NAATI CCL Spanish Insurance & Claims Practice Dialogues — Worked Examples

Good afternoon. I'm calling about the car accident claim you submitted online yesterday.

Sí. El accidente fue hace dos días y no puedo manejar. ¿Proporcionan auto de reemplazo?

Your policy includes rental car cover. You're covered for up to eighty dollars a day for a maximum of fourteen days. You can go directly to an authorised rental company.

¿Cómo se determina la culpa? El otro se pasó el semáforo en rojo.

A police report and dashcam footage make it easier to establish fault. If the other party is at fault, their insurer covers your costs including repairs and the rental car.

Tengo el video del dashcam pero aún no el informe policial.

Police reports take two to four weeks. Meanwhile, back up your dashcam footage — save copies to your computer and email them to yourself as a backup.

¿Qué pasa si es pérdida total?

If repair cost exceeds the car's market value, it's classified as a total loss. You'd receive the market value minus the excess, and the car becomes the insurer's property.

¿Cubre gastos médicos? Me duele el cuello.

Yes, your policy includes up to five thousand in personal injury cover. See a doctor and keep all receipts and medical reports. These are needed for the injury claim.

Mañana voy al médico y llevo el auto al taller. Ya respaldé el video.

Good morning. I'm the claims assessor. I'm here to inspect the storm damage you reported.

Pase. Una rama cayó sobre el techo y entró agua. El cielo raso y el empapelado de la sala están dañados.

I'll photograph and document the extent of the damage. Was any furniture or electronics damaged?

El sofá se mojó y no sirve. El televisor también se dañó con el agua.

Contents are covered under your contents insurance. Whether you receive the replacement value or a brand-new item depends on the type of policy. Do you have purchase receipts or credit card statements?

El sofá lo compré hace tres años por dos mil, tengo recibo. El televisor hace un año por mil quinientos con tarjeta.

Your policy is a new-for-old type. That means you're paid the cost of replacing the item with an equivalent new one, not its current market value. That's very favourable for you.

¿Cuánto es el deducible?

The excess for storm damage is five hundred dollars. However, the roof, furniture, and television are separate claims. Total payout depends on individual item assessments.

¿Cuánto tarda la reparación?

Roof repairs usually take one to two weeks, but after a major storm there's high demand. I'll prioritise an emergency tarp to prevent further water damage in the meantime.

Con su proveedor por favor. Quiero empezar cuanto antes. Al menos el techo antes de que llueva.

Welcome. You're thinking about upgrading your health insurance. What prompted this?

Mi esposa está embarazada y descubrimos que nuestro plan no cubre maternidad ni hospital privado.

An important point — private hospital pregnancy cover usually has a twelve-month waiting period. That means even if you upgrade now, it may not apply to this pregnancy.

No lo sabía. ¿Al menos cubre el parto en hospital público?

Under Medicare, childbirth in a public hospital is fully covered. Even without private insurance, you'll receive good medical care. Private only adds a choice of doctor and room.

¿Vale la pena mejorar para un embarazo futuro?

If you're planning a private hospital birth in future, upgrading now starts the waiting period. Most insurers have a twelve-month wait for pregnancy-related claims.

¿Qué es el reembolso de Medicare?

The government rebate covers part of your premium. The rate depends on your income and age. Lower income earners receive a higher rebate — up to about twenty-five per cent.

También quiero cobertura dental y óptica.

Dental and optical are included in extras cover. Bundling extras with hospital cover gives you a discount. Compare the annual limits and waiting periods to choose the best plan.

Esta vez en hospital público y mejoramos para el futuro. Deme presupuesto de un plan con dental y óptica.

You're calling about a medical expenses claim from an overseas trip. Can I have your policy number?

Lamentablemente me intoxiqué en Bali y me hospitalizaron. ¿Puedo explicar y confirmar mi póliza?

I'm sorry to hear that. Let me check your policy's medical cover limit. Your plan covers up to fifty thousand dollars in overseas medical expenses per trip.

Pagué cuatro mil de mi bolsillo en el hospital. ¿Me lo devuelven?

Yes, once you submit the receipts and medical records, you'll be reimbursed. For overseas emergency medical treatment, the excess often doesn't apply. Your policy waives the excess for emergency hospitalisation.

