RULES FOR THE DISTANCE PROVISION OF INSURANCE SERVICES
These rules govern and regulate the provision of insurance services at a distance by Insurance Broker Lex Ins Ltd. as a provider within the meaning of Art. 3 of the Distance Provision of Financial Services Act.
NATURE, OBJECTIVES AND APPLICATION
1.These rules are intended to ensure the protection of consumers in the provision of financial services at a distance and apply to any insurance contract concluded between a reinsurer - provider of insurance services on the one hand and an individual - insurer or insured, as a consumer of insurance services on the other hand, where:
- the insurance contract is concluded as part of a system for remote provision of insurance services organised by Insurance Broker Lex Ins Ltd.
- from the making of the offer until the conclusion of the insurance contract (insurance), the parties exclusively use means of distance communication (telephone, e-mail, etc.) - one or more.
2. In the case of the provision of insurance services at a distance, contracts which contain an initial agreement between the parties for the provision of the service followed by successive operations or by a series of operations of the same nature which are carried out at certain intervals, these Rules shall apply only in respect of the initial agreement.
2.1. These rules shall also apply to insurance contracts concluded at a distance which add new elements to the original agreement referred to in the preceding point.
2.2 Where the insurance contract does not contain an initial agreement for the provision of insurance services at a distance, but successive or separate operations of the same nature are carried out between the parties to the contract at specified intervals, the information requirements apply only in respect of the first operation.
2.3. In the cases referred to in the preceding paragraph, where no transaction of the same nature has been carried out for more than one year, the next transaction shall be deemed to be the first of a new series of transactions for the provision of distance insurance services and the information requirements in these Rules shall apply to it.
RESTRICTIVE CONDITIONS
3. The rights granted to consumers of insurance services under the Distance Financial Services Act are guaranteed by these rules and may not be restricted. Any arrangement which excludes or restricts in advance the rights of consumers of insurance services provided by Lex Insurance Broker Ltd at a distance is void.
4. Any waiver by consumers of insurance services of any rights granted to them under the Distance Selling Financial Services Act shall be void.
5. Any clause in an insurance contract which refers to the applicable law of another country which is not a member of the European Union and which excludes the application of the provisions of the Distance Marketing of Financial Services Act or the relevant law of a Member State of the European Union shall be null and void.
6. The insurance broker guarantees the privacy of the personal data provided by the consumer. The disclosure of personal data and their provision to third parties shall only be permissible where required by law.
PROVISION OF INFORMATION TO CONSUMERS
7. In every case of provision of insurance services at a distance, before the consumer of insurance services is bound by an offer or by an insurance contract (insurance) when concluding the contract at a distance, Lex Insurance Broker Ltd or the individual - employee acting on behalf and on behalf of the company, shall obligatorily and in a timely manner provide the consumer with information about the insurance broker, the insurance service and the insurance contract (insurance) in accordance with the requirements of Article 8 of the Insurance Act.
8. "Insurance Broker Lex Ins Ltd. shall provide the information referred to in the preceding paragraph in a manner that does not cause doubt as to its commercial purpose, in a clear and understandable manner depending on the type of communication medium used, subject to the requirement of good faith of the parties to commercial transactions and the protection of the interests of incapable persons.
9. "Lex Insurance Broker Ltd. shall provide the above information to the consumer of insurance services sufficiently in advance of the consumer being bound by any obligations under the insurance contract. Where the insurance service is provided on the territory of the Republic of Bulgaria, the information shall be provided in Bulgarian.
USING THE TELEPHONE AS A MEANS OF COMMUNICATION
10. When using a telephone as a means of communication or any other means of voice communication at a distance, Lex Insurance Broker Ltd. or the broker's employee shall disclose clearly and unambiguously his identity and the commercial nature of the call at the very beginning of the conversation with the consumer of insurance services.
11. Where the consumer expressly consents, the employee of Lex Insurance Broker Ltd. conducting the call shall provide the following information:
11.1. the identity of the person contacting the consumer and his/her business relationship with the insurance broker;
11.2. a description of the main features of the insurance services;
11.3. the total price payable by the consumer of insurance services to the insurance broker, which shall include any taxes payable through the broker, or, where it is not possible to state an exact price, the method of calculating the price, allowing the consumer to verify it;
11.4. the existence of other taxes and/or costs not payable through the broker or not specified by the broker;
11.5. the existence or otherwise of the consumer's right to cancel the insurance contract;
11.6. where the consumer has the right to withdraw from the contract, the time limit and conditions for exercising that right, including the amount that the consumer may be required to pay.
12. The employee of Insurance Broker Lex Ins Ltd. shall necessarily inform the consumer that additional information may be provided upon his/her request, as well as the nature of such information.
