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15 Shawwal 1445     24 April 2024

Skip Navigation LinksAfter Occurrence of A Loss FAQ

After Occurrence of A Loss FAQ

  • What are the actions to be taken by an insured in the case of an insured event?

    • An insured should comply with the insurance policy's terms, the first one of which is reporting the incident to the insurance company and taking all measures that can limit losses. The most important measure is to report to official authorities if the same is provided for in the policy and obtain an official report in this respect.
    • An insured should submit a claim to the insurance company which then provides the claimant with an acknowledgement of receipt.

  • Is there a specified period for settlement of claims submitted to insurers?

    • An insurer should settle claims submitted by individuals within a period of (15) days of Hijri Calendar from the date of receipt of complete claim documents. In case of corporate claims, the settlement period should not exceed (45) days. However, the insurer may extend the claim settlement period after notifying the legal supervisor and providing justifications for such delay.

  • Do insurers compensate for losses only?

    • An insured can submit subsequent claims after their entitlement to the indemnity is established. For example, an insured may claim compensation for costs arising from the insurer's delay in settling the claim, lawsuits filed, or use of an alternative car, provided that the claimant provides evidence of such costs except for the insurer's delay which is payable as soon as proven. The insured can file a delay claim separately or together with the other claims.

  • What action should be taken when settling a claim amicably with an insurance company?

    • ​The final settlement clearance is needed to resolve a claim as it is considered a conciliation releasing the insurance company from any and all present and future, known and unknown, rights of the claimant and a full and final discharge of the claim. All suits, complaints, proceedings brought by the claimant against the insurer before any other authority will be revoked. Hence, a claimant should read the clearance provisions before signing it to receive the compensation amount check and acknowledge acceptance of the settlement.

  • What action can be taken if an insurance company rejects a filed claim?

    • ​Make sure to receive a copy of the rejection letter issued by the insurance company or a copy of the form confirming the filed claim, and then lodge a complaint with the Consumer Protection Department at SAMA (toll-free number: 8001256666). In the event that a claim is not closed, a suit can be filed to the General Secretariat of the Committees for Resolution of Insurance Disputes and Violations by the (E-Services).

  • What is the difference between a complaint and a dispute?

  • What is the difference between “capacity” and “interest”?

    • ​Capacity: It is the legal right of a natural or legal person to have insurance coverage for the subject matter of insurance (e.g. a house) and, based on such capacity, the insured is entitled to file a lawsuit for compensation for a loss occurring to an insured object. To prove capacity, a legal relationship must be established between the insured and the subject matter of insurance; a notable example of such relationship is 'ownership'. Capacity of insurance claimants can only be proven if they are parties to an insurance contract, tasked with meeting its conditions.
    • Interest: It is the legal power to initiate suits derived from being the rightful claimant or a representative of the rightful claimant, such as suits brought by one who has insurance interest under an insurance contract (e.g. beneficiary) or suits filed by an attorney-in-fact on behalf of the original rightful claimant. Such interest has to be legal, effective and directly related to the subject matter of insurance.

  • Who is entitled to file a lawsuit over an insurance dispute before the Committees?

    • ​The following may file suits over insurance disputes, provided that there is the capacity or interest needed:
    1. Insurance and/or reinsurance companies.
    2. Insurance companies' clients (the insured).
    3. Insurance companies, in case they act on behalf of the insured.
    4. Insurance service providers.
    5. Other relevant parties, such as beneficiaries of different insurance coverages.

  • What are the competences of the Committees for Resolution of Insurance Disputes and Violations?

     

    1. All disputes arising from insurance contracts, including disputes between insurance companies and their clients and insurance beneficiaries or between these companies and other companies in case they act on behalf of the insured.
    2. Disputes between insurance companies and reinsurance companies or among companies of each activity, or disputes between these companies and insurance service providers.
    3. Violations of the regulatory and supervisory instructions of insurance and/or reinsurance companies.
    4. Violations committed by insurance service providers.
    5. Violations arising from the implementation of the Law on Supervision of Cooperative Insurance Companies and enforcement of fines as prescribed in the Law.
    • In the event a violation involves a crime, the Committee should refer it to the competent investigating authority to investigate the offender in preparation for initiating a lawsuit before the specialized criminal court. If the investigating authority deems the case to be non-criminal, the authority will return it to the Committee to look into the violation and take the necessary action.

  • What are the documents required to initiate lawsuits before the Committees?

