2012R038
Cargado por
Jhony Lewis QFTemas abordados
- responsabilidad por trabajos t…,
- cobertura,
- responsabilidad extracontractu…,
- carga de la prueba,
- aseguradora,
- derecho a recurrir,
- daños por productos,
- reclamación por incumplimiento,
- documentación requerida,
- jurisdicción
2012R038
Cargado por
Jhony Lewis QFTemas abordados
- responsabilidad por trabajos t…,
- cobertura,
- responsabilidad extracontractu…,
- carga de la prueba,
- aseguradora,
- derecho a recurrir,
- daños por productos,
- reclamación por incumplimiento,
- documentación requerida,
- jurisdicción
Common questions
Con tecnología de IAThe insurer justifies the rejection of the claim by arguing that the incident falls under the exclusions outlined in the insurance policy. Specifically, the incident is said to fall under an exclusion for damages caused by products that have left the control or custody of the insured, as per numeral 3.6 of the policy. The vehicle, which had an installed LPG conversion kit, faced an incident when it was no longer under the control of the insured's workshop, as it had been delivered to the client on December 7, 2011, and the incident occurred on December 8, 2011, in Colán . Furthermore, the insurer claims no coverage exists under Article II for a contractual liability exceeding an extra-contractual responsibility .
The DEFASEG's conclusion reflects an adherence to the regulatory standards that favor a strict interpretation of policy contracts, demonstrating a regulatory balance that prioritizes contractual clarity and explicit terms over interpretative leeway that might benefit either party. This conclusion underscores the importance of pre-defined coverage specifics and the need for special clauses to extend coverage beyond explicitly laid out exclusions, emphasizing the careful calibration of rights and obligations within insured-insurer relationships under legal and contractual frameworks .
DEFASEG underscores that its decision-making is based on coherent review of available documentation and lawful adherence to regulatory principles, stressing the contractual nature of insurance which necessitates strict adherence to its terms. It follows evidentiary rules stipulated in Article 196 of the Code of Civil Procedure, indicating the obligation of the party presenting an assertion or contradicting an assertion to provide proof, effectively placing the burden on claimants to substantiate their claims against the policy's stipulated coverage terms and conditions .
The Resolution concludes the claim is 'unfounded' based on the determination that the incident qualified as an exclusion under the insurance policy. It highlights that the physical custody or control of the insured's property is necessary for coverage, which was not the case at the time of the incident, as the vehicle was already returned to the client. Thus, without a specific coverage for completed and delivered works, the existing policy terms do not apply, leaving no legal grounds within the policy to support the claim under numeral 3.6 for the event that transpired .
The insured party contends that the policy should inherently cover responsibilities arising from completed and delivered works, arguing that such coverage should not require a special clause as it is not explicitly excluded in the general or specific conditions of the policy. Conversely, the insurer maintains that the policy specifically excludes coverage for damages from products outside of the insured’s custody or control, citing the need for an additional clause to cover completed and delivered works, thereby rejecting coverage based on the existing exclusions in numeral 3.6 .
The claimant argues that the policy covers operational work and asserts that the incident should fall under the coverage of works completed and delivered since there is no explicit exclusion listed for such responsibilities in the policy's general or particular conditions. The claimant insisted that the installation work should be considered as operational tasks whose responsibility is included in the policy, arguing further that exclusion clauses concerning civil responsibility of completed and delivered works were not applicable in this context .
The installation involved equipping a vehicle with a sequential kit, tank, and multivalves to convert it from gasoline to LPG, which the insured completed between December 5 and 7, 2011. The insured's work was deemed complete when the vehicle was returned to the customer on December 7, 2011. The incident occurred on December 8, 2011, when the car caught fire and was no longer under the control of the insured, thus meeting the criteria for exclusion as specified by the policy's terms that do not cover damages once the work had been completed and delivered .
DEFASEG's role is to resolve disputes based on the documentation filed and the legal rights conferred by the regulatory framework. It acts to verify whether claims are founded through adherence to the existing laws and policy conditions. However, its limitations arise from having to adhere strictly to the policy terms and legal doctrines without being able to reinterpret policy content outside the agreed exclusions, meaning its resolutions are bound by what is legally and explicitly defined within the existing contractual framework .
The legal framework, including regulatory articles from the Civil and Commercial Codes, mandates that insurance contracts are interpreted based on the express intentions declared by the parties, with ambiguity resolved according to common legal standards unless explicitly contradicted with proof. The policy exclusions, as a result, are enforced based on their literal presence and interpretation as stipulated by both parties, limiting claims strictly to conditions not expressly excluded, as seen in the reliance on article-specific references like article 1361 and article 380 to justify the decision-making outcome .
The Defensoría references several legal principles, including the obligatory nature of contracts as per the common intent of the parties outlined in Article 1361 of the Civil Code, emphasizing that terms not agreed upon need to be proven by the denying party. Furthermore, it cites Article 380 of the Commercial Code, which mandates the adherence to the coverage terms stipulated within the insurance policy and highlights that the burden of proof, as per Article 196 of the Code of Civil Procedure, lies with the party who alleges a fact or contradicts it by presenting new facts .