13. Before the consumer is bound by an offer or a contract for the provision of insurance services at a distance, Lex Insurance Broker Ltd. shall promptly notify the consumer of all the terms of the insurance contract of the conditions and procedure for the provision of insurance services at a distance, and shall provide the consumer with the information referred to in paragraphs 6 and 10 of these Rules on paper or on another durable medium accessible to the consumer. The information shall be accessible to the consumer and published on the Internet on the website of Lex Insurance Broker Ltd. at the following address: www.lexins.bg.
14. Where the contract for the provision of insurance services is concluded remotely at the initiative of the consumer through the use of a means of communication that does not allow the consumer to be notified of the terms of the contract, "Insurance Broker Lex Ins" Ltd. shall perform its obligations under the preceding paragraph immediately upon request, after the conclusion of the insurance contract.
15. The consumer is entitled throughout the term of the insurance contract to receive the terms and conditions of the contract in paper form when he expressly so requests. The consumer shall be entitled to change the means of distance communication used where this is not contrary to the contract concluded or is compatible with the nature of the insurance services.
16. The User shall not be obliged to make any payments to Insurance Broker Lex Ins Ltd, including fees, commissions or other costs that are not included in the terms of the insurance contract at its conclusion and the provision of remote insurance services.
17. The information on contractual obligations provided to the consumer prior to the conclusion of an insurance contract must correspond to the contractual obligations that would arise under the law applicable to the contract for the provision of insurance or financial services at a distance, provided that the insurance contract is concluded.
18. "Lex Insurance Broker Ltd warrants and accepts full responsibility that the information it provides to the consumer of insurance services is complete, correct, understandable and does not mislead the consumer.
RIGHT OF WITHDRAWAL AND RIGHT OF TERMINATION
19. The consumer of insurance services has the right, without compensation or penalty and without giving any reason, to cancel the concluded insurance contract within 14 days from:
19.1. the date of conclusion of the contract;
19.2. the day on which the consumer receives the terms and conditions of the contract and the information referred to in clauses 6 and 10 of these Regulations, where this occurs after the conclusion of the insurance contract.
20. The preceding paragraph shall not apply to:
20.1. insurance contracts relating to travel, baggage or other short-term insurance contracts with a term of less than one month;
20.2. insurance contracts which have been fully performed by both parties at the express request of the consumer before the consumer has exercised his right of withdrawal.
21. When exercising the right of withdrawal from the concluded insurance contract, the consumer shall notify "Insurance Broker Lex Ins" Ltd. before the expiry of the period specified in clause 18. The time limit shall be deemed to have been complied with if the notification made on paper or other durable medium accessible to the broker has been sent before the expiry of the relevant time limit.
22. "Lex Insurance Broker Ltd. shall inform the consumer of insurance services in an appropriate manner prior to the conclusion of the insurance contract (insurance) of the amount payable by the consumer.
23. Where the consumer of insurance services exercises his right to withdraw from the concluded contract for the provision of insurance services concluded at a distance and "Insurance Broker Lex Ins" Ltd. cannot prove that it has informed him of the cost of insurance services, the consumer shall not be liable for payment of the service received.
24. "Insurance Broker Lex Ins" Ltd. shall return to the consumer all the amounts paid by him, except for the amounts for the insurance services actually used, not later than 30 days from the receipt of the consumer's notification of the exercise of his right of withdrawal under clause 19.
25. The provision of remote insurance services to a consumer for a fee without an explicit and prior request from the latter is prohibited.
26. In the event that the consumer receives an insurance service for which he has not made an explicit and prior request, he shall not owe payment for the service to Insurance Broker Lex Ins Ltd. The absence of a response from the consumer of insurance services does not imply consent on his part.
27. Where the requirements of the Distance Provision of Financial Services Act have not been complied with when concluding an insurance contract (insurance) at a distance, the consumer of insurance services may terminate the contract within one month of the expiry of the period referred to in clause 19 without being liable for any compensation and/or penalty.
COMMERCIAL COMMUNICATIONS AND BURDEN OF PROOF
28. All commercial communications used by Lex Insurance Broker Ltd must comply with the following requirements:
28.1. they shall expressly indicate to the user that they are commercial communications relating to the provision of remote insurance services;
28.2. it shall be expressly stated that the commercial communications are made on behalf of Insurance Broker Lex Ins Ltd in the course of providing insurance services in its capacity as an insurance intermediary.
28.3. clearly and unambiguously present the promotional offer as such;
28.4. present clearly and unambiguously both the terms and conditions for obtaining remote insurance services and the terms and conditions for participating in the promotional offer.
29. When providing remote insurance services, Lex Insurance Broker Ltd. shall necessarily require the prior consent of the consumer when using: telephone, fax or other means of remote communication that enable individual communication.
30. The use by Insurance Broker Lex Ins Ltd. of means of distance communication as referred to in the preceding paragraph may not be associated with costs for the user of insurance services.
