Linked life insurance and visible prior conditions

abogado seguro vida

The payment of the compensation cannot be avoided when the contracting of a life insurance linked to a loan is imposed if the previous conditions were visible

  Consult your case for free now

The link between banks and insurance companies has some perverse effects, among which the imposition of the contracting of related insurance to obtain loans stands out.

Occasionally, the bank employee conditions the granting of financing to the contracting of insurance, which the customer is not at all interested in. The health questionnaire is completed as if it were a mere formality. In the event of a claim,  the insurer will get rid of the compensation based on the policyholder's intent when filling in the health questionnaire.

However, ese afán en la contratación de seguros vinculados puede volverseen contrade la companía de “bancassurance” en casos como el que analizamos a continuación: The client's condition was so evident, naked eye, that it is considered that the insurer knew about it from the first moment and therefore, by not exercising their power to terminate the contract, you must pay the compensation.

Insurance companies, at the time of knowing the inaccuracy in the responses to the health questionnaire, they can terminate the contract. If they do not, cannot be exempted from the payment of the insured capital.

Section 1 of the Provincial Court of Pontevedra in ruling on 16 July 2020, with No Resolution 286/2020, upheld the appeal filed by D. Sigismund. Condemned ABANCA VIDA Y PENSIONES DE SEGUROS Y REINSUROS, S.A. (ABANCA, onwards), to pay the insured the amount of 33.016,59 € plus legal interest increased in the 50% from the date of declaration of Absolute Disability, becoming of 20% after two years.

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. Segismundo subscribed an insurance with ABANCA on 27 January 2015, linked to a personal loan of 35.000 €. The hiring of the insurance was imposed if the financing was wanted.

In March 2017, was declared to D. Sigismund in a situation of Absolute Permanent Disability due to his physical condition.

ABANCA refused to pay the insured amount because it appreciated fraud when answering the health questionnaire, hiding his health problems, when asked specifically.

D. Sigismund filed a lawsuit, requesting that ABANCA be ordered to pay the insured amount.

Primera Instancia

The Court of First Instance and Instruction No. 3 de Tui passed sentence on 10 January 2020, dismissing the lawsuit filed by D. Sigismund.

The Court found malicious conduct on the part of D. Sigismund, as an insured party, for breach of their duty to declare the risk when completing the health questionnaire. He considered that he withheld information about his health that was already known to him at the time of signing the policy.

Provincial Court

D. Sigismund filed an appeal.

He claimed that the insurance contract was linked to a personal loan. Among the insurance guarantees, was the absolute and permanent disability in which the NCG Bank was declared a beneficiary for the loan coverage. He also claimed that his condition was very visible, as well as known to the person who acted on behalf of the insurer. Had a scar visible to the naked eye, that also affected oral expression.

The questionnaire was confusing, and when did you subscribe, was generally well until 2016 they recognized the Total IP, so he did not lie at the time of signing.

Duty to declare health status

Jurisprudence has established that, so that there is a breach of the duty to declare the risk by the policyholder, the following requirements must be met (SSTS 726/2016, of 12 December, 222/2017, of 5 April, 542/2017, of 4 October 323/2018, of 30 May):

1.- “That relevant data has been omitted or incorrectly communicated;

2.- That said data had been required by the insurer through the corresponding questionnaire and clearly and expressly;

3.- That the declared risk is different from the real one;

4.- 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;

5.- That the data is unknown to the insurer at that very moment;

6.- That there is a causal relationship between the omitted circumstance and the covered risk. "

The jurisprudence has also declared that the insurer is exonerated from paying the benefit in case of "Real deception, of an intentional omission or so seriously guilty that it shows rude forms ".

About, there is intent:

a) En STS 27-10-98 in a case in which the applicant for the policy suffered from 10 years before ischemic heart disease, with insufficiency cardiac.

b) STS 24-6-99, considers the action of the insured to be fraudulent, being diagnosed with lymphoma, and underwent chemotherapy, hide it and write the policy later.

c) STS 31-12-01 considers the action of the insured to be fraudulent that when the insurance , hidden that he is on sick leave due to IT due to disease, diagnosed with generalized second motor neuron injury, that required medical treatment and that subsequently degenerated into absolute permanent disability.

d) STS 11-5-07 considers the concealment of suffering retrorhagia malicious, under medical supervision and heavily medicated, when you sign the questionnaire.

