Life insurance and partial non-payment of premium

impago prima seguro

 

Non-payment of a periodic fee of life insurance,  is not considered only partial but total unpaid

 

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The single premium is indivisible, even if your payment is made in installments.

Ms. Teresa hired a mortgage. Along with this, signed a seguro de vida. Premium life insurance was agreed on two installment payments. Days before the insured event occur, Ms Teresa a document signed revocation the second installment payment of the premium already collected. The document was neither clear nor indicated the consequences of signature. After the death of Ms. Teresa, its rightful heir requested payment of the sum insured. The insurance company refused.

Antecedentes

The 25 July 2013, Ms Teresa entered into a mortgage BANK GROUP THREE BOX with, S.A. At the same time, he was offered a bonus in relation to the interests if subscribed one seguro de vida would cover, in case of death, the outstanding principal of the loan. So, It concluded on the same date, a seguro de vida with IBERCAJA Life Insurance and Reinsurance Company S.A. (IBERCAJA). Risk coverage began that day until 00.00 hours the 25 July 2014.

The insured risk was the death of the policyholder insurance. The insured capital was 58.000 euros. Insurance beneficiaries were the bank Caja Badajoz by the amount of outstanding credit debt up to the limit of the insured capital, by excess capital secured the legal heirs.

For payment of the first premium debit your bank agreed. fractionating the premium agreed on two semiannual payments. For the first payment, the insurance company spent the day of receipt of the subscription contract.

The 28 February 2014 the receipt of the second fractionation was billed spent.

The 3 March 2014 He returned to the charged second receipt secured.

The 30 March 2014 Ms. Teresa died from cancer, whose symptoms appeared after hiring insurance.

D. Jose Manuel, as legal heir of Ms. Teresa, He requested the payment of compensation for the insured risk occur. IBERCAJA refused, alleging fraud and failure of pathologies at the time of completing the health questionnaire and non-payment of raw.

D. José Manuel filed suit against IBERCAJA. He alleged the application of the art. 15.1 The LCS to be a single press, and it not determined as successive raw entity. He said his mother went to the bank to communicate its health and insurance agent decided to return the receipt. IBERCAJA added that did not send a letter to the default tomadora manifestándole. He argued that "even considering that there default, and a successive raw understood, temporarily you should enter insurance coverage until the day 4-4-2014, producing the incident the 03/30/2014 ".

IBERCAJA opposed. He hinted that the insured did not show all their pathologies in the cuestionario de salud, there dolo. And stressed that, in March 2014 Ms Teresa signed document return premium, thus concluding the insurance contract. He said the lack of payment of the first premium and invoked Article. 15.1 LCS. He considered that the application did not correspond to the interests of the art. 20 LCS.

Primera Instancia

The 16 July 2018 the Court of First Instance No. 1 Sant Boi de Llobregat ruled in respect. He estimated demand. and he argued:

“(….) It can not be understood that the insurer did not answer the questionnaire truthfully, thus depriving the defendant to assess risk when arranging the insurance, so in this sense it can not be exonerated from covering the risk befallen”.

As regards the validity of the policy:

... the defendant has, that the time of death the insured the contract was not valid for contract termination, since the receipt of the premium was returned by the express will of Mrs.. Teresa. Account in this regard the defendant commercial entity, Sr. Pedro, that at the beginning of the month of March 2014 (a few days after death), la Sra. Teresa went to the branch to resolve the insurance contract signed (…). To this end brings IBERCAJA (…) a receipt signed by Ms.. Teresa, under the heading entitled <> (…).

(….)

And in this sense You can not be given to the intended document ... decisiveness by default. In the same, even the consequences is clear from a mere contractual resolution, and the effects it generates stipulates that the term of the contract (…) It has to take into account the witness statement of the business of the insurance contract, Mr. Pedro, who knew nothing justify the reasons that led to the insured for wanting to terminate the contract, considering that ... he was only a few days of the insured risk occurs. (…) Namely, there is reasonable cause to explain the need for the mother of the actor to the return of the receipt, once this is passed to payment without any problems. (…) which can make us think, rather, the existence of a move / strategy to avoid paying the insurance company. Is a generic document, without information support any of the contractual specific situation of the client (…) so there can be no probative value such that default will involve the mother of the plaintiff and therefore, the absence of the contract payment to release the defendant.

(….)

no we can not forget the special circumstances in which the policy was signed and the role it played in hiring the bank.

Indeed, as follows documentary (…) depositions and statements (…) the plaintiff did not choose or hire a life insurance, or IBERCAJA as insurance company, but were conditions imposed by the Fund when granting mortgage loans. (…) In summary, we can not attribute negligent behavior in the insured who, at all times, acted on the information provided by the defendant commercial entity from which there can stay proved it was complete, real and effective taking into account the effect generated, and documentary support which is asserted.

– On the other hand the debate on the legal application to the case of the art. 15 LCS and if we are dealing with an insurance contract single premium or regular premiums or successive (…) the application must be concluded first paragraph, determining the total estimated demand for this premium payment at the time of the insured risk happen. It can not be understood that it is an insurance contract with successive bonus payments, which would lead to the suspension of coverage having one month after the second premium was unpaid, and that the defendant would entail it would not be obliged to pay the sum insured. From the examination of the contract is understood car agreed payment of a single premium (…) although fractionated semesters”.

