How to appeal an insurance decision in Poland. Complaint, Financial Ombudsman or court

What a complaint is and who can file it

Polish law does not use the word appeal for insurance decisions. The remedy is a complaint (reklamacja), that is a statement addressed to the insurer in which the client raises objections to its services (Article 2 point 2 of the Complaints Act).

A client is not only the person who bought the policy. The definition also covers a person entitled under an insurance contract, which includes someone injured by an insured driver, and a natural person claiming from the Insurance Guarantee Fund or the Polish Motor Insurers’ Bureau (Article 2 point 1 letters a and b). Filing a complaint is free.

Before you write. The reasons and the claim file

An insurer’s decision has to give reasons. If it refuses to pay or pays less than you claimed, it must state in writing the circumstances and the legal basis for its decision, explain why it did not accept your evidence, and inform you that you can go to court (Article 14 paragraph 3 of the Compulsory Insurance Act and Article 29 paragraph 5 of the Insurance Activity Act). A letter that only states an amount does not meet this obligation, and that is already an argument in the complaint.

The second step is the claim file (akta szkody). The insurer must make available the information and documents it gathered to establish its liability or the amount of compensation. You can ask for written confirmation and copies, and the insurer provides them electronically on request (Article 29 paragraphs 6 and 7 of the Insurance Activity Act). Without the cost estimate and the opinion of the insurer’s doctor it is hard to write a complaint that addresses the real reasons for the decision.

How to file the complaint

The complaint can be filed at any office of the insurer that serves clients. It can be made in writing, on paper by post or in person, or electronically, or orally, by telephone or in person at the office (Article 3 of the Complaints Act). A written complaint is easier to prove later, so it is the better choice.

A good complaint is specific. It identifies the claim number, says which part of the decision is contested, points to the evidence the insurer ignored or assessed wrongly, and says what you expect. A complaint makes sense above all when the insurer did not consider important evidence, for example medical records from later treatment. It makes less sense when the insurer has assessed all the evidence and the dispute is only about the amount. Then it is usually better to decide straight away whether the case is worth taking to court.

How long the insurer has to reply

The insurer must reply without undue delay and no later than 30 days after receiving the complaint. Sending the reply before the deadline is enough (Article 6 of the Complaints Act).

In particularly complicated cases the insurer may take longer, but it must inform you why there is a delay, what has to be established and when it expects to reply. That date cannot be later than 60 days after it received the complaint (Article 7).

If the insurer misses the deadline, the complaint is deemed to have been resolved as you requested (Article 8). That is why it is worth keeping proof of when the complaint was delivered.

The Financial Ombudsman

If the insurer rejects the complaint, you can ask the Financial Ombudsman (Rzecznik Finansowy) to step in (Article 24 paragraph 1 point 1 of the Complaints Act). The Ombudsman also runs an out-of-court procedure for resolving disputes between clients and financial institutions (Article 35). The Ombudsman will refuse to deal with the dispute if you have not first gone through the complaint procedure (Article 36 paragraph 4 point 2).

The Ombudsman’s procedure does not replace a court judgment. It can help where the insurer’s position is clearly wrong, but in a dispute about the value of an injury or a death, the amount is ultimately decided by a court.

Going to court

A complaint is not a condition for going to court. You can sue the insurer directly (Article 19 paragraph 1 of the Compulsory Insurance Act). If the court awards more than the insurer paid, interest may run from the end of the period the insurer had to pay, not from the judgment^{1Court of Appeal in Kraków (Sąd Apelacyjny w Krakowie), judgment of 9 December 2021, I ACa 916/20}. The risk of a low valuation is therefore on the insurer.

Before going to court, check whether you have signed a settlement. A settlement covers only the claims the parties knew of or could foresee^{2Court of Appeal in Lublin (Sąd Apelacyjny w Lublinie), judgment of 27 March 2023, I ACa 482/22}, but once it is signed, claiming more becomes much harder.

Time limits

There is no separate deadline for a complaint. The limit is the limitation period of the claim itself. A claim for damage caused by a tort becomes time-barred three years after you learned, or could have learned with due care, about the damage and the person liable, but no later than ten years after the event (Article 442¹ § 1 of the Civil Code). For personal injury, the period cannot end earlier than three years after you learned about the damage and the person liable (Article 442¹ § 3). If the damage resulted from a criminal offence, the period is 20 years (Article 442¹ § 2).

If you live outside Poland

The complaint, the request for the claim file and any court case can be handled by a Polish attorney under a power of attorney. You send the decision and the documents as scans, and the correspondence with you is in English. See also the guide injured in a road accident in Poland.

Questions we are asked most often