La descripción de la actividad en el seguro. La regla de equidad.
Cuando contratas un seguro es muy importante dejar claro en la póliza cuales son los riesgos de tu actividad, ya que una falta o errónea información por parte del asegurado podría suponer que la aseguradora se negara a pagar una indemnización en caso de siniestro.
Tengo una empresa que nos dedicamos a triturar papel para reciclarlo. Resulta que se nos incendió la fábrica y el seguro no nos quería pagar los más de 400.000 € de existencias afectadas por el fuego ya que en nuestro contrato, la actividad venía descrita como “empresa dedicada a la trituración de papel para su reciclaje”. Resulta que en la descripción no ponía que almacenábamos papel, y por eso el seguro nos excluía las existencias.
El seguro argumentaba que, al no estar explícitamente descrito que también almacenábamos papel, no nos pagaban las existencias quemadas. ¿Cómo quiere el seguro que me dedique a una actividad fabril productiva sin acopiar existencias? ¡Es de locos! Ya se sabe implícitamente que cualquier actividad de fabricación, transformación, montaje, distribución, venta al por mayor o al detalle de bienes debes almacenar mercancías forzosamente. Las únicas empresas que no almacenan mercancías son las de servicios, como pueden ser bufetes de abogados, centros médicos, empresas de ingeniería, etcétera. ¿Cómo podían buscarse esta excusa para no pagar?
Contacté con ClaimCenter y, después de muchas discusiones y tras 7 años de litigios, el juez sentenció a la compañía a que me pagaran 828.000 €, de los cuales 400.000 € correspondían a la indemnización de mis mercancías y 428.000 € más en concepto de intereses. Además condenaron al seguro en pagar las costas del juicio, que significa que debieron pagar a mis peritos y mis abogados. ¿Por qué sucedió todo esto?
La contratación del seguro
Los artículos 10 y 11 de la Ley 50/80 de Contrato de Seguro (LCS) establecen que el tomador (el asegurado) del seguro debe contestar fielmente al cuestionario a que el asegurador le someta para que pueda valorar el riesgo, y en su caso, qué riesgos decide asegurar. Este cuestionario sirve para concretar lo que se asegura y del que resultarán las Cláusulas Delimitativas.
Los tomadores/asegurados sólo debemos contestar aquello que nos preguntan. Nada más. Este aspecto es fundamental y obvio para que el asegurador pueda aceptar y cubrir correctamente el riesgo que queremos asegurar.
Las aseguradoras tienen una figura llamada “técnico de riesgos”, que colabora con ellas inspeccionando aquello que queremos asegurar. En las pólizas de vida es típico que los “técnicos de riesgos médicos”, además de someternos a un cuestionario, nos sometan a un “chequeo” cuyo objeto es “inspeccionar” si tenemos alguna patología que pueda influir en la valoración de nuestro riesgo. No es lo mismo asegurar a una persona de 40 años totalmente sana que una de la misma edad que ya ha sufrido un infarto cardiovascular.
Por tanto, y en virtud del cuestionario y la inspección, el asegurador redactará un contrato de seguro en el cual se establecen todos los aspectos de protección de aquello que queremos asegurar.
Los artículos 12 y 13 de la misma LCS dicen que tras la celebración del contrato, excluyendo los seguros de personas (salud, vida, accidentes,…), el asegurado (tomador) debe notificar al asegurador las circunstancias que agraven o disminuyan el riesgo, pero como habitualmente las personas no son técnicos ni conscientes de qué circunstancias agrava o disminuye el riesgo, habitualmente no se notifica por desconocimiento. En este caso el asegurador puede enviar periódicamente a inspectores para revisar aquello que se asegura y ver si ha sufrido variaciones. Es razonable que ante incrementos de riesgo pueden influir en un incremento de la prima o hasta la resolución del contrato y disminuciones de riesgo provoquen descuentos en la prima. Un aumento de riesgo, por ejemplo, sería la instalación de un depósito de gas en la empresa.
Otro caso distinto es el de los “gerentes de riesgo” de las grandes empresas, personas que pertenecen al staff de la propia empresa asegurada con conocimientos suficientes para evaluar cómo deben suscribirse los contratos entre asegurado y asegurador. Son estas personas, junto con los inspectores de riesgos de las aseguradoras, quienes acuerdan lo que cubren, las garantías que contratan, qué riesgos retienen y cuales ceden y transfieren a los aseguradores.
