since 2/2000
Al terrorismo - "NO" / Terrorism "NO"
boat and golf insurance in Spain
Commercial Premises insurance - Spain
Community Insurance 'Comunidad' - Spain
Company Platinum - health plan for employees in Latin America and the Caribbean
English insurance agent in Spain
Patrocinadores - América Latina y el Caribe
health insurance Czech Republic
international health, medical and travel insurance cover
international travel insurance
Maritime plan - international health cover (crew only)
Oil and Gas Industry - health insurance
Teachers - international health cover (Spain)
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Spain: Sanitas agent (BUPA Group)
Sanitas Mundi - General Conditions (English)
XIII. DISPUTES
1. In the event that no agreement is reached about the nature of an illness and/or the amount to be refunded, each party shall appoint an appraiser, whose acceptance must be stated in writing. Should one party fail to designate an appraiser, it shall be under obligation to do so within eight days of being required to do so by the other party, and should it fail to do so by the latter deadline, it shall be understood that it accepts the opinion of the other party's appraiser and shall be bound thereby.
2. Where the appraisers are in agreement, they shall draft a joint report reflecting the causes of the claim, the appraisal of damages, other circumstances affecting refunds of expenses and the proposed amount to be refunded.
3. Where the appraisers do not reach agreement, the two parties shall appoint a third appraiser by consensus and if no consensus can be reached, such appointment shall be made by the Judge of the Court of First Instance in an act of voluntary jurisdiction in accordance with the provisions of the Rules Civil Law Procedure on the appointment of appraisers by rote. In this case the appraiser's report shall be issued by the deadline established by the parties or, failing this, within thirty days of the date of the third appraiser's acceptance of his or her appointment.
4. The parties shall be immediately notified by some reliable means of delivery of the appraisers' report, which shall express the unanimous or majority opinion, and they shall be bound thereby, unless it is legally challenged within thirty days by the Insurer and one hundred eighty days by the Member, both computed from the date of notification of the aforesaid report. Should no legal action be taken with respect to the report within the aforesaid deadlines, it shall be rendered unappealable.
5. Should the appraisers' report not be challenged, the Insurer shall be bound to pay the amount of the refund as established by the appraisers within five days.
6. In the event that due to arrears in payment by the Insurer of an unappealable refund the Member should be obliged to file a legal claim, the respective indemnity shall be subject to interest at the official annual rate, which in this case shall be accrued from the date that the appraisal became unappealable for the Insurer and, in any case, the Insurer shall also be liable for the legal costs incurred by Member, and the sentence shall make specific reference to such indemnity, whichever the legal proceedings involved.
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