Life insurance and absence of causation relationship

 abogado seguro vida

You must compensate for life insurance if there is no relationship between the omission when filling in the questionnaire and the cause of the loss

 

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When hiring life insurance, the insured has the obligation to answer the questions that are asked about his health. But an inaccuracy, does not necessarily entail the loss of the right to compensation: If there is no causal relationship between the omission and the cause that produced the loss, the company must compensate.

En varias entradas How is it going, We have analyzed the non-existence of a causal relationship. This time,  is the Judgment of the Civil Chamber of the Supreme Court, of 16 November 2020, with No Resolution 611/2020,  the one that reflects this doctrine.

It is frequent that in the cases in which the contracting of life insurance is linked to the granting of a mortgage loan, la cumplimentación del cuestionario de salud sea realizada de una forma “mejorable”: there are cases in which the bank employee is more interested in achieving his objectives than in carrying out the procedure rigorously and situations in which the client wants to obtain the loan at all costs. All this in the long run leads to numerous legal conflicts.

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 20 November 2009, D. Gervasio took out life insurance with ASEVAL. The insurance covered the risk of death of the insured from any cause with an initial sum of 70.000 € and an annual revaluation of 5%. The insurance was linked to the contracting of a mortgage loan. The policy was signed at the office where the loan was signed.

D. Gervasio passed away on 24 December 2014 for lung cancer. Cancer was diagnosed in 2013, without having a causal relationship with the medical history that the insured had.

Ms.. Mariana reported the death to ASEVAL. This denied him compensation, claiming that D. Gervasio did not declare in the questionnaire any conditions prior to the date of subscription of the policy.

Ms.. Mariana claimed ASEVAL, your deceased husband's insurance company, requesting fulfillment of the life insurance contract linked to a mortgage loan.

The 23 July 2017, Ms.. Mariana filed a lawsuit against ASEVAL, requesting that the insurer be ordered to pay 90.000 € as principal derived from the payment obligation agreed in the life insurance contract.

Primera Instancia

The Court of First Instance No. 2 of La Bisbal d’Empordá, He gave judgment on 15 March 2017, estimating demand. He ordered ASEVAL to pay Ms.. Mariana 90.000 € as principal plus interest in art. 20.4 LCS.

The Court considered that there was no "Proof of illness prior to the time of insurance subscription, the fact of the cardiac pathologies was not related to the accident (lack of causal link), as well as the fact that the questionnaire never asked about a history of smoking or a coronary history or relevant medical history. "

Provincial Court

ASEVAL filed an appeal.

The 2nd Section of the Provincial Court of Girona issued a ruling on 19 June 2017, estimating the appeal, completely rejecting the demand.

The Section dismissed the claim for infringement of the duty of declaration of risk by the insured.

The Chamber considered that there was “Proven that the insured breached his duty to declare the risk (art. 10 LCS) by acting maliciously; In order to assess this violation, it is not necessary that there be a causal relationship between the omitted health history and the cause of death, sino que lo único relevante esla omisión de circunstancias que hubieran podido condicionar la existencia misma del contrato o de sus concretas cláusulas o términos.”

Supreme Court

Ms.. Mariana filed an extraordinary appeal for procedural infringement and appeal for cassation.

The extraordinary appeal for procedural infringement was dismissed.

In the appeal, he formulated a single plea: violation of art. 10 LCS in relation to art. 89 LCS, Regarding the opposition of the sentence appealed to the jurisprudence of the Supreme Court.

For jurisprudence the interpretation of art. 10 LCS is articulated in the following terms:

“i) that the duty to declare the risk must be understood as a duty to answer or respond to what the insurer asks, On which also fall the consequences derived from not presenting or submitting an incomplete questionnaire, too generic or ambiguous with questions about the general health of the insured clearly stereotyped that do not allow the insured to link said history with the disease causing the claim.

ii) that what this court must examine is whether the type of questions asked to the insured were conducive to the latter being able to represent what health history known to him or that he might know referred to, namely, if the questions allowed him to be aware that, by not mentioning their pathologies, was hiding data relevant to the exact risk assessment and causally related to the claim. "

The jurisprudence has also indicated that the breach of the duty of declaration of art. 10 LCS was considered violated when the following requirements were met:

“1) that relevant data has been omitted or incorrectly communicated;

2) that said data would have been required by the insurer through the corresponding questionnaire and in a clear and express way,,es,that the declared risk is different from the actual,,es,& nbsp; that the data omitted or communicated with inaccuracy was known or should have been known with a minimum of diligence by the applicant at the time of making the declaration,,es,that the data is unknown by the insurer at that moment,,es,that there is a causal relationship between the circumstance omitted and the risk covered ",,es,The Supreme Court considers that none of these requirements stated concur in this case,,es;

3) que el riesgo declarado sea distinto del real;

4) that the information omitted or inaccurately statement was known or should have been known at least diligence by the applicant at the time of declaration;

5) that the data is unknown to the insurer at that moment; and

6) that there is a causal relationship between the omitted circumstance and the covered risk. "

The Chamber upheld the appeal applying the jurisprudential doctrine. The background that D. Gervasio hid,

"Referring to heart attack and cardiovascular diseases related to it should not cause, in accordance with the jurisprudence on art. 10 LCS, the effect of releasing the defendant insurer from payment of compensation, given the lack of causal relationship between the omitted antecedents and the cause of the death of the insured, that he was diagnosed with lung cancer four years after subscribing the insurance and that it has not been proven that until then he had manifested any symptoms. "

The Chamber considered that the person who should bear the consequences of submitting an incomplete health questionnaire was the insurance company, because it omitted questions about health history that could be related to the cause of D's death. Gervasio.

Conclusion

Es la compañía aseguradora quien debe de soportar las consecuencias de presentar un cuestionario de salud incompleto o desacertado. Si la omisión por el asegurado no tiene relación con la causa del siniestro, must be compensated for life insurance.

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