Provincial Court

 The appellant stated in its application that the discrepancy was over the term of the contract. It based its claim on the following arguments:

– He considered that the plaintiff had not proved that the appellant unilaterally carry out the cancellation of the contract. Not that Mrs. Teresa not be voluntary return of the receipt of the premium.

– The existence of an erroneous assessment of the evidence to the relevant circumstances have been omitted. Lack of completeness and consistency in sentencing. He considered that the return of the corresponding charge in the second half was irrefutable proof of the lack of validity of the contract on the date of death of the insured.

– Infringement of arts. 14 and 15 LCS and jurisprudence that interprets. He alleged that there was a lack of payment of the first premium, not the next or successive. And that this supposed lack of validity of the policy.

Infringement of art. 20 LCS.

Hearing determined that "a new assessment of the evidence leads to the conclusions reached by the judging a quo, whose reasoning we own”.

Regarding the return of the receipt of the premium, the Court noted that:

the only possible explanation is that employees of the financial institution ... ensure the interests of his employer, and convince Mrs.. Teresa, with explanations that did not conform to reality, to sign a document with a pre-drafted formula seriously damages their interests. This determines that validity can not be granted a maneuver in which they came into collision harming consumer interests”.

So good, on arts. 14 and 15 LCS, the Court noted the STS 22 October determined that the relative: It is true that Articles 14 and 15 LCS establecen respectivamente, la obligación del tomador del seguro de pagar la prima correspondiente (art. 14 LCS ) y las consecuencias del incumplimiento de dicho deber ( art. 15 LCS ). Es cierto también que la doctrina y la jurisprudencia han considerado que la prima es indivisible, lo cual se deducía ya del art.388C. Trade (…). La indivisibilidad, however, no tiene nada que ver con el pacto sobre el pago a plazos de una prima, cuyo monto total va a cubrir los siniestros acaecidos durante la duración del contrato. En primer lugar debe recordarse que el propio art. 14 LCS dice que el tomador debe pagar la primaen las condiciones estipuladas en el contrato”; thus, the judgment of this Court in 16 September 2004 says “(…) La prima única o periódica puede ser pagada a plazos. Esta posibilidad va en apariencia contra el principio de la indivisibilidad de la prima. However, esto no es así́, pues las partes pueden convenir en el pago a plazos de la prima que se estima única. Los términos convenidos asumen relevancia únicamente como una modalidad accesoria de la prestación, ya que no afectan a la modalidad de la obligación, sino a su cumplimiento. La prestación sigue siendo única con relación al período del seguro, aun cuando la ejecución de la misma se efectúe a plazos que se pagan por el tomador... In any case, el aplazamiento del pago de una parte de la prima no da lugar al aplazamiento de la cobertura, ya que al haberse aceptado por la aseguradora esta modalidad de pago y haberse pagado uno de los plazos, el contrato estaba ya en vigor y había empezado a funcionar la cobertura pactada.”

La Audiencia aludió a la jurisprudencia emanada de las diferentes Audiencias Provinciales al respecto, y citó la sentencia de la AP de Málaga de 12 April 2016, según la que: “the second paragraph of Article 15 LCS que se refiere al impago de una prima sucesiva es decir no correspondiente a la primera anualidad y como quiera que la cobertura y la prima son indivisibles ha de entenderse que habiéndose pagado una fracción de la misma, tampoco resulta en puridad aplicable el apartado primero que contempla el impago de la prima única o de la primera anualidad de forma íntegra”.

Se consideraría un pago parcial de la prima, y no un impago. Al considerarse la prima como única, el pago de parte de ella hace que comience a contar el período establecido en la póliza.

Respecto de la aplicación del arts. 20 LCS, la Audiencia determinó que lo determinante era si el asegurador había incurrido en mora. He cited the STS 5 April 2016 que aludía a la Sentencia 743/2012 of 4 December: “Si bien de acuerdo con lo dispuesto en el artículo 20.8º LCS , the existence of cause implies the absence of fault or delay attributable to the insurer, and exempt from the surcharge consisting default interest, in appreciation of this exemption because this Court has maintained a restrictive interpretation in response to the punitive nature which may be attributed to the effect of the rule preventing that process is used as an excuse to hinder or delay payments to injured. (…) This interpretation rule that the mere existence of a process, the mere fact constitute go to the same cause to justify the delay itself, or may be presumed reasonableness of the opposition. The process is not an obstacle to impose on the insurer's interests unless you appreciate a real need to resort to litigation to resolve a reasonable doubt or uncertainty about the birth of the same obligation to indemnify. (…) En todo caso… viene siendo criterio constante en la jurisprudencia no considerar causa justificada para no pagar el hecho de acudir a proceso para dilucidar la discrepancia suscitada por las partes….”.

Therefore, la Audiencia desestimó íntegramente el recurso. Con imposición de costas a la recurrente.

Conclusion

Las primas de los contratos se seguro, son indivisibles. So good, la prima puede ser única o periódica pero esta posibilidad de pago no afecta al principio de indivisibilidad de la prima. En las primas periódicas, el impago de una cuota es un impago parcial y no un impago total de la prima.

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