Tuve que cambiar el vuelo de regreso. ¿Cubren el costo del cambio?

If the flight was changed for medical reasons, the change fee and fare difference are covered. A medical certificate confirming you were unfit to fly is required.

¿Cómo es el proceso de reclamo?

Complete the claim form online and upload the receipts, medical records, doctor's certificate, and flight change receipt. Once all documents are submitted, reimbursement usually takes ten to fifteen business days.

¿Debo comprar por viaje o conviene el plan anual?

If you travel overseas more than twice a year, an annual plan is better value. A single-trip policy costs about a hundred and fifty, while an annual plan is around three hundred.

De ahora en más voy con el anual. Hoy presento la documentación en línea.

Good afternoon. Your car insurance renewal is due next week. I'm calling to review the renewal details.

Sí, llevo tres años. Pero la prima de renovación parece más alta. ¿Por qué?

Premiums are recalculated annually based on your car's market value, rising repair costs, changes in accident rates, and the risk profile of your address. This year, repair costs have risen across the board.

¿Hay forma de reducir la prima?

There are several options. Increasing your excess lowers the premium. Raising it from five hundred to one thousand dollars saves about a hundred and fifty per year. There are also low-kilometre plans and dashcam discounts.

¿Cuál es el riesgo de subir el deducible?

Higher excess means lower premium but more out of pocket at claim time. With a thousand-dollar excess, even a minor repair like a bumper costs you the full thousand first.

¿Debería comparar con otras aseguradoras?

Yes, I'd recommend comparing. Use comparison websites to get quotes from other companies, then come back and negotiate with us. Also check whether your long-term customer discount and no-claims bonus will carry over.

¿Qué es la bonificación sin reclamos?

Your premium is discounted based on claim-free years. You've had three claim-free years, giving you a good discount. Making a claim would reset it to zero.

Comparo y decido. Emítame el certificado de bonificación por favor.

You're enquiring about life insurance. Can you tell me about your family situation and what you're looking to achieve?

Mi esposa y nuestro primer hijo acaban de nacer. Quiero asegurarme de que estén protegidos si me pasa algo.

Excellent decision. There are several types — term life covers a set period, total and permanent disability, and trauma cover for critical illness. Which interests you most?

¿Cuánto necesito? ¿Cómo se calcula?

A guide is to add up your mortgage, living costs until your child is independent, education costs, and any debts. For most young families, one to one and a half million is common.

¿Cuánto es la prima mensual?

For someone in their early thirties, non-smoker, office job, one and a half million in term cover costs around sixty to eighty dollars per month. Premiums increase with age.

Escuché que por el super es más barato.

Yes, premiums can be deducted from super so they don't affect take-home pay. However, this reduces your retirement savings over time. It's worth comparing both options.

¿Cómo designo al beneficiario?

You nominate the beneficiary when applying. Naming your spouse is most common. You can also name a trust for minor children so the payout is managed until they're adults.

Evaluaré combinar temporal y super. Quiero tomar la decisión correcta para proteger a mi familia.

You've submitted an income protection claim for medical reasons. Can you tell me about the situation?

Hace tres meses me diagnosticaron depresión severa y ansiedad. El psiquiatra dice que no puedo trabajar por ahora.

Mental health conditions are covered by income protection insurance. Under your policy, after a thirty-day waiting period, you'll receive seventy-five per cent of your monthly salary for up to two years.

¿Cuándo empiezan a pagar? Ya llevo tres meses sin trabajar.

Once approved, payments are backdated to day thirty-one. Since you've been off for two months, you'd receive a lump sum for the period after the waiting period.

¿Dejan de pagar cuando vuelva? Quiero empezar con medio tiempo.

We support gradual return. If you return part-time, the policy pays the difference between your part-time income and your pre-disability income. This makes the transition easier.

¿Qué documentos necesito?

You'll need a psychiatrist's diagnosis, treatment plan, certificate of incapacity, payslips showing lost income, and a letter from your employer confirming your absence.

¿Pueden rechazar el reclamo por ser salud mental?

Mental health claims aren't automatically rejected. However, pre-existing conditions at the time of taking out the policy must be disclosed. Non-disclosure could void the claim.

Junto los documentos y los presento esta semana. Gracias por el apoyo.