    ​

    • The required documents vary depending on the type of insurance; however, the following documents are mandatory for all claims in general:
    • Complete information of the claimant (full name - occupation - place of residence - contact numbers)
    • The defendant's full name, contact numbers and location
    • Copy of the national ID - residence permit (for non-Saudis)
    • Copy of the commercial register (in case the claimant is a legal person, company, association, etc.)
    • Complete information of the attorney-in-fact (full name - occupation - place of residence - contact numbers) (in case the lawsuit is brought by an attorney-in-fact)
    • Copy of the power of attorney document (in case the lawsuit is brought by an attorney-in-fact)
    • Copy of the national ID of the attorney-in-fact (in case the lawsuit is brought by an attorney-in-fact)
    • Response of the defendant (insurance company) or proof of the claim submitted against the defendant (In implementation of Item 4 of Article 3 of the work rules of the Committees for Resolution of Insurance Disputes and Violations)
    • Specification of the lawsuit subject, value and grounds
    • Copy of the insurance policy/ insurance certificate / insurance table. (according to the type of document available with the claimant)

     

    Apart from that, please make sure that all required attachments are submitted when filing suits through e-services.

  • What is the mechanism used by the Committees to consider suits?

     

    • A lawsuit is first considered by the Primary Committees as prescribed in Article (20) of the Law on Supervision of Cooperative Insurance Companies issued by Royal Decree No. (M/32) dated (02/06/1424H), as amended by Royal Decree No. (M/30) dated (27/05/1434H). Such Committees should be formed pursuant to a ministerial resolution and be composed of three specialized members, working full-time if possible, at least one of whom is a legal adviser, for a tenure of three renewable years.

  • What is the territorial jurisdiction of the Primary Committees for Resolution of Insurance Disputes and Violations?

    • Pursuant to Ministerial Resolution No. (1648) dated (27/05/1436H), the territorial jurisdiction of Primary Committees is as follows:
    • Riyadh Primary Committee: It has jurisdiction over disputes and violations occurring in the regions of Riyadh, Al-Qassim, Northern Borders, Ha'il and Al-Jouf.
    • Jeddah Primary Committee: It has jurisdiction over disputes and violations occurring in the regions of Makkah, Madina, Jazan, Asir, Al-Baha, Najran and Tabuk.
    • Dammam Primary Committee: It has jurisdiction over disputes and violations occurring in the Eastern Region.

  • What is the type of decisions issued by the Primary Committees?

    • ​They are primary decisions appealable to the Appeal Committee within (30) days from the date of receiving the decision.

  • Which authority has jurisdiction over appeals against the decisions of the Primary Committees?

    • ​Decisions can be appealed against before the Appeal Committee as prescribed in Article (22) of the Law on Supervision of Cooperative Insurance Companies issued by Royal Decree No. (M/32) dated (02/06/1424H), as amended by Royal Decree No. (M/30) dated (27/05/1434H), stipulating the formation of an appeal committee pursuant to a royal decree with at least three advisers, working full-time if possible, who are specialized and knowledgeable in the jurisprudence of transactions and insurance, and their tenure of membership shall be three renewable years.

  • Where is the Appeal Committee located?

    • ​In Riyadh city.

  • When do the decisions of Committees become final and enforceable?

    • ​The decisions of Committees are deemed final and enforceable in the following cases:
    • When the dispute is settled through conciliation by the parties before the Primary Committee.
    • When the defined period for appealing against the Primary Committee's decision (within 30 days from the date specified for receiving the decision) expires without submitting a request for appeal.
    • When a final decision is issued by the Appeal Committee.

  • What are the rules and regulations applied to insurance disputes by Committees?

    • ​Committees apply the approved working rules and procedures as well as the provisions of the Law of Procedure Before Sharia Courts and its Implementing Regulations in cases for which the working rules have no provisions. They arbitrate in accordance with the Law on Supervision of Cooperative Insurance Companies, its Implementing Regulations and issued regulatory rules and instructions. The Committees also comply with regulatory standards and controls established for litigation and acceptance of dispute cases in terms of form and substance, in addition to ensuring that the dispute presented falls within their scope of competence legally specified. Moreover, the Committees settle suits in accordance with the nature of dispute and applicable rules and as agreed upon according to the law and the comparative jurisprudence.

  • What are the working rules and procedures of the Committees?

    • ​They are a set of rules issued pursuant to Ministerial Resolution No. (190) dated (09/05/1435H), pertaining to regulating the works of both Primary Committees and Appeal Committee regarding the manner through which suits are brought before them. They specify details of attached documents required for approval of suits initiated. They also clarify details of litigation and pleading before the Committees, applicable laws, and mandates of the General Secretariat of the Committees for Resolution of Insurance Disputes and Violations.