Appealing Against an Insurer’s Decision – How to Challenge an Undervalued Claim
An insurer’s decision is not a court judgment and you are not obliged to accept it. Insurers undervalue claims as a matter of routine – counting on the fact that the injured party does not know their rights or will not want to enter into a dispute. The appeals procedure is relatively straightforward, and the difference between the first offer and the amount obtainable can be very significant.
Contents
- Why insurers undervalue claims
- How the appeals procedure works
- Legal arguments worth using
- What to do if the appeal is rejected
- Specific features of appeals under different types of insurance
- Practical examples from our caseload
- Frequently asked questions
Why Insurers Undervalue Claims
Undervaluing claims is not accidental – it is part of a business model built on the assumption that some injured parties will accept the first offer without asking further questions. In property damage cases, the most common methods are: applying labour rates below market levels, imposing non-original replacement parts instead of originals, failing to account for the full extent of the damage, applying depreciation to parts without a legal basis, and refusing to reimburse replacement vehicle costs.
In personal injury cases, insurers undervalue compensation for pain and suffering, ignore the long-term consequences of injuries – particularly those that are not externally visible, such as spinal injuries or the psychological effects of an accident – and overlook the costs of private medical treatment and rehabilitation. In voluntary insurance cases, such as personal accident policies or group policies, there is the additional problem of a restrictive interpretation of the General Terms and Conditions and the questioning of the causal link between the accident and the loss.
How the Appeals Procedure Works
The first step is a careful analysis of the decision received. It is worth checking whether all reported elements of the loss have been accounted for, whether the labour rates applied reflect local market prices, whether unjustified depreciation has been applied to parts, whether the estimate covers original parts, and whether the compensation for pain and suffering reflects the actual extent of the injuries suffered and their consequences.
The next step is gathering documentation. In property damage cases, the key documents are: a repair estimate from an independent workshop or authorised service centre, photographic documentation of the damage and invoices confirming costs incurred. In personal injury cases, the necessary documents are: full medical records from the time of the accident, medical opinions assessing the degree of permanent impairment, rehabilitation records, invoices for medication and medical appointments, and documents evidencing lost income. In voluntary insurance cases, the basis is the policy and General Terms and Conditions together with the opinions of independent specialists.
The appeal itself should identify specifically which elements of the decision are challenged, state the amount the injured party considers correctly due and provide a factual and legal justification supported by the attached documentation. The insurer has 30 days to consider the appeal, or 60 days in particularly complex cases, under the Act on the handling of complaints by financial market entities.
Legal Arguments Worth Using
In cases of undervalued vehicle repair costs, the basis is Article 363 § 1 of the Civil Code, which provides that compensation should take the form of restoring the previous state of affairs. This means the right to repair using original parts at local market rates. This is confirmed by the Supreme Court resolution of 12 April 2012 (III CZP 80/11), under which compensation covers repair costs calculated on the basis of original parts prices.
In cases of undervalued pain and suffering compensation, the basis is Article 445 § 1 of the Civil Code. Compensation for pain and suffering should take into account all aspects of the harm suffered – physical pain, psychological suffering and the permanence of the accident’s consequences – and should be of real economic value to the injured party, as confirmed by Supreme Court case law.
In cases of refusal to pay under voluntary insurance, it is worth invoking the principle of in dubio contra proferentem – ambiguous provisions of an insurance contract should be interpreted in favour of the insured. This follows from Article 385 § 2 of the Civil Code and is consistently applied by courts in disputes with insurers.
What to Do If the Appeal Is Rejected
If the insurer upholds its decision or offers a sum still inadequate to compensate the loss, the next step is a complaint to the Financial Ombudsman. Proceedings before the Financial Ombudsman are free of charge and may take the form of an intervention or mediation – they frequently prompt the insurer to change its position without the need for court proceedings. Alternatively, a complaint may be submitted to the Polish Financial Supervision Authority if the insurer’s conduct shows signs of breaching insurance market regulations.
The ultimate and most effective remedy is court proceedings. Experience from our practice shows that court judgments in compensation cases are generally favourable to injured parties, with awarded amounts significantly exceeding insurers’ pre-litigation offers. It is also worth knowing that if the case is won, the court orders the insurer to pay the costs of the proceedings, including legal representation fees.
