The translation of this document is outdated.
Translation validity: 01.06.2018.–22.02.2024.
Amendments not included:
15.02.2024.
The Saeima1 has adopted and
the President has proclaimed the following law:
Insurance
Contract Law
Chapter I
General Provisions
Section 1. Terms Used in the Law
(1) The following terms are used in this Law:
1) sum insured - the amount of the insurer's
commitments specified in an insurance contract in monetary terms
or the provisions for its calculation;
2) policy holder - the person who enters into an
insurance contract for the benefit of himself or herself or of
another person;
3) insurance against losses - insurance when valuable
properties or interests are insured, and the amount of the
insurance benefit to be disbursed depends on the amount of losses
incurred by the the insured person;
4) insurable interest - the interest of the insured
person in avoiding any losses upon the occurrence of the insured
risk;
5) insurance benefit - the amount of money to be
disbursed or services to be provided for the insurance event in
conformity with an insurance contract;
6) insurance event - an event related through causal
relationship to insured risk upon the occurrence of which the
disbursement of insurance benefit is provided in conformity with
an insurance contract, or end of insurance period of the life
insurance contract with accumulation of funds if an event related
through causal relationship to insurance risk has not occurred
during the insurance period;
7) insurance contract - agreement between an insurer
and policy holder in accordance with which the policy holder
undertakes the obligations to pay insurance premium in the
manner, time periods and amount laid down in the contract, as
well as to fulfil other obligations laid down in the contract,
and the insurer undertakes obligations to disburse the insurance
benefit to the person indicated in the contract in conformity
with the insurance contract upon the occurrence of the insurance
event, and also to fulfil other obligations laid down in the
contract;
8) insurance object:
a) in insurance against losses - valuable property or
interests;
b) in civil liability insurance - civil liability of a
person;
c) in personal insurance - life, health or physical state of a
person;
9) insurance period - the period of time during which
insurance premium is being paid in accordance with the insurance
contract and during which insurance is effective;
10) insurance application - a document or any other
information which a policy holder submits to the insurer in order
to inform the latter of the insurance object, facts and
circumstances which are necessary for the assessment of insurance
risk;
11) insurance premium - insurance payment laid down in
the insurance contract;
12) insured person - the person who has the insurable
interest and for the benefit of whom the insurance contract has
been concluded:
a) in insurance against losses - the person indicated in the
insurance contract or the person to be determined in accordance
with the insurance contract who suffers the losses upon the
occurrence of the insurance event and for whom the insurance
benefit is to be paid;
b) in civil liability insurance - the person indicated in the
insurance contract or the person to be determined in accordance
with the insurance contract whose civil liability is insured;
c) in personal insurance - the natural person indicated in the
insurance contract or the natural person to be determined in
accordance with the insurance contract the life, health or
physical state of whom is insured and to whom the insurance
benefit is to be paid;
13) insured risk - the event provided for in the
insurance contract that is independent from the will of the
insured person and the occurrence of which is possible in the
future;
14) insurance offer - the proposal of an insurer to
conclude or to amend an insurance contract;
15) liability limit - sum insured in terms of money in
the civil liability insurance;
16) surrender value - the sum of money the amount of
which or procedures for the calculation of which are laid down in
the life insurance contract with accumulation of funds and which
is disbursed to the policy holder, if upon his or her initiative
the insurance contract is terminated early or is recognised to be
invalid, or is terminated early in the cases laid down in
Sections 14 and 26 of this Law;
17) civil liability insurance - insurance when the
civil liability of a person is insured for the losses caused to a
third party as a result of the action or failure to act of this
person;
18) compensation principle - insurance principle based
on which the insurance benefit is calculated by taking into
account the amount of losses incurred in an insurance event;
19) co-insurance - agreement between several insurers
to insure the same insurance object within the framework of a
single insurance contract;
20) beneficiary - in personal insurance and in
insurance against losses, the person who is indicated in the
insurance contract and to whom the insurance benefit or its part
is to be paid in the cases laid down in the insurance
contract;
21) personal insurance - insurance of the life, health
or physical state of a person;
22) subrogation action - claim of an insurer in the
amount of the sum disbursed which is to be brought against the
insured person in the civil liability insurance in the cases laid
down in laws and regulations or insurance contract;
23) subrogation right - the right of the insurer who
has disbursed the insurance benefit to take over the right to
claim of the insured person against the person responsible for
losses in the amount of the disbursed sum;
24) third party in civil liability insurance
(hereinafter - the third party) - such third party to whom losses
have been caused and for whom the insurance benefit is due in the
civil liability insurance.
