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.
If you wish to claim against an insurance company in Spain, or against a refusal to pay for a life insurance policy, contact us or visit our court services.
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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
White & Baos 2021 – All Rights Reserved.
2 thoughts on “Claim against Insurer in Spain. Refusal to pay out on life insurance policy. Pre-existing diseases.”
Dear Sirs, your information was interesting, however my query regards the cancellation of an insurance connected to a mortgage , which was cancelled regardless of the fact the mortgage still had another 10 years to run.
My husband and I had a mortgage which was cancelled when he turned 70 ( a fact we were not informed of. ) Our bank insisted on our taking the policy the time which was for the value of the mortgage .
The year my husband turned 71 no payment was taken for the insurance which we paid annually. I contacted the bank by email ( at the time we were living outside spain) and visited thr next time we were here, asking why the payment had not been taken. I was told the policy had finished because my husband was over 70. I expressed my concern that the mortgage was still in effect for sometime to come and I would prefer to continue the policy as it was supposed to cover any outstanding balance in the event of his death. I was repeatedly ignored. I requested several times a copy of my policy, of which I had never received a full copy. I was told everything was in Madrid and it would take time to obtain a copy. Many requests were made, a single sheet was eventually given but not a complete policy.
Unfortunately 5 months after the cancellation of the policy my husband suddenly passed away following complications from an operation.
The bank refused to cover any remaining mortgage, the remainder I am continuing to pay. I
cannot believe a bank can operate I this way, to take money for years and cancel with no recompense from the policy whatever. I feel we were sold this NECCESSARY insurance under false pretences. I would really appreciate your views. I am sure this is not acceptable under EU law.
Thank you for your message.
It is essential to check the wording of the policy agreed ( general and particulars terms ). In order to identify if that clause existed or not, how was worded, etc.
Also, it could be relevant to check the information provided by the insurer or the bank on the insurer behalf; before signing the policy, to check if that was transparent.
If you want, you could contact to our email firstname.lastname@example.org