Specific Features of Appeals Under Different Types of Insurance
Under third-party liability insurance, the scope of the insurer’s liability is set by statute and cannot be restricted by the General Terms and Conditions. The key is to demonstrate all elements of the loss – both material and personal injury.
Under comprehensive insurance, the policy terms and General Terms and Conditions are decisive. The insurer may apply exclusions and limitations of liability, but only those that follow expressly from the contract. Any unclear or ambiguous provisions must be interpreted in favour of the insured.
Under personal accident insurance, the key is demonstrating the causal link between the accident and the health impairment, and obtaining a correct percentage assessment of that impairment. Insurers undervalue impairment assessments – it is worth challenging them with the opinions of independent medical specialists.
Under group insurance policies, the impairment tables set out in the General Terms and Conditions apply. Careful analysis of these tables is often critical – it sometimes emerges that the insurer has applied an incorrect classification of the injury, attributing a lower percentage of impairment than the policy itself provides for.
Practical Examples from Our Caseload
A client received compensation of PLN 8,500 for a damaged Volkswagen. An independent estimate showed the actual repair cost to be PLN 16,800. After submitting an appeal based on an authorised service centre estimate and demonstrating that the labour rates applied did not reflect local market conditions, the insurer increased the compensation to the full amount.
A client sustained a cervical spine injury in a collision. The insurer awarded PLN 3,000 in compensation for pain and suffering, characterising the injuries as minor. After an appeal was submitted with full medical records and a neurologist’s opinion on the long-term consequences of the injury, the insurer increased the compensation to PLN 12,000 – without the matter going to court.
An employee covered by a group workplace insurance policy sustained a hand fracture in a road accident. The insurer awarded a benefit for 2% permanent impairment, while the impairment table in the General Terms and Conditions provided for 6% for that type of fracture. After an appeal citing the specific table entry, the insurer corrected its decision and paid the benefit for the full 6% impairment.
Frequently Asked Questions
How long do I have to appeal against an insurer’s decision? There is no fixed statutory deadline for submitting an appeal to the insurer – you can do so at any time, as long as the limitation period for the claim has not expired. For road traffic claims, this is generally three years from the date on which you became aware of the loss and of the person liable. It is not worth waiting, however – the sooner the appeal is submitted, the sooner the correct amount will be paid.
Does submitting an appeal interrupt the limitation period? Yes. Bringing a claim before the insurer interrupts the limitation period for the duration of the claims handling process – under Article 819 § 4 of the Civil Code. Once those proceedings conclude, the limitation period runs again from the beginning.
Can I appeal if I have already accepted part of the compensation? Yes, provided you have not signed a settlement agreement containing a waiver of further claims. Simply accepting a payment does not close the door to recovering the remaining amount.
The insurer has rejected my appeal – what now? You can submit a request for intervention to the Financial Ombudsman or refer the matter to court. It is worth consulting a lawyer before taking further steps – they will assess the merits of the claim and identify the most effective strategy.
Is it worth appealing on my own, or should I involve a lawyer straight away? In simpler cases – for example where the difference in the repair estimate is clear and well documented – a self-submitted appeal can be effective. In claims for compensation for personal injury, disputes about the degree of permanent impairment or refusals to pay under voluntary insurance, professional preparation of the appeal significantly increases its chances of success.
Contact Us
An insurer’s decision that does not reflect the true extent of the loss is a starting point for negotiation – not the end of the matter.
It pays to be properly prepared: both in terms of documentation and legal arguments.
We handle cases for drivers in Poznań and across the Wielkopolska region, with in-person and online consultations available for clients elsewhere in Poland.
Adwokat Marta Krzyżanowicz and Adwokat Michalina Koligot Law Firm “Adwokat dla Kierowców w Poznaniu”
ul. Adama Mickiewicza 18/3, 60-834 Poznań
tel. +48 795 001 536 · +48 531 335 713
kontakt@adwokatdlakierowcy.pl · www.adwokatdlakierowcy.pl
This text is for general information purposes only and does not constitute legal advice. Every case requires individual analysis.