31. Whenever providing insurance services at a distance, Lex Insurance Broker Ltd. assumes the obligation to prove that the company is:
31.1. complied with its obligations to provide information to the consumer of insurance services;
31.2. it has complied with the deadlines referred to in point 19 of these Rules and Article 12, par. 19;
31.3. it has obtained the consent of the consumer of insurance services to conclude an insurance contract and, if necessary, to perform it during the period during which the consumer has the right to cancel the contract concluded under point 19.
32. For proof of the provision of pre-contractual information as well as statements, Article 293 of the Commercial Act shall apply, and for electronic statements - the Electronic Document and Electronic Signature Act.
33. Pre-contractual information, as well as statements made by telephone, other means of voice communication at a distance, video link or e-mail, shall be recorded with the consent of the other party and shall have evidentiary value for establishing the circumstances contained therein.
34. Any clause in a contract for the provision of insurance services concluded at a distance, which provides that the burden of proving the fulfilment of the obligations of Insurance Broker Lex Ins Ltd provided for in the Insurance Services Act is borne by the consumer of insurance services, shall be null and void.
35. Articles 143 to 148 of the Consumer Protection Act shall also apply to the contract for the provision of insurance services at a distance.
CLAIMS FOR PAYMENT OF INSURANCE COMPENSATION
NOTIFICATION OF THE OCCURRENCE OF AN INSURED EVENT
36. Notification to the Insurer of the occurrence of an insured event and damage caused shall be made in accordance with the provisions of Art. 105, Para. 1 and para. 2 of the Insurance Code and within the time limits specified in the General Terms and Conditions of each type of insurance.
37. The notification of the occurrence of an insured event shall be sent in free text or by filling in a form according to the Insurer's specimen by electronic means. It must indicate the number of the insurance policy under which the claim is made and the capacity of the person making the claim - insured, contractor, beneficiary. Acceptance shall be certified by registration (entry number and date) in the clerical or information system (claims register) of the Insurer.
38. The occurrence of an insured event may also be notified by telephone, and the Insured shall be obliged to submit a written notification of the event in accordance with the Company's template at the earliest possible moment, further specifying the circumstances surrounding the occurrence.
CLAIM FOR PAYMENT OF INSURANCE INDEMNITY
39. A claim for payment of an insurance indemnity shall be deemed to have been made to the insurer by the completed and registered notice given directly by the insured or his legal/authorised representative.
40. The Insured is obliged to allow the Insurer/insurance broker to inspect the damaged property and to provide him/her with all documents directly related to the establishment of the insured event and the amount of the damage. The insurance intermediary shall notify the Insured in writing of the additional documents and information that he must provide to prove the basis and amount of the claim. The Insurer may require additional evidence subject to the provisions of Article 105(3), (4) and (5) of the Insurance Code. The submission of all evidence (initial and subsequent) by the Insured shall be certified by the Insurer by affixing an entry number and/or date to the documents received.
41. The facts and circumstances ascertained during the survey shall be entered in a damage survey report. The report shall be drawn up at the time of the inspection.
42. The Insurer shall have the right to request and obtain from the Insured other documents and/or materials, beyond those specified in the Contract and the General Terms and Conditions and/or these Rules, which are directly or indirectly relevant to the insured event and may serve in determining the grounds for payment of the insurance indemnity or its amount, subject to the conditions of Article 105, paragraph 4 and paragraph 5 of the Insurance Code.
43. All correspondence must be in writing at all stages of the claims settlement process. Requests for documents from the Insured shall only be made in writing - by letter, email or other means that clearly document this.
DETERMINATION OF THE INSURANCE INDEMNITY
44. The insurance indemnity shall be determined within the limits of the insurance cover agreed in the policy for each occurrence under the insurance.
45. The amount of the insurance indemnity shall be determined according to the degree of correspondence between the sum insured and the actual/replacement value of the property destroyed or damaged at the date of the event.
46. If the insurance contract is concluded against a first risk, the full amount of the loss shall be indemnified, insofar as it does not exceed the sum insured under the policy.
47. In cases where two or more insurance contracts have been concluded with different insurers in respect of the same property interest, for the same covered perils, and the sum of the individual sums insured exceeds the actual/replacement value of the insured property, the Insurer shall be liable in such proportion as the sum insured under the insurance contract concluded with it bears to the total sum insured of all the policies.
48. To prove the claim, the Insured shall submit all necessary documents and evidence, including but not limited to - to establish the existence of a valid insurance contract, the quality of the insured person, the occurrence of the insured event, the type and amount of damage.
48. To prove the claim the Insured shall submit all necessary documents and evidence, including but not limited to - to establish the existence of a valid insurance contract, the quality of the insured person, the occurrence of the insured event, the type and amount of the damage.
