Life insurance and health questionnaire in Burgos

seguro vida

If there is no causal relationship between the omission in the questionnaire and the origin of the claim, the company must pay the life insurance compensation

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Inaccuracy in the health questionnaire that is not related to the cause of death, does not allow the insurer to get rid of the payment of compensation for life insurance.

The section 2 of the Provincial Court of Burgos has resolved one of these cases in its judgment of 1 June 2020, with No Resolution 167/2020, estimating the appeal filed by Dña. Elena against ABANCA LIFE AND INSURANCE PENSIONS, S.A. (onwards, ABANCA), condemning it to pay 8000 € plus the interests of the art. 20 LCS.

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. Leoncio took out a loan, to which a seguro de vida as a requirement for its award.

When passing D. Leoncio, Ms.. Elena claimed ABANCA to collect the insured capital after the production of the insured claim. The insurance company refused, claiming that, D. Leoncio, when completing the health questionnaire, infringed art. 10 LCS, hiding information about their pathologies.

Ms.. Elena filed a lawsuit against ABANCA, reclamando 8.000 €, plus interest of art. 20 LCS, because he considered that the death of D. Leoncio was caused by a cause other than the pathology that he had omitted when he signed the policy, not being a reason for ABANCA to have no obligation to pay the insured capital.

Primera Instancia

The Court of First Instance and Instruction No. 1 de Miranda de Ebro issued sentence on 28 June 2019, dismissing the lawsuit filed by Dña. Elena vs. ABANCA, absolviéndola.

Provincial Court

Ms.. Elena filed an appeal.

He alleged:

  • Error in assessing the evidence,
  • infringement of legal doctrine, and,
  • subsidiary, Serious doubts of fact and rights regarding the non-imposition of costs in First Instance.

The Section only admitted the reason for the violation of legal doctrine.

He reviewed D's death certificate. Leoncio, to know the cause of death. Found that the pathology that triggered the fatal outcome was not related to the ailments hidden in the health questionnaire.   There is no causal relationship, The duty of declaration by the policyholder is not understood to have been violated and the company is obliged to compensate.

The Hearing brought up judgments from both the Supreme Court, as well as various Provincial Courts.

The STS 03/10/2003 stated that “there is no record that the insured's statement misled the insurers, because there is no evidence that he suffered from a serious illness, nor does it appear that it was the cause of the loss.”

The SAP of Section 9 of Madrid, of 31/01/2020, He established that (…) so that it exists breach of the duty to declare risk by the policyholder, must attend following requirements:

  • that relevant data has been omitted or incorrectly communicated;
  • 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;
  • que el riesgo declarado sea distinto del real;
  • 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;
  • that the data is unknown to the insurer at that moment;
  • that there is a causal relationship between the omitted circumstance and the covered risk.”

For Section, there was no causal relationship or nexus between the ailments that D omitted. Leoncio when he answered the health questionnaire and the disease that ended up causing his death, so that, D. Leoncio did not breach art. 10 LCS, and, therefore, Ms.. Elena has the right to collect the insured capital plus the interests of art. 20 LCS.

Conclusion

If there is no causal relationship between the omissions in the health questionnaire and the origin of the claim,  the insurer must pay the compensation provided for in the life insurance contract.

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