(2) In addition to the terms used in this Section, other terms
used in the Law shall correspond to the terms used in the
Insurance and Reinsurance Law.
Section 2. Purpose and Scope of
Application of this Law
(1) The purpose of this Law is to ensure the possibility for
the persons involved in the insurance contract to exercise and
protect their rights.
(2) This Law governs the provisions of the insurance contract,
the procedures for concluding and terminating the contract, the
provisions for taking a decision on insurance benefit and
disbursement thereof, the rights and obligations of the insurer
and persons involved in the insurance contract arising from the
insurance contract.
Section 3. Law Applicable to
Insurance Contract
(1) The law applicable for governing the contractual relations
arising from the insurance contract shall be determined in
accordance with the provisions on insurance contracts of
Regulation (EC) No 593/2008 of the European Parliament and of the
Council of 17 June 2008 on the law applicable to contractual
obligations (Rome I) (hereinafter - Regulation No 593/2008).
(2) In the cases indicated in Article 7(3)(a)(b) and (c) of
Regulation No 593/2008 the parties to the insurance contract may
choose also the law of the country of domicile (registration) of
the insurer.
(3) Prior to entering into the insurance contract, an
obligation of an insurer is to inform an policy holder of the law
of that country which will be applied for governing the
contractual relations arising from the insurance contract, or
inform the policy holder of the country the law of which may be
chosen if there is such option in accordance with Regulation No
593/2008.
Section 4. Procedures for the
Examination of Complaints and Disputes
(1) An insurer has the obligation to indicate in the insurance
contract which has been concluded with the policy holder -
natural person - the information regarding the procedures for the
examination of those complaints and disputes which are arising
from the insurance contract, including by extra-judicial
manner.
(2) An insurer has the obligation to examine a complaint which
has been submitted by a policy holder, insured person or other
person who has the right to claim the insurance benefit on the
service not-complying with the provisions of the insurance
contract, and to provide a motivated reply within 20 days after
receipt of the complaint. If a reply cannot be provided within
the indicated time period due to objective reasons, the insurer
has the obligation to provide information which justifies the
necessity for the extension of the deadline for the provision of
the reply and indicated a reasonable time period when the reply
will be provided.
Section 5. Provision of
Notifications, Requests and Information
(1) The notifications, requests and information laid down in
this Law or insurance contract shall be provided by the insurer
in one of the following manners:
1) in writing;
2) through the use of a durable medium or website if the
provisions provided for in Paragraph two of this Section are
fulfilled;
3) through the use of the means of distance communication
other than that referred to in Clause 2 of this Paragraph on
which agreement has been reached.
(2) The insurer shall comply with the following provisions,
when providing a notification, request and information through
the use of a durable medium or website:
1) the use of a durable medium or website is appropriate based
on the evaluation of the particular communication circumstances
or information to be provided;
2) a policy holder is provided with a possibility to choose to
receive the information in written form;
3) upon the request of a policy holder, insured person or
other person who has the right to claim the insurance benefit,
the insurer shall provide him or her notifications, requests and
information in written form and free of charge;
4) the information referred to in Sections 3 and 8 of this Law
may be provided on the website of the insurer provided that the
following conditions have been additionally met:
a) the policy holder has agreed to provision of the
aforementioned information on the website;
b) the website address and indication where the aforementioned
information can be accessed on this website have been notified to
the policy holder by means of distance communication;
c) it is ensured that the aforementioned information remains
accessible on the website for the time period while such
information is necessary for the policy holder or insured
person.
(3) An insurer shall provide the notifications, requests and
information laid down in this Law or insurance contract in the
official language of the Republic of Latvia, except when the
parties have clearly agreed on the provision of the
notifications, requests and information in another language.
(4) Also the policy holder, insured person or other person who
has the rights to claim the insurance benefit has the right to
send the notifications and requests laid down in this Law and
insurance contract to an insurer in writing or through the use of
a durable medium in accordance with the procedures laid down in
the insurance contract.
