When it understood the casualty in life insurance?

 seguro de vida

 

In life insurance and disability, the time considered the casualty is essential to determine whether or not entitled to compensation

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5th Section of the Provincial Court of A Coruña in sentence 24 July 2019 resolution number 297/2019 He has solved one of these controversies. Ms.. Araceli signed a mortgage loan contract with life insurance and disability insurance and permanent. Later he suffered an accident that was derived consequences of transcendence. Ms.. Araceli decided to make an early cancellation of the loan past few years. It was finally declared by the INSS in situation incapacidad permanente absoluta, and asking the insurer to pay the agreed compensation. The insurer refused on the grounds that, when he canceled the mortgage loan so did life insurance and disability. The date of declaration of invalidity of the INSS was the date on which it was understood the casualty. The audience in this judgment makes a judicial review on It is understood when the casualty, issue on which the doctrine is not unanimous. Where there is no continuity between the incident and the administrative declaration, the date will be fixed in the accident which determined the subsequent inability.

Fact background,,es,Juan Alberto and Paulina filed suit against FTA,,es,Asset Securitization Fund,,es,requesting the declaration of nullity for abusive of the floor and ceiling clauses contained in the novation contract of the mortgage loan of,,es,with the corresponding refund of amounts unduly collected,,es,The Securitization Fund Management Company,,es,Beech,,es,acting on behalf of FTA, he responded to said claim alleging that he lacked passive legitimacy since the entity had no legal personality and that it constituted only a private and open fund and that therefore the passive legitimization corresponded to BBVA as successor of Catalunya Banc that was the Company fund constituent,,es

The 19 October 2005 Ms.. Araceli signed, with her husband, mortgage loan contract with Banesto amounting entity 105.777 euros.

Along with the loan agreement a group policy covering the risks of death and total and permanent disability due to illness or accident was signed.

He was appointed as the first beneficiary of this to the lending bank for repayment of amounts outstanding on the date of loss.

The 14 July 2010 Ms.. Araceli had an accident with serious injuries. It required assistance in various hospitals.

The 22 March 2012 Ms.. Araceli was declared temporary disability due to common illnesses.

The 1 June 2012 borrowers canceled the mortgage loan for the amount of income 72.458,31 euros.

The failure resulted in the resolution of the INSS 3 April 2013, effects of 22 March, in which he declared Dña. Araceli in situation degree of permanent disability in absolute for all work. The cause was a clinical residual disease.

The insurer refused to pay compensation for alleged that, to cancel the loan early was extinguished insurance.  The statement by the INSS of the status of permanent disability almost a year later excluded the right to compensation.

Ms.. Araceli filed its lawsuit seeking payment of compensation.

Primera Instancia

The 6 July 2018 the Court of First Instance No. 2 in A Coruna gave judgment for which he felt entirely the lawsuit.

He condemned to pay the plaintiff 73.313,12 euros by the outstanding principal amount of the mortgage loan insurance object to the date of the incident which caused the permanent disability, plus, 3.030,98 euros by the difference between the amount paid to the bank and capital assure the date of loss.

Likewise, the statement condemned the defendant to reimburse the plaintiff the amount of insurance premiums paid after the occurrence of the claim. And, the payment of interest of art. 20 LCS.

Clause on early termination of the loan,  the Court did not consider it proven that Mrs.. Araceli had chosen to terminate the insurance at the time of loan cancellation. He understood that the option was assumed that insurance should continue in force until the annual renewal date of the 24 October 2012, after the cancellation of the loan.

The court also referred to the established case law of the Supreme Court by which considered the "date of onset of disease decisive declaration of invalidity to decide if the loss is covered by insurance, whatever the date is administratively declare permanent disability.

Finally, The resolution concluded that in the case of litis, the contingency occurred force the insurance contract well "after illness, unbroken, It was reached disability, so that personal and physical situation of invalidity born to this disease occur and the administrative declaration only recognizes the pre-existing situation so the insurer is obliged to pay the sum insured ". Therefore, when the accident occurred, the contract was valid and therefore this was covered, but it was declared invalid later. Fulfilling all the provisions in Articles 1 and 100 Law of Insurance Contracts.