49.The insurer, before making a decision on the claimed loss, shall also assess the circumstances:
49.1.that occurred during the term of the contract and led to an increase in risk, and those of which the Insured has not notified the Insurer;
49.2.leading to the occurrence of the insured event due to insufficient measures on the part of the Insured for the preservation and protection of the property;
49.3.caused by third parties which caused the occurrence of an insured event.
PAYMENT OF INSURANCE INDEMNITY
50.In the event of the occurrence of an insured event, the Insurer shall pay the Insured the specified insurance indemnity within the period provided for in Art. 107, par. 1 of the CP.
51.In all cases of refusal to pay the insurance indemnity or determination of an indemnity different in amount from that claimed by the Insured, the Insurer shall send a reasoned reply to the Insured. The Insurer may refuse payment of the indemnity:
- in the cases provided for in the concluded insurance contract;
- in case of intentional causing of an insured event by the Insured or a third party beneficiary;
- in the event of non-performance of an obligation under the insurance contract which is significant in view of the Insurer's interest and has been provided for by law or in the insurance contract;
- the occurrence of the damage as a result of events which do not constitute risks covered under the insurance contract;
- the occurrence of the insured event outside the term or territorial scope of the insurance contract;
- in other cases provided for by law.
52.The Insurer may also refuse payment of the insurance indemnity if it is established that fraud has been used in any respect in the submission of the claim or if fraudulent or misleading means and/or techniques are used by the Insured or by any person acting on his behalf in order to obtain benefits under the insurance, and the person who has carried out the said acts or omissions shall be handed over to the competent authorities for the enforcement of his liability under the criminal legislation of the Republic of Bulgaria. Fraudulent means any act or omission which misleads or maintains an existing misconception in the representatives or employees of the Insurer as to the occurrence of the insured event or other circumstances relevant to the right to obtain insurance indemnity and/or its amount.
OBJECTIONS AND REVIEW, APPEAL PROCEDURE
53.Disputes and disagreements arising between the parties in connection with the settlement of insurance claims shall be settled by negotiation. If no agreement is reached, the person entitled to insurance indemnity may appeal against the refusal to pay the indemnity claimed or its amount. Such appeal may be made both to the Insurer and to the competent court, in accordance with the Bulgarian legislation in force. The right of action before the court shall be independent and autonomous, without being conditioned by the appeal procedure before the Insurer itself.
54.The appeal against the decision of the Insurer shall be made by the person entitled to the insurance indemnity or the person concerned by written appeal.
55.The appeal may be accompanied by written evidence which has not been submitted to the Insurer in the file and which relates to the insured event, the causes of the occurrence, the conduct and fault of the perpetrator who caused the damage, the basis and the amount of the insurance indemnity.
56.The complaint received shall be examined by the Insurer within thirty (30) days of receipt.
57.In the event that the negotiations and the subsequent appeal by the Insured fail to reach a settlement, the Insured shall have the right to sue in court at the Insurer's registered office in accordance with the provisions of the Code of Civil Procedure.
DISPUTES AND COMPLAINTS
58.Consumers of insurance services shall have all the rights under the FICPA to lodge complaints relating to contracts for the provision of insurance services at a distance with the Consumer Protection Commission.
ADDITIONAL PROVISIONS
59.Legal definitions under the FSMA:
A "financial service" is any service of banking, lending, insurance, supplementary voluntary pension insurance with personal contributions, investment intermediation, and the provision of payment services.
'Means of distance communication' means any means that can be used to provide services at a distance without the simultaneous physical presence of the provider and the consumer.
FINAL PROVISIONS
60.These rules for the provision of insurance services at a distance have been drawn up and adopted in accordance with the requirements of the Act on the Provision of Financial Services at a Distance, the Consumer Protection Act and the Insurance Code. The Rules are generally available to the clients of Insurance Broker Lex Ins Ltd and are published on the company's website: www.lexins.bg.
"Insurance Broker Lex Ins" Ltd. is licensed by license 94 dated 23.06.2008 of the Financial Supervision Commission of the Republic of Bulgaria to operate as an insurance broker under "General Insurance" in accordance with the Insurance Code. The activity carried out by Insurance Broker Lex Ins Ltd. as an insurance intermediary is subject to control under the Financial Supervision Commission Act.
Contact the FINANCIAL SUPERVISION COMMISSION:
Financial Supervision Commission
1000 Sofia, ul. "16 Budapest
Headquarters: 02 94 04 999
Fax: 02 829 43 24
e-mail: bg_fsc@fsc.bg
Submission of complaints and documents:
e-mail: delovodstvo@fsc.bg
These rules for the provision of insurance services at a distance were adopted at a Meeting of the Board of Directors and approved by the Manager of Lex Insurance Broker Ltd. and shall come into force and apply as of 01.07.2019.