Chapter
II
Procedures for the Conclusion of an Insurance Contract
Section 6. Insurance Application and
Offer of an Insurer
(1) In order to conclude an insurance contract, an insurer is
entitled to request an insurance application from a policy
holder.
(2) An insurance application shall not impose an obligation
either on the insurer to conclude an insurance contract or to
undertake commitments to compensate losses, or on the submitter
of the insurance application to undertake any commitments to
conclude an insurance contract.
(3) If within 15 days from the date of receipt of an insurance
application an insurer has failed to notify in writing the
submitter of the application of the terms of insurance in
accordance with which the insurer is willing to conclude an
insurance contract, or it has not notified of the necessity to
carry out an in-depth analysis of the insurance object and
insurance risk, it shall be considered that the insurer has
refused to conclude an insurance contract.
(4) If an insurer determines certain time period for the
submitter of the insurance application for the provision of a
reply to the expressed insurance offer, it may not refuse from
the expressed insurance offer until the end of the laid down time
period. If the time period for the provision of a reply is not
laid down, the insurance offer becomes invalid if the submitter
of the insurance application has not notified of acceptance or
refusal of the insurance offer within 30 days.
Section 7. Information on Insurance
Object
(1) Upon concluding an insurance contract, the obligation of a
policy holder and insured person is to provide the information
requested by the insurer on the condition and circumstances of
the insurance object which is necessary for the assessment of the
possibility of the occurrence of insurance risk and amount of
potential losses, including the information which applies to the
health condition of the insured person in personal insurance and
is necessary to conclude an insurance contract. The insurer shall
also use publicly available information or information at his or
her disposal which is lawfully acquired on the condition and
circumstances of the insurance object for the assessment of the
possibility of occurrence of the insurance risk and possible
amount of losses.
(2) The policy holder and insured person shall be responsible
for the veracity of the provided information.
(3) If prior to the conclusion of an insurance contract a
policy holder or the insured person has not submitted the
information indicated in Paragraph one of this Section, and the
insurer has concluded the insurance contract, it may not use the
fact of non-provision of information as a reason for the
termination of the insurance contract or amending provisions
thereof, except for the cases where the information has not been
submitted due to wrongful intent or gross negligence.
(4) A policy holder and the insured person have the obligation
to notify an insurer of other insurance contracts in effect he or
she is aware of, which pertain to the same insurance object.
(5) If an insurance contract is concluded repeatedly
immediately after the previous insurance contract with the same
insurer and on the same insurance object and, when concluding the
repeated insurance contract, the policy holder fails to indicate
that the information regarding the insurance object or the
information for the assessment of the possibility of the
occurrence of the insurance risk and possible amount of losses
which he or she has provided upon concluding the first insurance
contract has significantly changed, the insurer has the right to
rely on the fact that the information provided at the time of
entering into the first insurance contract has not changed.
(6) Prior to concluding an insurance contract, an insurer,
where it is necessary for the assessment of the possibility of
the occurrence of insurance risk, has the right to verify the
insurance object or information on risks which are related to the
insurance object by informing the policy holder or insured person
thereof. During the operation of the insurance contract, the
insurer, in accordance with the procedures laid down in the
contract, has the right to verify whether changes have occurred
in relation to the insurance object or information on risks which
are related to the insurance object. If the insurance contract
has been concluded, the insurer shall not make inspections in
respect of the health data of the person during the operation of
the insurance contract.
Section 8. Provisions of Insurance
Contracts
(1) Provisions of an insurance contract must be clear and
comprehensible.
(2) The date, place of contract conclusion, insurance period,
the firm name and legal address of the insurer (if the insurer is
a branch of the insurer, the legal address of the head office of
the insurer shall be also indicated), the policy holder, the
insured person, the beneficiary (if any), insurance risk,
insurance object, sum insured, insurance premium for each class
of insurance, the insurance benefit or procedures for the
calculation thereof for each insurance event event, the time
periods and procedures for the payment of insurance premium, the
time period for taking the decision to disburse insurance benefit
or to refuse to disburse it, the provisions for the termination
of the contract, the obligations and responsibilities of the
parties for non-compliance with the provisions of the contract
shall be indicated in an insurance contract.
