Mrs Irene, her five-year-old son accidentally poured the cocoa of her friend's visit. She immediately reported the damage to her insurance company and truthfully spelled out all the circumstances of the insured event. However, the insurance company has decided not to pay the damage, although it is the case that the insurance policy should be covered. The insurer's main argument was that, according to the Civil Code, the mother is not responsible for the damage caused by her minor child, unless she is properly supervised. According to this interpretation, the insurance company did not incur any liability for damage and therefore there is no reason to pay the indemnity. Her friend and Mrs. Irena, who is primarily governed by the rules of human decency, had to pay the damage from her own pocket.
However, if Mrs. Irena neglected her son's oversight, the insurance company could have grabbed the insurance conditions, which would mean that if the insured violates the obligation to prevent the damage, he or she may not pay the benefit. "If the insurer enters a similarly absurd interpretation of the insurance conditions, the entire liability insurance will become an empty product that can not be used in any life situation," says Lukáš Zelený, head of the legal department of consumer organization dTest. In such a case, it can be argued that the provisioning of insurance conditions creates a significant imbalance of rights to the detriment of the consumer because, as compared to regular premium payments, you can never be expected to receive insurance payments from the insurance company. Inappropriate contractual arrangements should not be taken into account.
Also the list of exits is quite extensive. As a rule, insurance companies do not pay indemnity for damages caused by relatives and the insurance does not cover the liability you take over the legal regulations. So, for example, if you have a foreign property in your custody that you accidentally damage, you will not be able to claim insurance benefits. As far as child third-party liability insurance is concerned, it usually does not apply to situations where your child breaks your own property. The space for payment of insurance benefits is often very narrow. "In addition, you can have an agreed deductible in the contract, which always reduces the insurance benefit. The participation is determined either by a fixed amount or expressed as a percentage of the insurance benefit, " explains Lukáš Zelený. Insurance companies rarely pay for total damage, as a rule, they will deduct at least their own estimate of the amortization of the damaged property.
If you want to argue with the insurance company to justify your claim, it will probably run for a long track with a very uncertain outcome. "Since there is no administrative body authorized to make binding disputes between insurers and their clients, the only authority to which consumers can apply is a court. However, court proceedings are lengthy and costly, and their outcome is always uncertain. Financial arbitrator services can only be used in the event of a life insurance dispute, " adds Lukáš Zelený.
Consumers can try to reach an agreement with the insurance company through the complaints portal of YourStížnosti.cz run by dTest or the out-of-court dispute resolution service, which works at the Czech Trade Inspection. However, dTest and the Czech Trade Inspectorate can not issue binding decisions in these disputes.
Source: tz, edited editorially
