We are expert lawyers in Claims against insurance companies for breach of contractual obligations
Our scope of action in the field of claims against insurance companies for breach of the obligations contained in insurance policies covers all risks that may affect the existence, bodily integrity or health of the insured, that is, all person insurance contracts. It is also object of our intervention, controversies derived from claims covered by a multi-risk policy for home or business, in case of flood, fire, robbery, theft, civil liability...
Failure to comply with the obligations contracted by insurance companies after the subscription of person insurance policies is frequent, proceeding to the refusal to cover a claim included in the policy or to its insufficient compensation.
The types of personal insurance are:
- Life insurance: It is that insurance contract in which the provision consists of the payment of an amount to the insured or a beneficiary, one or more times, when occurs an event that refers to the duration of human life. It is jurisprudential doctrine, regarding the duty to declare the risk by the policyholder before the conclusion of the contract, in interpretation of art. 10 LCS, that what frees the insurer is the intent or gross negligence of the insured, not the mere inaccuracy in her answers.
- Accident insurance: It is the one that undoubtedly generates more litigation. It covers a bodily injury that derives from a violent, sudden, external cause beyond the intention of the insured, which produces temporary or permanent disability or death. The insurer guarantees the payment of the compensation contained in the policy conditions when the insured suffers a bodily accident, usually both in the exercise of his profession and in his private life, which causes immediately or within a term permanent disability or death. However, is usual that limiting clauses of the insured's rights are introduced in general conditions of the policy, with the purpose to determine the compensation for permanent disability through a percentage of the guaranteed capital based on the degree of permanent disability and aftermath suffered by the insured, contrary to the particular conditions, in which only a fixed figure appears as the amount of compensation for such concept. This way to proceed would require compliance with the requirements of art. 3 LCS.
- Health insurance: It is that insurance in which the insurer undertakes, in the case of more or less serious alteration of health, to pay certain amounts and the price of medical or pharmaceutical expenses derived from the assistance provided to the insured by third parties (unrelated to the insurer).
- Health care insurance: It is the insurance by which the insurer undertakes to provide "directly" medical, surgical and hospital care services, either through its own medical centers and medical staff, or through professional third parties arranged by means of a service lease contract. It is important to point out that, in the event that medical negligence derives from the provision of this health care, the insurance companies may be directly held liable.
- Death insurance: The insurer will be obliged to provide the funeral services agreed upon the policy in the event of insured death. The excess of the insured sum over the cost of the service provided by the insurer will correspond to the policyholder or, failing that, to his heirs. In the event of concurring death insurance policies, the insurer that has not been able to fulfill its obligation to provide the funeral service under the terms and conditions provided in the contract, will be obliged to pay the insured sum to the heirs of the deceased insured. In the event that the insurer has not been able to afford the provision due to causes beyond its control, force majeure or because the service has been performed through other means than those offered by the insurer, the insurer will be obliged to pay the insured sum to deceased insured heirs. In the event of concurring death insurance policies, the insurer will be obliged to return premiums paid for the policy that policyholder has decided to cancel since the occurrence occurred.
With regard to multi-risk home or business insurance, it is usual to contract legal defense coverage to proceed both with the defense and claim of damages against third parties. It is important to know that, if you have suffered a loss, the defense regarding damages caused to third parties is reserved to the legal services of your company, but, as an insurance policyholder, you have the power to freely designate a lawyer in which you trust to defend your interests.
