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FAQ

Who is a TPA?

A third-party administrator ( TPA ) is an organization that processes insurance claims. It is also a term used to define organizations in the insurance industry that administer other services, such as underwriting and customer service. The TPA – third party and independent – performs an activity traditionally handled by the insurance company or by the company receiving the claim itself, acting on its behalf. Thus, an insurance company can use a TPA to manage claims processing and provider networks, and the TPA maintains independence from its principals.

    What does a TPA do?

    It manages the claims autonomously, providing for the inquiry of the file and the expert assignments if necessary, the analysis of the policy guarantees, the evaluation of the event in point an et quantum.

    Why can't I sue TPA&A in relation to a claim?

    TPA&A lacks passive legitimacy because it is not obliged to answer for the right claimed as it is extraneous to the object of the controversy.

    How do I contact you and send documentation?

    To contact us you can write an e-mail to sinistri-lic@tpaeaitalia.com or a PEC to sinistri-tpaea@legalmail.it

    You can also contact us by phone at 02 54776511 and, soon, by “Change”. All the necessary information is on the Contact page.

    In any case, it is important to always indicate the number of the file for which you ask or you want to provide info and documentation.

    What is the difference between insured and damaged?

    The insured is the subject who subscribes an insurance contract while the injured party/third party is the one who suffers the damage.

    What is an RCT policy?

    It is an insurance contract of civil responsibility for damages caused to third parties.

    Right of access to records

    The right of access to the acts is guaranteed according to Art 146 of the Insurance Code
    1. Without prejudice to the provisions on access to individual personal data contained in the code on personal data protection, insurance undertakings providing compulsory insurance against civil liability in respect of the use of motor vehicles and craft shall allow policyholders and injured parties the right to access the documents at the end of the procedures for the assessment, ascertainment and settlement of damages concerning them.

    2. The exercise of the right of access is not permitted when it concerns documents relating to investigations which reveal indications or evidence of fraudulent behaviour. On the other hand, it is suspended in the event of a legal dispute between the company and the applicant, without prejudice to the powers attributed by law to the judicial authority.

    3. If, within sixty days from the written request, the insured or damaged party is not in a position to examine the requested documents and to take a copy of them at his/her own expense, he/she may lodge a complaint with ISVAP also with a view to having his/her right guaranteed.

    4. The Minister of Production Activities, in agreement with the Minister of Justice, by regulation adopted on ISVAP’s proposal, shall identify the type of documents subject to and excluded from access and shall determine the obligations of the undertakings, the charges to be borne by applicants, as well as the terms and other conditions for exercising the right referred to in paragraph 1.

    Am I entitled to a reasoned rejection?

    TPA&A prefers to provide a reasoned and detailed feedback as a result of a rejection for absence of responsibility, however, in the case of claims that contractually fall within the deductible of an institution, different texts can be agreed with the insured. Legally, there is no obligation to detail the reasons for the rejection, but our staff is available to provide any clarification by telephone, trying to make the issues in dispute understandable even for those who are not involved in the dynamics. The Insurer/TPA entrusted with the service is not configured as a manager of public service and therefore is not subject to the obligation to communicate in writing the reasons for any rejection.

    (If necessary) who intervenes to evaluate the damage?

    The liquidator, after having ascertained any profiles of responsibility has the faculty – if he deems it opportune – to appoint a trustee to assess the value of the damage. The appointment of an expert, forensic doctor, technician to ascertain the damage does not imply – legally – an implicit admission of responsibility. Furthermore, there is no legal obligation to carry out an evaluation in the presence of an expert, since a documentary evaluation is also possible.

    Why do I have to provide my data?

    The access to the datas is indispensable, together with the authorization to the treatment of the datas according to the law in force, in order to allow us to instruct correctly the practice until the settlement of the same.

    Can I proceed to the repair of damage before the survey of an expert?

    It is possible to repair the damage, without this implying a sure compensation, taking care to document every step by producing detailed photographic material, having care to keep eventual damaged and replaced pieces allowing us to evaluate the damage suffered even afterwards.