Cases related to insurance contracts
PrintSETTLEMENT AGREEMENT: payment of insurance benefit in the event of accidental death
The petitioner and the financial service provider concluded a settlement agreement at the hearing, agreeing that in addition to the insurance benefit already paid in the claim settlement procedure, the financial service provider will pay further HUF 11 million.
In the proceedings launched at the Board, the petitioner requested the financial service provider to pay the insurance benefit applicable to accidental death. The petitioner and the financial service provider concordantly stated that the insured had taken out four bank card accident insurance contracts. The insured died in an accident, after which the beneficiary applied for the payment of the sum insured for the event of accidental death. The financial service provider paid the benefit partially; however, in the case of two contracts it refused to pay the sum insured for the event of accidental death, arguing that although according to the bank card accident insurance contract it is permitted to take out several insurances for the same insured, the total insurance benefit paid on the basis of all contracts concluded with the insurer must not exceed the defined maximum amount. The petitioner filed a complaint through his legal representative, arguing that based on the Civil Code no over-insurance applies in the case of accident insurance hence the relevant clause of the insurance contract is contrary to the law.
In his petition submitted to the Board he repeatedly referred to the infringing nature of the contractual clause. In its response, the financial service provider continued to refuse to pay the insurance benefit, it proposed no settlement, but – upon a call – it sent the general contractual terms of the four accident insurance contracts. Having reviewed the general contractual terms, it could be established that the contract concluded first did not yet include the maximum rule it was stipulated only in the contractual terms belonging to the three contracts concluded later. This meant that in the first contract the parties had not agreed in an insurance benefit cap. Based on the attached general contractual terms, the Board also noticed and established that the disputed contractual clause is a provision that departs from the provision applied between the parties earlier, and as such, based on Section 205/B (2) of the old Civil Code, it becomes part of the contract only if the other party has expressly accepted it after a separate notice to this effect. The documents of the contracts concluded later did not contain any evidence that the financial service provider had called the contracting party's attention to the departure from the previously applied contractual provision and that the different provision had been expressly accepted. After this the parties consulted and the financial service provider undertook to pay the formerly unpaid amount, thus the parties concluded a settlement agreement.
SETTLEMENT AGREEMENT: life insurance contract
The petitioner submitted a petition based on his life insurance contract to resolve a dispute related to his claim to pay the difference between the value at maturity and the amount paid by him. He stated that he had concluded a 10-year mixed life insurance contract with the financial service provider. He disagreed with the amount of the contract value at maturity he found the operating costs too high and complained of the fact that despite the high yield shown in the annual notification, he did not even get back the amount paid by him. In its response the financial service provider stated that in the disputed life insurance it undertook for the event of the termination of the life insurance contract by maturity that it would pay the current value of the fund prevailing on the maturity date. During the term of the insurance it operated and kept records of the dedicated fund and bore the risk. The current value of the fund on the maturity date was identical with the amount paid and complied with the contractual terms in every respect. The calculation of the current sum insured on the maturity date and the amount to be paid is performed in accordance with the General Regulation on the Insurance of Persons.
The parties concluded an agreement. It turned out from the documents that the content of the proposal possessed by the petitioner and that of the proposal sent by the financial service provider as annex to the response differed. The life insurance needs analysis questionnaire contained corrections compared to the original one. The financial service provider asked for the postponement of the hearing to clarify the difference. During the continued hearing it declared that it was unable to clarify the difference in the documents, and in view of this it would pay the disputed amount based on the settlement agreement.
SETTLEMENT AGREEMENT: unit-linked life insurance contract
There was a unit-linked life insurance contract in place between the petitioner and the financial service provider. Upon the surrender of the contract the petitioner noticed that the insurer deducted costs in a high amount. The petitioner applied for the reimbursement of the costs, the deduction of which he deemed illegitimate. The service provider, maintaining its opinion that it acted in accordance with the contract when deducted the costs, revised its position, considering all circumstances of the case and the high ratio of the deductions compared to the deposits, and within the framework of a settlement agreement it paid more than half of the amount claimed by the petitioner, in excess of a half-million forints.
SETTLEMENT AGREEMENT: unit-linked life insurance contract
Based on a unit-linked life insurance contract made between the petitioner and the financial service provider, the petitioner placed the investment units, for a certain period, in the Hungarian Equity Asset Fund. Later on he found that the yield of the asset fund substantially fell short of the performance of the BUX index, specified as the benchmark index for the fund. He asked for the reimbursement of the calculated difference. Based on the Board's guidance the financial service provider recalculated the value of the investment units placed in the asset fund and found that the argument of the petitioner was grounded. With a view to closing the dispute definitively, within the framework of a settlement agreement it paid the whole difference calculated by the petitioner, in an amount exceeding a half-million forints.
BINDING RESOLUTION: payment of insurance indemnity related to health insurance
The petitioner had an individual health insurance contract, based on which he applied to the service provider for the payment of daily hospitalisation fees. The financial service provider, referring to the exclusions stipulated in the contract between the parties, refused to pay. The member acting in the case obliged the service provider to pay the daily hospitalisation fees to the petitioner based on the insurance contract concluded between the parties, as it erroneously ordered the application of the exclusions. The service provider complied with the binding resolution.
RECOMMENDATION: expiry of motor third party liability insurance
The petitioner had a motor third party liability insurance (MTPL) and in his petition he claimed that despite the fact that he did not conclude a new insurance with the service provider, it issued a new policy with higher premiums, thus the premiums paid on his former insurance did not cover the new insurance premiums and because of this the service provider terminated his MTPL insurance due to premium non-payment. The financial service provider declared that it made a new insurance proposal and issued the new insurance policy based on that, at the same time cancelling the previous insurance in view of the prohibition of double insurance.
The member acting in the case established that the service provider cancelled the previous MTPL illegitimately therefore he proposed that the premiums paid should be booked on the previous insurance and the new MTPL should be cancelled. He explained that based on the effective MTPL Act, the contract may be terminated in two ways, i.e. termination by the insured in writing or by the parties' common consent. The service provider was unable to confirm that the petitioner had terminated his previous contract in writing; instead, it had cancelled it, interpreting the proposal for the new contract as implied acceptance; in addition, it was also unable to prove the termination of the contract by common consent. The acting member took the position, based on the effective MTPL contract, that the previous insurance contract was cancelled illegitimately, hence in the recommendation he argued for the restoration of the original legal relationship.
RESOLUTION TO TERMINATE: reimbursement of cost based on travel insurance contract
The petitioner heir applied for the reimbursement of the cost of the return of mortal remains based on a travel insurance contract. According to his position, based on the applicable insurance terms and conditions, the financial service provider is obliged to pay the claimed amount. He disputed that the conditions specified by the financial service provider were applicable to the given case. His sister had a travel insurance related to bank card insurance. The insured died; the cause of death was circulatory collapse caused by drug use.
In its response the financial service provider declared that pursuant to the provisions of the General Contractual Terms, in view of the exclusion causes regulated in respect of the return of mortal remains, it was not possible to reimburse the costs of the return of the deceased's mortal remains. It presented the “Customer Information and Contractual Terms” applicable to the group insurance related to foreign and domestic travel of bankcard holders, based on which the circulatory collapse caused be the consumption of large doses of drugs, tranquillisers and alcoholic beverages does not qualify as accident, thus the return of the mortal remains cannot qualify as an insured event either. The parties conducted detailed consultations at the hearing, and the petitioner accepted the position of the financial service provider and withdrew his petition.