Европейски портал за електронно правосъдие

Данни за случая
- Национален идентификатор: Supreme Court of Cassation, Judgement 60063/2021
- Държава-членка: България
- Общоприето наименование:N/A
- Вид решение: Решение на върховния съд
- Дата на решението: 30/06/2021
- Съд: Върховен касационен съд
- Заглавие:
- Ищец:
- Ответник:
- Ключови думи: unfair terms, insurance contract

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Членове от директивата

Unfair Contract Terms Directive, Article 3 Unfair Contract Terms Directive, ANNEX I, 1., (f)
Уводна бележка

A clause in a life insurance contract concluded with a consumer in which the circumstances excluding the insurer's liability in case of death or incapacity for work are formulated in general and upon concluding the contract no questions were asked under Art. 362 of the Insurance Code is null and void.
Факти

Two credit agreements have been concluded between a consumer and a bank. To insure the risk of default on loans, life insurance policies have been concluded with the beneficiary bank. The consumer dies from complications of heart failure and diabetes, diseases he had before concluding credit agreements. The insurer refuses to pay compensation, claiming that this risk is not included in the scope of insurance contracts. As an argument, he refers to a clause that is identical in both insurance contracts and reads as follows:

Any death caused or resulting directly or indirectly, in whole or in part, from any of the following factors is not covered by this policy: any illness and incapacity / which the insured client knew of or was diagnosed or for which the insured client has been treated or for which he has received medicine before the date of entry into force of the individual insurance or before the date of reimbursement of the insurance coverage, in case of cancellation in case of non-payment ”.

The borrower's daughter, who is his heir, is suing the insurer to pay the insurance indemnity under the two insurance contracts of the creditor bank.
Правен въпрос

Is a clause in an insurance contract unfair within the meaning of Art. 143, para. 2, item 6 of the Consumer Protection Act / Directive 1993/13, Art. 3, Annex, P. 1 (f) /, in which the circumstances relevant to the covered risks "Death" and "Incapacity for work" are formulated in general and in the hypothesis of lack of questions under Art. 362 of the Insurance Code?
Решение

The court considers the clause cited above to be null and void due to a contradiction with Art. 143, para. 2, item 6 of the Consumer Protection Act / Directive 1993/13, Art. 3, Annex, P. 1 (f) /. In order to accept this, the court takes into account the special provisions in the Insurance Code, which require the insurer to gather information about significant circumstances through questions about the health status of the insured before taking out personal insurance. The insurer did not ask such questions in the specific case. The Supreme Court considers that it is not permissible for the insurer to include in the contract a general wording clause instead of asking purposeful questions, which would exclude the insurance risks with regard to general and broadly formulated circumstances. The court considers that the assessment of the health status of the insured can be based only on information collected under the provisions of Art. 362 of the Insurance Code order / through questions /. Next, the court notes that the general way in which the clause is worded allows it to be applied to any cause of death, as the words "indirectly" and "partly" are unclear criteria.

URL: http://www.vks.bg/pregled-akt?type=ot-spisak&id=C2294241D50324F6C225870400465318

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Резултат

The Supreme Court of Cassation overturns the decision of the Stara Zagora Regional Court that had rejected the consumer's claim, declares the clause null and void and upholds the consumer's claim for payment of insurance indemnity.

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