Variations in health status and life insurance

abogado seguro vida

Seguro de vida: Should I communicate the variations in my health status to the insurer?

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Set the second paragraph of the article 11 Law of Insurance Contracts that:

“In personal insurance, the policyholder or the insured is not obliged to communicate the variation in circumstances related to the health status of the insured, that in no case will they be considered an aggravation of risk. "

 In this post we review a case in which the insurer claimed that it had not been informed of the variations in the health status of the insured.

The 1st Section of the Provincial Court of Pontevedra issued a ruling on 13 July 2020, with No Resolution 410/2020, dismissing the appeal filed by ABANCA VIDA Y PENSIONES DE SEGUROS Y REINSUROS, S.A. (onwards, ABANCA). 

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. Ignacio contracted a policy with ABANCA in 2007 life insurance and absolute and permanent disability. In 2012 a modification of said policy was signed regarding the amount insured and the premium to be paid by the insured.

Later, D. Ignacio was declared a permanent absolute disability after being diagnosed with psychotic symptoms. ABANCA refused to pay the insured amount after the loss occurred, because he considered that in 2012 hid that in 2009 suffered from an anxiety disorder that kept him off work 40 days.

D. Ignacio filed a lawsuit against ABANCA.

Primera Instancia

The Court of First Instance No. 4 of Pontevedra issued sentence on 3 December 2019, estimating the lawsuit filed by D. Ignacio, condemning ABANCA to pay the insured the capital contracted, in addition to interest and costs.

The Court considered that, although D. Ignacio did not declare the anxiety disorder suffered in the year 2009 when answering the health questionnaire in the new contract signed in February 2012, said omission did not involve a violation of art. 10 LCS. The background of the year 2009 they were not serious, and it was only a single episode of sick leave due to anxiety. Also, permanent disability did not derive from this anxiety picture, but from another ailment, therefore, there was no causal relationship between anxiety and the pathologies that led to the declaration of absolute permanent disability.

Provincial Court

ABANCA filed an appeal, claiming that D. Ignacio, in 2012, hidden, maliciously or grossly at fault, the anxiety picture suffered in 2009, violating art. 10 LCS.

For his part, D. Ignacio challenged the judgment handed down in the first instance because he considered that what he signed in 2009 and 2012 they were not two different contracts, but in the 2012 an insurance modification was signed. The first insurance policy was signed in 2007. Then, did not intentionally or grossly negligent conceal any illness when filling in the health questionnaire, because the anxiety picture occurred in 2009.

He considered the Chamber, by varying, only, between the contract of 2007 and the 2012, the amount of the insured capital and the first to be paid, they were facing the same contract. So that two different contracts could be considered, doctrine has established that "So that the extinction occurs and the substitution is fully repeal, necessary, or an express repeal clause, or an objective incompatibility or contradiction between both regulations or systems of organization of interests. " In this case, there was no extinction of the old obligation, namely, of the policy contracted in 2007.

The Chamber took into account the contract signed in 2007. As duties and charges derived from that policy, the obligation to communicate the aggravation of the risk was included, as established in the arts. 11 and 12 LCS. However, Article. 11.2 stated that “In personal insurance, the policyholder or the insured is not obliged to communicate the variation in circumstances related to the health status of the insured, that in no case will they be considered an aggravation of risk. "

Therefore, D. Ignacio did not miss his duty to testify about the circumstances related to the risk after the questionnaire he was submitted to when he contracted the policy, namely, in 2007, as there was no obligation to communicate changes in their health status, as they were not considered as an aggravation of risk, but the realization of the covered risk.

For all the above, The Chamber rejected the appeal filed by ABANCA.

Conclusion

If you bought life insurance, and later, you are diagnosed with a disease, the second paragraph of the article 11 exempts you from the obligation to notify the insurance company of the change in your health status.

 

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