently accredited or it is not possible to clearly establish the facts that are the subject of the complaint or claim, the Company will require the claimant to complete the documentation sent within a period of ten calendar days. Failure to do so will result in the complaint or claim being discontinued without further proceedings.
The period of time used by the claimant to rectify errors referred to in the previous paragraph will not be included in the calculation of the period of two months provided for in Article 8 of this Regulation.
3. Leave to proceed on the complaints and claims may only be rejected in the following cases:
a) When data that is essential data for the processing is omitted that cannot be corrected.
b) When an attempt is made to submit as a complaint or claim, appeals or other acts that fall within the jurisdiction of administrative or legal bodies or arbitrators, or if these are pending resolution or litigation or the matter has already been resolved by any of those bodies.
c) When the matters that are the subject of the complaint or claim do not concern the legally recognised interests or rights of clients of the Company.
d) When the complaints or claims submitted are a reiteration of other formerly resolved complaints or claims, submitted by the same client with regard to the same circumstances.
e) When the two year period for filing complaints or claims has lapsed.
4. When it is understood that the complaint or claim is not to be given leave to proceed, due to one of the reasons indicated above, the interested party will be notified by means of a reasoned decision and this party will have a period of ten calendar days to present his/her objections. In the event that the interested party responds and the grounds for inadmissibility are upheld, this party will be notified of the final decision made.
Article 6.- Processing
1. During the proceedings, the Company may request from the claimant any data, clarifications, reports or evidence that it deems necessary for the resolution of the case. The Company may set reasonable deadlines for the completion these requests, but these deadlines may not exceed fifteen calendar days without justified grounds.
2. In the event that, during proceedings, the claimant begins administrative action or takes any legal action concerning the same matter which is the subject of the complaint or claim, the Company will discontinue the complaint or claim without further proceedings.
Article 7.- Ruling
The Company may, before issuing its ruling, make the necessary arrangements and the appropriate proposals to the client to come to an amicable settlement. In this event, the agreement between both parties will be binding and the proceedings will be deemed concluded.
Similarly, proceedings will be discontinued in the case of settlement to the satisfaction of the claimant and in the case of withdrawal, which must be expressly communicated by this party.
Article 8.- Term for issuing the ruling
The Company has two months from the submission of the complaint to issue its ruling.
Article 9.- Content and notification of the ruling
The rulings concerning the complaints or claims will be reasoned, containing clear conclusions about the requests formulated. These rulings will be founded on applicable law, the contractual clauses, standards on transparency and customer protection, as well as good financial practices. In the event that the ruling is not in line with the criteria set down in similar past proceedings, the grounds justifying the change in criteria will be stated.
The rulings by the Company will expressly mention the claimant’s right, in the event of disagreement with the result of the ruling, to take the matter to the Customer Service Ombudsman or any other body the claimant may deem appropriate.
Once the ruling has been issued, it will be communicated through the same means by which the complaint or claim was filed, unless the claimant expressly specifies an alternative.
Article 10.- Effects of the ruling for the complainant
The claimant is under no obligation to accept the ruling issued by the Company and he/she may begin the administrative proceedings or take the legal action he/she deems appropriate.
Notwithstanding the foregoing, the Company may contact the claimant in order to seek his/her acceptance in writing. Acceptance will be given within the terms of the ruling and it will be accompanied by the express waiver of any other claim, whether judicial, administrative or otherwise.
Article 11.- Effects of the ruling for the company
The ruling issued will be binding on the Company.
The Company will implement the ruling with the maximum period of one month, when, by virtue of the ruling, it must pay an amount or carry out any other action in favour of the claimant, unless, in view of the specific circumstances of the case, the ruling establishes a different period of time. The period of time for implementing the ruling will be counted from the day on which the Company is aware of the acceptance of the ruling by the claimant.