Life insurance and health questionnaire in Madrid

 

Ibercaja sentenced to pay life insurance for not failing to fill out the health questionnaire

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Section 10 of the Provincial Court of Madrid issued a judgment on 29 January 2020, with No Resolution 55/2020, dismissing the appeal filed by IBERCAJA VIDA COMPAÑÍA DE SEGUROS Y REASEGUROS S.A.U. (IBERCAJA VIDA, onwards). He confirmed the sentence handed down in the first instance by the Court of First Instance and Instruction nº 2 from Leganés, condemning the payment of 60.000 € to IBERCAJA LIFE, being due to pay to the consort of the deceased at the time of his death, Ms.. Leonor, for having full standing in the procedure.

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

D. Ildefonso contracted life insurance with IBERCAJA VIDA. Upon death, the insurance company refused to pay the agreed benefit to his consort at the time of his death, Ms.. Leonor, because he considered that the statements of the policyholder in the health questionnaire had been inaccurate, for not having revealed the anxiety pictures that were in his medical history.

Ms.. Leonor filed a lawsuit against IBERCAJA VIDA, requesting that they pay the amount due.

Primera Instancia

The Court of First Instance and Instruction No. 2 de Leganés sentenced the 17 May 2019, estimating the demand filed by Ms.. Leonor, deceased's consort, D. Ildefonso. The court sentenced IBERCAJA VIDA to pay the claimant € 60,000, plus the legal interest of said sum until its total payment.

Provincial Court

IBERCAJA VIDA interpuso recurso de apelación. He gave the following reasons:

  • first plea: breach of art. 497 LECivil, that he had not received any notification of the procedure.
  • second reason: lack of active legitimacy of Dña. Leonor.
  • third plea: non-compliance by the policyholder of the articles 10 and 89 LCS. There were illnesses prior to taking out the insurance, related to D's death. Ildefonso, that were hidden when taking the health questionnaire.
  • fourth plea: breach of art. 20 LCS, because there is just cause for not paying the benefit, when evidenced by documentary evidence that objective facts are given that prevent the satisfaction of the service.

All the reasons were rejected by Section 10 of the Provincial Court of Madrid.

The primer motivo was dismissed because they did appear in the proceedings, Day 24 September 2018, Through Diligence of Ordination of 25/09/2018.

Regarding locus standi, the Section considered Dña's irrefutable. Leonor, for being D's wife. Ildefonso at the time of his death.

Nor was it breached by D. Ildefonso los precepts 10 and 89 LCS. Section considered, although, the appeal was reviewing in nature, would interfere with the assessment of the test carried out in the first instance, concluding that he could not re-examine it.

He valued the expert evidence and the testimonies carried out in the first instance, concluding that it could not be understood as proven that “D. Ildefonso was or had been in continuous medical treatment for more than three months, (…) was one of the questions on the health questionnaire, lo que se what would be done to all the wives be a colación, since the aforementioned document is not incorporated into the proceedings by final court decisions. That the anxiety tables that determined the appointments of D. Ildefonso were only mild (…)”.

Last, the fourth plea was also dismissed, because the Section considered that it could not be argued that there were serious doubts about the coverage of the incident, being necessary to exhaust the judicial route. D's medical history. Idelfonso was not talking about serious episodes of anxiety. He was not in continuous medical treatment for more than three months.

Conclusion

According to him article 10 LCS, the policyholder has the duty to declare to the insurer all the circumstances known to him that may influence the risk assessment. This obligation is covered,  both in the event that the insurer does not submit you to any questionnaire, as this is not complete or exhaustive.

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