THERE are many enquiries that come to our law firm, regarding the refusal to pay for a life insurance policy. Refusals, obstacles, and delays, are used by some of the insurance companies in Spain.
Delays and obstacles
It is very common, that insurance companies delay the procedures. Sometimes they don’t directly refuse payment, but they use all kinds of techniques to delay such as excessive and unnecessary documentation requested; delays in responding to emails, etc.
Previous or pre-existing diseases
One of the most common excuses is the lack of information about a previous illness. Thus, insurers sometimes claim that the insured did not report their pre-existing illnesses correctly and this therefore, meant that the insurer was unable to estimate the actual risk covered.
Often, they suggest therefore, that in the health questionnaire completed when applying for such insurance, the entire truth was not revealed or that important data related to illnesses prior to signing the policy was hidden.
The health questionnaire
If you are going to claim compensation for a death, it is essential that you;
- Review the general and particular conditions of the policy.
- Review the health questionnaire, which normally should have been requested by the insurer or broker.
It should be noted that sometimes, the health questionnaire is deficient. Sometimes it is very general, ambiguous, incomplete, etc. and there are even cases where the declaration has already been completed by the insurer.
Refusal to pay out on life insurance
Thus, in case of refusal to pay out on life insurance policy, claiming this is because of an undeclared pre-existing disease; it is important to verify if is a health questionnaire was supplied and if it was correctly completed.
If such did not exist or was insufficient, the insurer could not claim the existence of a previous undeclared disease as an excuse for not paying.
Cause of death
It is not always the case that a previous, undeclared illness may prevent the insurer from paying the agreed compensation. Incorrectness or inaccuracy of the health questionnaire is not enough. The undeclared illness must be the cause of death.
The recent ruling of the Provincial Court of Jaen, of 16/04/2020 amongst others is relevant as although it recognised that a chronic illness was not mentioned by the policyholder it observed that
- The omitted disease must have a causal relationship with the death.
- Death must be the consequence of a pre-existing disease or illness, knowingly undeclared.
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The information provided in this article is not intended to be legal advice, it merely conveys information related to legal issues.
Carlos Baos (Lawyer)
White & Baos.
Tel: +34 966 426 185
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