La descripción de la actividad
Es obvio que no tiene el mismo riesgo una empresa que fabrica petardos y material pirotécnico que una planta embotelladora de agua. Aunque el valor del inmueble que ocupan sea el mismo, la empresa pirotécnica pagará una prima de seguro mucho más elevada ante el riesgo de sufrir un incendio o una explosión que no la embotelladora de agua. El riesgo de la pirotécnica es mucho mayor.
El asunto está que en el contrato de seguro de la empresa pirotécnica debe figurar de manera explícita que se trata de ese tipo de empresa, y no de una “embotelladora de agua”. Si resulta que con ánimo de engañar, la empresa pirotécnica declara que es una embotelladora de agua para pagar menos prima de seguro, el asegurador puede dejar de pagar la indemnización en caso de siniestro. La LCS así lo establece.
Por tanto, la descripción de la actividad debe estar bien definida en el contrato, y aunque haya aspectos que la definición no contemple de manera explícita, de manera implícita se entienden incluidos si para el desarrollo esa actividad concreta es necesario aquello que ha sido objeto de siniestro.
En el ejemplo real con el que hemos iniciado este post, el argumento de ClaimCenter fue doble. Primero que una empresa fabril siempre tiene existencias, y por tanto, aunque no estuviera contemplado en la descripción, sin existencias no puede desarrollar su actividad. El segundo argumento fue que el asegurador había asegurado existencias y el tomador había pagado prima por tenerlas aseguradas. No era normal que la aseguradora dijese que no tenía conocimiento de que la actividad tuviera existencias aseguradas y no quisiera pagarlas cuando tenía un capital
asegurado de 400.000 € de existencias contratadas y desde hacía varios años el asegurado pagaba prima por ellas. Todo un despropósito.
La regla de equidad
Pero ¿qué ocurre cuando se produce un error accidental en la contratación del seguro?
En ocasiones, en los cuestionarios ponemos datos erróneos por despiste o porque no sabemos qué nos están preguntando. Estos errores se producen de manera involuntaria. Siempre recomendamos que ante la duda hay que preguntar siempre, y debemos ser muy rigurosos a la hora de responder a cuestionarios para no tener problemas cuando sufrimos un siniestro.
Si involuntariamente declaramos que tenemos una puerta blindada en nuestra casa y es erróneo, o tenemos una alarma pero cuando estábamos ausentes nos olvidamos de activarla, resulta que, en caso de siniestro, el asegurador puede reducir la indemnización en la misma proporción del descuento que se aplicó en la prima frente al coste que nos hubiera supuesto el seguro de conocer la verdadera entidad del riesgo, y nos explicamos con un ejemplo.
Si en su momento declaramos que teníamos una alarma conectada a una central de alarmas que protegía nuestra vivienda y sufrimos un robo justo el día que nos ausentamos sin activar esa protección, para la aseguradora será como si ese riesgo no tuviera alarma, porque el hecho de no activarla durante nuestra ausencia es lo mismo que no disponer de ella. Si gracias a declarar que teníamos alarma nos beneficiamos de un descuento de un 25% sobre la prima, en el caso del robo donde nos olvidamos de conectar la alarma, el seguro nos descontará ese mismo 25%. A eso se llama aplicar una regla de equidad.
Otra cosa es que nosotros hubiéramos conectado la alarma y la empresa de vigilancia no se hubiera percatado de la perpetración del robo. En ocasiones sucede. En ese caso sería una responsabilidad de la empresa de vigilancia de alarmas, donde el seguro nos pagaría y recobraría todo o parte del siniestro a la empresa de vigilancia de alarmas.
Derogación de la regla de equidad
La LCS establece que las aseguradoras podrán realizar este tipo de descuentos. Pero en numerosas ocasiones los asegurados hemos formalizado correctamente el cuestionario y ha sido el seguro quien ha cometido un error de transcripción. En estos casos, aunque la misma LCS dice que el asegurado tiene la obligación de “repasar” el contrato, la inmensa mayoría de jueces entienden que se trata de un error del seguro y no permiten a éstos aplicar ese tipo de descuentos (aplicar una regla de equidad) ya que el error fue del seguro, no del asegurado que no es técnico ni especialista en seguros y en la mayoría de ocasiones jamás se mira qué dice su contrato de seguro.
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