What is the insurance claim?

The “accident” is a fundamental part of the insurance. It is the accidental, unexpected and unexpected act or event, about an insured fact that is contemplated in the policy, which implies that it can be compensated. As a mechanism that causes the insurance to act, the accident must meet a series of assumptions that must be taken into account in order to receive compensation.

There are different types of claims, depending on the nature of the insurance. For example, in life insurance it is the death or disability of the insured, while in health insurance it is the illness or accident that derives from the medical care of the insured.

Characteristics of the claims


The mechanism of action in case of an accident in all cases is very similar. It is always necessary to communicate quickly and diligently to the insurance company for it to act, but also must meet a series of requirements that must be taken into account:

Unforeseen fact


The accident is always something unpredictable that occurs suddenly, without it being expected to happen. It is an important point since prior knowledge can lead to a lack of coverage, as is the case with the lack or exclusion of health insurance that results, for example, from having a pre-existing illness when contracting insurance.

It has to be an involuntary fact

A car accident, a pipe breakage or a disease occurs completely involuntarily. If not, again an exclusion can occur as having intentionally broken a break in the home, or as, for example, performing a risk activity in health insurance, which is also usually included in the exclusions.

It is not cumulative 

Each accident that occurs in a vehicle or in the home must be considered individually and not presented cumulatively.

Accidental event


An accident is not caused by deterioration of the insured asset, but by a quick and accidental cause. The deterioration must be treated by the insured through repair or maintenance actions.

If these points are met and once the incident has been notified to the insurance company, the management, verification of the incident and its resolution is simple, either with the payment of compensation, repair of the good or provision of the service.

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