aInsurance companies may reject a multi-purpose certificate as evidence of disability, but the final decision on whether the certificate prevails over other means of proof still rests with the courts.
This alert was issued by the consumer support platform DECO PROTETE, which uses as an example the ruling of the Superior Court of Justice (STJ), published in the Diário da República at the end of June, in which it “ruled in favor of the insurance company that rejected the multipurpose certificate as proof of the consumer’s incapacity”.
It was life insurance tied to a mortgage loan. According to the ruling, the insurance policy provided protection in cases of “absolute and permanent disability”, due to illness, “translating into a disability greater than 66.6%”.
The subscriber to this insurance, after suffering from a serious illness, has been evaluated by a medical committee.
This recognizes absolute and final incapacity to work, reaching 76%. Dependence on third parties was also recognized, which was proven by a multi-purpose disability certificate. Therefore, the consumer assumed that she would be entitled to the compensation provided for in the life insurance policy, which would lead to the total consumption of her mortgage.
However, in this case, the insurance company considered that other documents should be submitted, including a report from the treating physician, with the date of the diagnosis that led to the disability, or documents from the Caixa Geral de Aposentações.
The company refused to pay compensation immediately, and requested new expert evidence from the National Institute of Legal Medicine and Forensic Sciences (INMLCF). This concluded that the disease did indeed cause disability, but at a rate of 21.9%, meaning that the insured would no longer be dependent on others.
The case reached Syrians for Truth and Justice, which concluded that “the multi-purpose testimony provides complete evidence of the facts stated therein and proven by the medical board,” as Deco Proteste says, and should therefore be accepted. However, this evidence may open the way for other expert evidence, as happened in this case.
The conclusions reached by the medical committee were obtained “using scientific knowledge” and based on “personal judgments,” as stated in the ruling, with Syrians for Truth and Justice pointing out that these conclusions could be overturned, as they were based on “logical deductive conviction.”
Therefore, since personal and technical judgments are subjective, their weighting against other expert evidence “is subject to the judge’s free assessment,” the platform says.
Exceptions can be called.
Deco Prosti also explains that insurance companies can claim exclusions, as happened in this case, where “the insurance company claimed that there was an inaccuracy in the customer’s initial data, which overlooked the fact that he suffered from a rheumatic disease at the time of joining, which the company denied.” The consumer.
The insurance company was initially ordered to accept the multi-purpose certificate as full evidence of payment of compensation. However, after appeal to the Court of Appeal, the order was eventually granted.
Thus, the judicial interpretation in these cases was unified, as it was decided that it was up to the court to decide, after presenting two pieces of evidence of incapacity, which would prevail.
DECO Prosti also explains that this decision does not conflict with the right to be forgotten, which states that “patients who have recovered or whose disease is under control cannot be discriminated against, for this reason, in contracting credits and life insurance”.
In the event of discrimination in a life insurance contract linked to housing loans, consumers must confront the insurance company, and if the problem persists, a complaint must be filed in the complaints book, or with the Insurance and Pension Funds Supervision Authority.
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