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According to established case law, where an insurer relies on the insured\u2019s failure to perform a contractual obligation to refuse payment, the obligation must be of a kind that links its breach causally to the insured event, the extent of the loss or the ability to establish that loss. This also applies where the policy or general terms treat particular conduct as a ground for releasing the insurer from liability, including by defining it as an excluded risk, because the conduct could cause the event, increase the loss or impede proof. In Judgment No. 207 of 13 January 2017 in commercial case No. 3394\/2015, the Supreme Court of Cassation held that in such cases the insurer\u2019s right to refuse payment depends on proof of a causal link between the insured\u2019s conduct and the event, the extent of the loss or the ability to establish it. The judgment also addressed the test of materiality under Article 211, point 2 of the repealed Insurance Code. Its approach is consistent with Supreme Court of Cassation Judgments No. 102 of 2 October 2012 in commercial case No. 615\/2011; No. 185 of 5 March 2014 in commercial case No. 350\/2012; No. 15 of 12 April 2012 in commercial case No. 454\/2011; and No. 49 of 29 July 2013 in commercial case No. 840\/2012. Under those decisions, materiality must be assessed on the facts of each case.<\/p>\n
Both under the general rule in Article 408 of the Insurance Code and in the other excluded-risk cases discussed here, an insurer refusing payment must establish the particular facts on which the refusal is based and their causal connection with the loss. This also follows from the statutory requirements for the content of insurance contracts and their general terms in Section IV of the Code, Articles 362 et seq.<\/p>\n
If you have been involved in a road accident or an insurer has refused payment for an insured event, an experienced insurance lawyer can assess the options in your case.
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