Everyone has contracted some insurance. Be it cars, home, life or about some good. We could define it as the contract “by which the insurer undertakes, by charging a premium and in the event that the event occurs whose risk is covered, to indemnify, within the agreed limits, the damage caused to the insured or to pay a capital, an income or other agreed benefits”, according to the Insurance Contract Law.
But there is a more doubtful issue for clients who come to our law firm specializing in insurance, and it is the distinction between general, particular and limiting conditions.
General conditions and particular conditions
Regarding the composition of the policy, we can distinguish between the general conditions, clauses common to all contracts made with the same insurance company, and the particular conditions, clauses applicable to the specific case – sometimes called specific or special conditions-.
Well, at this point we must warn that sometimes we find ourselves in the General Conditions of the policy with exclusions or restrictions to the covered contingency that greatly affect the right of the insured.
These conditions are called limiting rights and are characterized by restricting, conditioning or modifying the insured’s right to compensation once the risk covered by the insurance has occurred.
In order for them to be valid, they must be expressly accepted in writing by the insured -as required by article 3 of the Insurance Contract Law- and must also be written “clearly and precisely”. Otherwise, they will be deemed not posted and their nullity may be requested.
Finally, it is also important when we talk about the clauses in an insurance contract, to distinguish the limiting clauses that we have just referred to from the risk delimiting clauses. The latter are those through which the object of the contract is specified, establishing which risks, if they occur, give rise to the insured’s right to benefit.
Sometimes it is not an easy task to determine if we are between one or the other, having to go to the jurisprudential casuistry to clarify the issue.
Limiting clauses examples
There are a lot of issues when it comes to insurance that covers water damage. Insurers always try to sweep to your side, and deny compensation or that it is as low as possible. For example: limit water damage only to cases in which the origin is a pipe, and deny if the origin is a tank, a swimming pool, rain or any other reason.
What are obscure clauses of a contract?
These clauses are the ones that limit, condition or prevent a covered guarantee from taking effect for the beneficiary, but the text does not make its intention clear and clear, but rather can be interpreted in different ways. It is an unethical method of insurers, who, as we say, always do everything possible not to pay compensation.
If you have a problem with your insurance entity, and you are waiting to collect any compensation but they are hindering you, contact our law firm, the first visit is free.