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www.e-agentelocaldeseguros.com Spain: Sanitas agent (BUPA Group) Sanitas Mundi - General Conditions (English) XVIII. CLAIMS-CONTROL AND PROCEDURE A. Control of the activity of the Insuring Body befalls the Spanish State, exercising this through the Directorate General of Insurances and Pension Funds of the Ministry of Economy. B. In the event of any kind of claim concerning the insurance agreement, the Policyholder, Insured Party, Beneficiary, injured Third Party or Beneficiaries in any of these, must address the complaint in writing to: 1. The Insured's Department of Customer Service (Departamento de Atención al Cliente), Calle Ribera del Loira nº 52 (28042 Madrid) or by fax to the number 91 585 24 80, or the the email address clientes at sanitas dot es who will acknowledge receipt in writing and will likewise provide its reasoned decision in writing. 2. Once this internal procedure of the Insurer's has been exhausted, or in the event of failure to agree with its decision, a claim may be made to the Insurance Ombudsman (Defensor del Asegurado) designated by the Insurer in the following cases: a) In those cases of claims whose amount does not exceed 12020,24 euros and affect the interpretation of the General and Specific Conditions of the policy. Claims may not be lodged with the Ombudsman which apply to the personal or professional conduct of the doctors, hospitals or medical services in general which provide care for the injured parties. b) Whenever, even in the event of falling outside the above circumstances, the Insurer is in agreement. To lodge a claim with the Ombudsman the claimant must address themselves in writing to Apartado de Correos 50072 (28080 Madrid) expounding the reasons for their claim. Upon receipt of the same, the Ombudsman shall acknowledge it accordingly in writing and will pronounce their competence or otherwise in the matter. Once the claim has been investigated and within 1 month of the statement of competence, notwithstanding those exceptions in which this period may be extended up to a legal maximum of 6 months including the period elapsed from the submission to the Department of Customer Service, a reasoned written judgement will be conveyed to both the claimant and to the Insurer, for whom it shall be binding. 3. Likewise, an administrative procedure for a claim may be undertaken with the Directorate General for Insurances. Accordingly, the claimant must show that the term established for the judgement on the claim by the Ombudsman has expired or that the claim has been rejected. 4. In any event, a claim may be pursued in the competent Courts or Tribunals.
Return to Index (English Conditions) For more information your English Sanitas agent is: David Harris Mobile / cell: (00 34) 609 522 300 email: saniprof@wanadoo.es Any questions or comments to saniprof@mail.ddnet.es - thanks. (Free messenger service - I cover the whole of Spain (click here...))
Apartado (PO Box) 19 28760 Tres Cantos Madrid Tlf: ( 00 34) 91 804 3802 Fax: (00 34) 91 803 2484
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