and) The of 14-2-14, that the action of the insured who on the date of the questionnaire had antidepressant treatment and recurrent ideas of death was fraudulent, although not autolytic, thought manifested as suicidal subsequent to application for insurance prior to policy issuance, siendo el asegurado consciente de la enfermedad que padecía, produciéndose finalmente el suicidio. Añade la sentencia que: “Esta Sala debe declarar que no puede exigírsele a la aseguradora una búsqueda sin meta sobre las posibles enfermedades, pues dadas las respuestas negativas al cuestionario, era someter a la aseguradora a una investigaciónsu genereque tampoco exoneraría al asegurado del dolo en el que incurrió.

f) The of 4-12-14, con la referencia a la enfermedad padecida (un tumor) era de tal entidad, en su seguro de vida, que su omisión al ser preguntada la tomadora del seguro sobre si había padecido alguna enfermedad de cáncer, intervención quirúrgica o si estaba bajo supervisión médica no puede tener otra finalidad que engañar al asegurador. Todo ello aun cuando los empleados rellenaron el cuestionario con las contestaciones suministradas por la tomadora, previa formulación de las preguntas que incluían aquellas relativas a haber padecido con anterioridad una enfermedad de cáncer. En ese caso hemos de entender que ha existido una infracción del deber de declaración.

g) The of 17-2-16, entiende que se produce ocultación cuando el tomador era consciente que venía padeciendo una patología de depresión que condujo a la enfermedad (trastorno bipolar) causante de su invalidez, tratándose de antecedentes depresivos que, lejos de manifestarse de forma esporádica, como episodios aislados, dieron lugar a numerosas crisis que merecieron sucesivas actuaciones de los servicios de atención primaria, que precisaron tratamiento con medicación, “por lo que nada justificaba que respondiera negativamente a la pregunta de si había tenido o tenía alguna limitación psíquica o enfermedad crónica, y menos aun, que también negara haber padecido en los 5 años anteriores alguna enfermedad que precisara tratamiento médico”.

 In return, no se apreciado dolo que exonere a la aseguradora del pago de la indemnización en supuestos en los que las dolencias omitidas en la declaración de salud, que habían motivado la declaración de invalidity, estaban asociadas a deformaciones físicas y a limitaciones funcionales de movilidad evidentes y necesariamente apreciables a simple vista. “Namely, eran evidentes a la vista del empleado de la Caja que, por cuenta de la Compañía aseguradora concertó con el tomador del seguro de vida vinculado al préstamo hipotecario. Eso significa que fue quien contrató por cuanta de la aseguradora, quien obvió estas evidentes dolencias y admitió que no aparecieran reflejadas en la declaración de salud (…) invalidez que por otra parte, no fue la que a la parte causó la muerte ( STS 2-12-14 ) b) O cuando no se comunican circunstancias que se consideran intrascendentes, como cuando no se comunica la existencia de un quiste porque en el informe médico se dice queera negativo para malignidad” ( STS 18-7-12).

Last, tampoco puede estimarse que el asegurado haya incurrido en dolo contractual cuando el contrato de seguro es accesorio del contrato principal de préstamo, y además le vino impuesto por la entidad bancaria, of forma que difícilmente puede considerarse que el asegurado indujo a la otra parte a la celebración del contrato de seguro ( STS 16-3-16).

Consequences of the inaccuracy in the health questionnaire due to previous visible conditions

The Section brought up the STS 29 March 2006, since jurisprudence has considered that "In order to assess the significance of inaccuracies that may have been committed in the declaration, the insurer's ability to complete its information about declared customers and, and general, the conduct of the insurer during the life of the contract in relation to the study and classification of certain clients, of which was not used in this case. "

In this case, Section considered, if the insurance company became aware of D's inaccurate statement. Sigismund after signing the contract, and did not opt ​​for its resolution within the legally established period, it was understood that the inaccurate statement was considered irrelevant, not being able to free themselves from the obligation to pay compensation alleging fraud or gross negligence on the policyholder.

Therefore, revoked the judgment issued in the first instance and partially upheld the claim, condemning ABANCA to pay D. Sigismund the insured capital of the contract.

Conclusion

If the insurance company is aware that the insured has made an inaccurate statement in the health questionnaire after signing the contract, and does not opt ​​for its resolution within the legally established period, it is understood that the inaccurate statement is considered irrelevant, not being able to free themselves from the obligation to pay compensation by alleging fraud or gross negligence on the policyholder in the event of the insured loss.

Consult your case for free now

Leave a Reply

Language


Set as default language
 Edit Translation


Subscribe to receive a book PDF


Just for signing up receive via email the link to download the book "How to change lawyers" en format digital.
Sign up here

Sígueme en Twitter



Subscribe me

* This field is required