The insurance company appealed demand. He stressed the link between the loan and insurance, because it is a loan protection insurance. So, ensured that there would be no policy in force at the time of the contingency occurs because the linked loan voluntarily canceled in advance. In the same way, the insurance policy was canceled 24 October 2012 in its annual maturity, when there was no longer linked loan capital. Since until 22 March 2013 no absolute permanent disability recognized by the INSS.

It was also argued on the legislation on social security and labor law, by which, “in cases of permanent disability due to common illnesses, to determine the date of the event causing the purpose of setting responsibilities from, I would have to go to the rule on mandatory Social Security benefits, that fixed in Date of the opinion of the Disability Assessment Team (EVI)”.

The contingency entitled to the benefit should be the recognition of absolute permanent disability and not the beginning of the process that may or may not ultimately result in his statement. For the appellant, in the contested case the incident occurred after the loan repaid and extinguished insurance.

Provincial Court

The 24 July 2019 5th Section of the Provincial Court of A Coruña gave judgment confirming the right to compensation. Could not be accepted appellant's thesis, even if, the response of the courts on fixing the date of the incident was not unanimous.

Therefore he listed the following statements to consider the criteria to follow:

STS 17 June 1993 by which "thea declaration of invalidity, far from being the fact of causation of damage or loss, it is merely an administrative formality ... that in no way can identify with it.

STS 24 May 2005 He argued that the issue was "if the loss occurs when starting a disease, or if the contrary occurs when the invalidity is objective ".  That judgment was based on the STS 17 June 1993 which established that, “If the determining disease ... absolute incapacity occurred during the term of the policy underwritten by Alico, it will be obliged to pay the amounts agreed, however, which it has been declared administratively much later.

However the STS 14 June 1999 he departed from previous statements and determined that "it was the insurer whose contract was in effect at the time they occur the fall was the origin of disability, namely, the operative event of the same, the event was the hedged risk, as it says Article 1 of the Act insurance and when there was, It caused the disability or sick leave of the insured, unbroken, He ended with the declaration of permanent total disability of the insured, statement, no constitution, of disability.”

In this judgment the STS was inspired 23 December 1999 to form its ruling: “…covering the risk during the term of the contract and at this time the loss occurred, but it was declared invalid later, with which it has strictly observed the provisions in Articles 1 and 100 Act insurance contract.”

Therefore, jurisprudential decisive for this latter stream was the date of the event and not the date of the legal classification of this.

counterpoint, She hearing brought up the STS 10 July 2013 containing a particular vote for understanding the magistrate who “…the insured risk is the inability or declared invalid by administrative or judicial decision and not the disease that led to it, that would only be the operative event risk. Therefore, the damaging event, risk insured, It occurs when the declaration of incapacity or disability occurs”.

Therefore, It was the subject of discussion in the courts to determine which should be the date to be taken into account as date of the incident, for the purpose of determining whether that date must match the date of the declaration of incapacity by administrative bodies or judicial, the, if on the contrary, You must match the date of illness or accident as a result of which, subsequently, failure is declared”.

Therefore, the Court determined that to know that I had to apply criteria be the case. So, in practice they could be three different assumptions:

1º The illness / accident directly generated Invalidity. Therefore, personal and physical situation of invalidity born to a pre-existing situation occur the disease / accident and only recognized the administrative declaration.

2º After the illness / accident, unbroken, it came to the invalidity. Therefore, We would be in the previous course.

3º The insured suffered an illness / accident which was not known if it would lead to a declaration of incapacity or healing. Therefore, It was necessary a negative evolution of the same for your situation might become determining disability. interference of many contributing factors to the production of the result thus produced. In this case, the administrative declaration of this situation had to be considered as constitutive and determinant of temporal and economic effects of insurance coverage concerted.

With all the Court concluded that in the case under Litis was before an accident, in which after this and unbroken you get to the inability. With what the risk insured had to place it on the accident which determined the subsequent declaration of severe disability.

The High Court partially upheld the appeal on conviction to pay the premiums paid after 22 March 2012. thus confirming the remaining pronouncements of the judgment of First Instance.

Conclusion

In the life and disability insurance is considered the casualty in the accident which it determined the subsequent declaration of invalidity if between the accident and the administrative declaration there was no continuity solution.

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