SOS Conso. The insurer must not take back with one hand what it gave with the other – refuse, for example, compensation, even though promised, for a flood, on the grounds that the latter would be attributable to ” negligence on the part of the insured ”. The clauses which provide for exceptions to his contract must therefore, since 1930, to be “Formal and limited”. That is to say, according to case law, “Clear, unambiguous, and not subject to interpretation”.
However, protests the insurance mediator, Arnaud Chneiweiss, in his activity report 2020, made public on August 30, the contracts are still riddled with imprecise exclusion clauses, not in accordance with the’article L. 113-1 of the insurance code, which is said “ shocked “ : ” That can only harm the image “ of his profession, at a time when it is being challenged for his refusal to compensate for operating losses linked to the Covid-19 epidemic.
Mr. Chneiweiss therefore asks that insurers finally ban from their policies fuzzy expressions such as“Failure to observe the rules of the art” where the “Lack of maintenance”, as they did in the past for the ” a good family’s father “.
The Court of Cassation has also toughened its tone. Until now, the vague exclusion clauses contested in the courts were admittedly already invalidated, and deemed unenforceable against the insured, except (as explained by the Court in its 2011 report) if they were attached to lawful provisions. But that changed, on the occasion of the next case.
Imprecise back pain
In June 2010, the CNP refused to compensate a farmer, José-Emmanuel X, victim, after an industrial accident, of lumbosciatica: all the insurance contracts he had taken out, in order to guarantee bank loans, in the event of death or disability, exclude “Low back pain and sciatica”.
The tribunal de grande instance of Narbonne (Aude) proves him right, January 17, 2017, except for a contract, of which he judges that the clause is not “Formal and limited” because it excludes “Disabilities resulting from low back pain, sciatica (…) and other back pain ”. However, the expression “And other back pain”, imprecise, has already earned the CNP the invalidation of one of its contracts by the Court of Cassation on January 18, 2006.
But, observes the Montpellier Court of Appeal, September 18, 2019, the expression is, this time, appended to specific terms. It suffices to delete it, so that the clause becomes “Perfectly clear, formal and limited”, she judges.
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