Life insurance and complement premium exoneration

seguro exoneracion pago

 

To what point supplement insurance premium payment exemption produces its effects?

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Compensation for Supplement Insurance premium payment exemption It should be done from the time of production of the accident and not from the declaration of such a situation by the INSS.

The Provincial Court of Pontevedra, section 1, in Case 3 septiembre de 2019 and No 465/2019 He resolved in favor of the policyholder in a case on a Supplement Insurance premium payment exemption. The tomadora concluded a seguro de vida and Supplement Insurance premium payment exemption. Incident occurred consistently in the declaration of disability the same. The insurer set as triggering event the time the Disability Assessment Team issued an opinion. But the Court concluded that the time from which should deploy its effects supplementary insurance was in production loss (specifically, detecting a disease) and not when a report was issued by the Administration.

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 7 May 2004, Ms.. Cándida signed with the company MAPFRE VIDA S.A., a policy of seguro de vida an Supplement Insurance premium payment exemption absolute and permanent disability.

The effective date of the policy began on 15 May 2004 and ending on 15 May 2019.

The guaranteed capital was 21.421,45 euros.

The main life insurance guaranteed receipt of benefits for both the case of survival and of death.

For his part, with complementary insurance premium payment exemption for permanent total disability, the policyholder would be exempt from payment of premiums both life insurance and supplementary insurance itself.

In January 2010 Ms.. Candida was diagnosed with breast carcinoma.

Como consecuencia, the 28 January 2010 He was discharged with a diagnosis of "malignant neoplasm female breast".

The 12 November 2010 by resolution of the INSS was declared in situation invalidez permanente the degree of absolute for all work.

Later, the 1 October 2013 he told Mrs.. Candida does not affect any degree of permanent disability for improvement.

Ms.. Cándida filed administrative complaint was estimated by Resolution 12 December 2013. It was recognized in a situation of total permanent disability for usual occupation due to common illnesses.

That decision was appealed to the social jurisdiction.

The 26 January 2015, INSS he recognized, again, Dña. Cándida not involved in any degree of permanent disability. The objective consequences appreciated revealed an impairment practically nil with the possibility of work activities.

The 28 April 2015 the Labor Court No. 1 Pontevedra resolved that Ms.. Candida was still in situation incapacidad permanente absoluta for any profession or trade for common illness.

The INSS appealed the earlier judgment.

Finally, the 14 June 2016 the Social Chamber of the High Court of Galicia confirmed the judgment.

The 3 May 2016, Ms.. Candide asked the insurance company pay compensation. Given the refusal, She filed a complaint.

Primera Instancia

The 12 December 2018 el Juzgado de Primera Instancia nº 1 Lalin gave judgment for estimated the lawsuit against MAPFRE VIDA SA. condemning the plaintiff to reimburse the premiums paid since January 2010 the policy of life insurance and supplemental insurance fee waiver. All with payment of legal and default interest of art. 20 Law of Insurance Contract (LCS).

The Juzgadora instance based its decision on the declaration of permanent total disability derived from breast carcinoma and depressive direct consequence of the disease.

Therefore, from January 2010 (time of diagnosis) was taking place because of exemption from payment of premiums, corresponding, therefore, the return of their amounts.

The fact that Ms.. Cándida not communicate his statement of disability, in order for an exemption from payment by the insurer, fit to understand by ignorance had on the insurance clauses.

Provincial Court

Against the first instance judgment, the insurer defendant appealed, claiming that, under the previous judgment of the Labor Court of Pontevedra, was severe reactive depression which led to the declaration of failure of the plaintiff. Said depression had not been diagnosed until the report of the Mental Health Unit 18 October 2013. And it was in the opinion of the Disability Assessment Team (EVI) of 17 December 2014 when it first appeared diagnosed with a mixed adjustment disorder.

The appellant added that, “in the event that the contingency that the invalidity is derived by common disease (no accident), the rule, the lack of agreement, It is going to rule on mandatory Social Security benefits that sets the triggering event on the date of the opinion of the EVI, except when the consequences appear consolidated with incapacitating nature at an earlier date ". It consisted not is proven that depression had occurred simultaneously with the diagnosis of cancer. Juzgadora itself recognized that instance was severe reactive depression which led to the declaration of absolute inability of the plaintiff. Thus, the sentence should be corrected in the sense that, the triggering event (declaration of absolute permanent disability) It should be understood occurred since the date of the opinion of the EVI (17-12-2014). Exemption from payment of premiums would come from the 17-12-2014 the, in the worst case from the date of the resolution of the INSS he granted the plaintiff an absolute permanent disability (12-11-2010). The insured that the plaintiff had full knowledge of the clauses of insurance. He did not report their situation until October 2015, keeping force, for such conduct, coverage of death which required payment of premiums.

The 3 September 2019, Section 1 of the Provincial Court of Pontevedra delivered its judgment No 465/2019 dismissing Mapfre insurance.

At issue it was the time of operation of the supplementary insurance coverage.

A considered successful respect the decision of the judge "a quo” of placing the claim at the time of disease diagnosis breast carcinoma. This is because this diagnosis was crucial to the subsequent recognition by the INSS a situation degree of permanent disability in absolute for all work. This situation remained disability judgments of the social jurisdictional order of the years 2015 and 2016.

The judgment of the Court of Social Pontevedra and determined that, to the specific effects of the disease, should be added a picture of severe depression. A considered point such as depressive disorders and firming cofactor for the incapacitated.

It should be considered reactive depression emerging from the first moment of awareness by the patient's underlying disease (mother carcinoma).

The control DNA. Andrea, friend of the actress, He noted that this had depression since "the zero". He added that, from the diagnosis, the plaintiff was never able to work; treatment affected him to the heart, I could not walk or breathe.

There were reports provided Unit of the Mental Wave corresponding to the years SERGAS 2010, 2011, 2012 and 2013 They are substantiating the need for therapy from diagnosis by the plaintiff.

Therefore, It hearing considered appropriate place in January 2010 the date of occurrence of the risk being hedged by supplementary insurance for exemption from payment of insurance premiums. This involved the origin of the conviction of the insurance demanded the restitution of the amount of premiums paid by the plaintiff since January 2010.

The return of premiums paid must be for the full amount,   for exemption from payment of premiums guaranteed insurance, without exception of any amount.

Conclusion

The time from which the supplementary insurance premium exemption operates is the Production of the incident, as this is what will trigger the declaration of the situation secured (disability or death).

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