In short. This module covers challenging the insurer's declinature, the available dispute resolution routes, and limitation and the time limit for bringing an action.
Learning outcomes
After completing this module you will be able to:
- choose a dispute resolution route;
- build a matrix of claims and evidence;
- distinguish the limitation period from the one-year period in VÕS § 475(3).
Key points
Analysing the declinature
A challenge starts by comparing the insurer's reasons with the policy, the terms and the evidence. The complaint should state the outcome sought, the contested condition (for example whether an exclusion applies or the effect of a breach) and the supporting evidence.
Routes
The insurer's complaints procedure, insurance conciliation, the Consumer Disputes Committee (for consumers), arbitration (if agreed) and the courts are different procedures. The Financial Supervision Authority supervises market participants but does not award compensation in civil disputes.
Limitation
The limitation period for claims under an insurance contract is three years and starts at the end of the calendar year in which the claim fell due (VÕS § 475(1)). If the claim has been notified to the insurer, limitation is suspended until the policyholder receives the insurer's decision; the claim nevertheless expires ten years after the end of that calendar year (§ 475(2)). The general rules of TsÜS on interruption and suspension of limitation also apply (for example bringing an action, § 160).
The one-year period for bringing an action
If the insurer notifies in writing that it rejects the request, it is released from its obligation if the policyholder does not bring an action within one year of receiving the reply; this consequence follows only if the reply informed the policyholder of the legal effect of the one-year period (VÕS § 475(3)). The statute does not provide for suspension of this period during negotiations or an internal complaint to the insurer. For conciliation, check the rules of procedure of the conciliation body, which may provide that the period is suspended; a complaint to the Financial Supervision Authority is neither an action nor an application for conciliation.
Read before the quiz
Articles on this site:
- Limitation of insurance claims in Estonia: VÕS § 475 explained
- Insurance conciliation in Estonia: a guide for foreign insurers
- Civil procedure and evidence in Estonian insurance disputes
- Arbitration of insurance disputes in Estonia
Legal sources:
Practical case
Write down your own answer before opening the suggested approach.
On 15 March the insurer declined the claim in writing, stating the one-year period for bringing an action and the consequence of missing it. On 20 March the customer sent a complaint to the Financial Supervision Authority and believes that all time limits are now suspended. Prepare an action plan for the first week.
Suggested approach
1) Record the date of receipt of the declinature and check that the reply states the consequence of the one-year period (VÕS § 475(3)); the period runs from receipt of the reply. 2) Explain to the customer that a supervisory complaint is neither an action nor an application for conciliation and does not suspend the period. 3) Analyse the ground for declinature, collect the policy, terms and evidence and build a matrix of claims and evidence. 4) Choose the route: insurance conciliation (check the effect of its rules on the period), arbitration if agreed, or an action. 5) Diarise the last day for bringing an action with a safety margin.
Self-check quiz
Answer the three questions and press "Check answers". An explanation is shown for each question.