¿Cuándo comunicar un siniestro a la compañía de seguros?

abogado seguros

 

Breaching within 7 days of the Law on the Insurance Contract does not prevent or lessen the obligation of the insurance company to pay compensation

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Article 16 of the Law on the Insurance Contract set:

The insurance policyholder or the insured or the beneficiary shall notify the insurer of the occurrence of the incident within a maximum period of seven days have known, unless it is set in a broader term policy. Failure to comply, the insurer may claim damages caused by the lack of declaration.
This effect will not occur if it is proved that the insurer has been informed of the incident by other means.
The insurance policyholder or the insured must, also, give the insurer all kinds of information about the circumstances and consequences of the accident. In case of violation of this duty, the loss of the right to compensation will only occur in the event that he had crowded malice or gross negligence.

Namely, non-communication within 7 allow the insurer days reclamase damage to result of the omission but nothing indicates that the company could stop compensation. Article 16 LCS imposes two obligations to the insurance taker: On the one hand report the incident before during seven days. But also it requires it to provide the insurer all information about the "circumstances and consequences of the accident".

Only if the customer omits this information acting with malice or gross negligence, the insurer could avoid compensation. And respect it should be noted that Spanish civil law, The good faith is presumed. The burden of proof of the existence of the fraud alleged lies who. In his case should be the insurer who proves the existence of damage and the causal link with the delay communicating the incident.

As indicated by the SAP Mallorca 17 June 2016:

“The purpose of the duty of communication is based on the need for the insurer to defend their interests and to fulfill the obligations under the Law on the Insurance Contract, and ascertaining if hedged, and if so the amount of damages resulting from the same or perform within forty days from the statement of the claim payment of the minimum amount of what the insurer may owe, It is according to the circumstances known. The loss of the right to indemnity or compensation for injury or damage, They are not automatic but must be proved by the insurer, that failure has been fraudulent or culpable, and damages caused by the breach and causation given between damage and failure.”

Although the interpretation of Article 16 the LCS is not in doubt from the point of view jurisprudential, it would still be frequently alleged by insurance companies to try to avoid fulfilling its obligation and compensation. Among the most recent, We can cite the SAP Elche 31 March 2017 or SAP Lleida 31 March 2016.

Ultimately, the fact of communicating a sinister later than seven days does not imply the loss of the right to compensation unless the information is omitted on the same willful misconduct or gross negligence. In any case, Our recommendation is that communication is made as soon as possible.

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