Order No. 19071 of 2024: The Burden of Proof in Insurance Claims Reporting

The ruling of the Court of Cassation No. 19071, issued on July 11, 2024, offers an important reflection on the issue of claims reporting in the field of insurance. The decision focuses on the insured's obligation to promptly notify the insurer of the claim and the consequences related to non-compliance with this obligation.

The Regulatory Context

According to Article 1913 of the Civil Code, the insured has the obligation to notify the insurer of the claim. However, non-compliance with this obligation can have different consequences depending on the nature of the violation, which can be fraudulent or negligent. In fact, if the non-compliance is fraudulent, the insured loses the right to compensation, as established by Article 1915, paragraph 1. In the case of negligence, on the other hand, the insurer may reduce the compensation in proportion to the damage suffered, as provided by Article 1915, paragraph 2.

The Maxim of the Ruling

OF THE INSURER Obligation - Non-compliance - Fraudulent and negligent nature - Consequences - Burden of proof on the insurer - Content - Case. For the insured to be considered in breach of the obligation imposed by Article 1913 of the Civil Code to notify the insurer of the claim, it must be ascertained whether the non-compliance has a fraudulent or negligent nature, given that, while in the first case the insured loses the right to compensation under Article 1915, paragraph 1, of the Civil Code, in the second case the insurer has the right to reduce the compensation in relation to the damage suffered, pursuant to Article 1915, paragraph 2, of the Civil Code; in both cases, the burden of proof lies with the insurer, who is required to demonstrate, in the first case, the fraudulent intent of the insured, and in the second, that the insured voluntarily failed to fulfill the obligation and the damage suffered. (In this case, the Supreme Court overturned the merits ruling that denied the right to compensation due to the late reporting of the claim without providing reasons regarding the attribution of the delay to the fraud or negligence of the insured).

Practical Implications of the Ruling

This order, therefore, clarifies the importance of the burden of proof on the insurer. In particular, the insurer must demonstrate:

  • That the non-compliance with the obligation to report by the insured was fraudulent, meaning there was fraudulent intent;
  • That the non-compliance was negligent, meaning the insured voluntarily failed to fulfill the obligation and that this caused damage to the insurer.

This distinction is fundamental, as it determines the possibility for the insured to receive compensation or to see it reduced. The Court, in this specific case, overturned a merits ruling that had not adequately assessed these aspects, emphasizing the importance of a thorough analysis of the claim situation.

Conclusions

In summary, ruling No. 19071 of 2024 represents an important step forward in the protection of the rights of the insured, drawing attention to the burden of proof on the insurer. It is essential that insurance companies carefully evaluate the causes of any delays in reporting claims so that the rights of the insured are always respected and adequately protected.

Bianucci Law Firm