Recently, the Supreme Court has ruled stating that the omission of diseases in the health questionnaire will only release the insurer from its obligation to pay compensation in cases in which intent or gross negligence of the insured is detected, in accordance with the provisions in art. 10 of the Insurance Contract Law.
Specifically, through its Sentence no. 235/2021 of April 29 indicates the requirements that must be met for the application of the aforementioned precept: “1) That a relevant piece of information has been omitted or incorrectly communicated; 2) that said data had been required by the insurer through the corresponding questionnaire and in a clear and express manner; 3) that the declared risk is different from the real one; 4) that the data omitted or inaccurately communicated was known or should have been known with a minimum of diligence by the applicant at the time of making the declaration; 5) that the data is unknown to the insurer at that very moment; and 6) that there is a causal relationship between the omitted circumstance and the covered risk.”
Likewise, it insists that the insurer must assume the consequences of an incomplete, generic or ambiguous questionnaire, and the questions must be examined to ascertain whether the insured intentionally concealed or withheld relevant data for the exact assessment of the risk, or simply omitted it. without being aware of the relevance of it, because the questionnaire was not well formulated.
At Albos Law we carefully analyze the subscribed policies, as well as the questionnaires carried out, in order to accurately determine if we are in a case in which the application of art. 10 of the Insurance Contract Law and, therefore, viable for judicial claim.
Link to the Judgment: https://app.vlex.com/#vid/866677314