(3) If laws and regulations provides for mandatory insurance,
the requirements arising from these laws and regulations shall be
included in the insurance contract. If such requirements are not
included in the insurance contract, this contract shall not be
regarded to be mandatory insurance contract.
(4) Other provisions which are not in contradiction with the
applicable laws and regulations of the Republic of Latvia may
also be included in an insurance contract.
(5) An insurer shall, during the operation of the insurance
contract, ensure that the current information is available for
the policy holder and the insured person on changes in the firm
name, contact information and other information of the insurer
which is necessary for the fulfilment of contractual obligations
by the policy holder and insured person.
(6) The insurance object, the aggregate of insurance risks and
exemptions laid down, sum insured and liability limit laid down
in the insurance contract shall be regarded to be the subject
matter of the insurance contract.
(7) An insurer shall process personal data, including health
data, in accordance with the laws and regulations governing
personal data protection. The duration of personal data
processing may not exceed the limitation period laid down in this
Law or period during which the data is processed in accordance
with other legal grounds.
Section 9. Special Provisions of the
Contract on Legal Expenses Insurance
(1) When insuring legal expenses, the following shall be
provided for in the insurance contract in addition to that laid
down in Section 8 of this Law:
1) separate presentation of the insurance risk and insurance
premium if the insurer insures the legal expenses insurance risk
together with any other insurance risk;
2) the rights of the insured person to choose a lawyer or
another person with appropriate qualification (hereinafter - the
lawyer) who can defend and represent the interests of the insured
person in civil proceedings, criminal proceedings, administrative
proceedings, or proceedings or court proceedings in an
administrative violation case, or without involving in these
proceedings, except when:
a) the insurance is applied only to the cases which are
related to the use of road transport in the territory of the
Republic of Latvia;
c) the insurance is applied to the provision of assistance in
the case of accident or damages where road transport is
involved;
c) the insurer who has insured legal expenses and insurer who
has insured assistance does not deal with any of the classed of
civil liability insurance;
d) the provisions of Paragraph three of this Section are
ensured;
3) where the conflict of interests is arising between the
insured person and insurer when adjusting the the claims of legal
expenses - the rights of the insured person:
a) to choose the lawyer;
b) to appeal the decisions taken by the insurer in accordance
with the applicable laws and regulations of the Republic of
Latvia.
(2) An insurer shall inform the insured person of the rights
of the insured person referred to in Paragraph one, Clause 3 of
this Section where the conflict of interests arises between the
insurer and insured person.
(3) Services of legal nature and representation of the parties
shall be ensured by lawyers if the legal expenses of the parties
involved in one dispute have been insured by one and the same
insurer.
(4) An insurer is entitled to entrust the adjustment of the
requirements related to legal expenses insurance to another
qualified person. If the adjustment of the requirements related
to legal expenses insurance is done by an employee of the
insurer, he or she shall deal only with that class of
insurance.
(5) Provisions of this Section are not applicable to:
1) legal expenses insurance if such insurance applies to
disputes or risks arising from the use of sea-going ships or are
related thereto;
2) activity carried out by an insurer who ensures civil
liability insurance, when defending and representing the insured
person, if defence and representation is concurrently carried out
in the interests of the insurer;
3) legal expenses insurance which is carried out by the
insurer in aid insurance which complies with the following
conditions:
a) the activity is carried out in the Member State other than
the permanent place of residence of the insured person;
b) the activity is a part of the contract which applies only
to assistance which is provided to the persons for whom
difficulties arise during a travel while being away from their
homes or their permanent place of residence;
c) it is indicated in the insurance contract that legal
expenses insurance is additional risk to assistance
insurance.
Section 10. Language of an Insurance
Contract
An insurance contract shall be drawn up and concluded in the
official language of the Republic of Latvia. If a policy holder -
natural person - wishes to conclude the insurance contract in a
foreign language, such consent of the policy holder must be
clearly expressed. If the insurance contract with the policy
holder - legal person (or association thereof) - has been
concluded in a foreign language, it shall be regarded that policy
holder has agreed to conclude the contract in a foreign language,
unless he or she proves the contrary.
Section 11. Conclusion of an
Insurance Contract
(1) An insurance contract shall be considered to be concluded
only when the insurer and a policy holder have reached an
agreement on the provisions of the insurance contract referred to
in Section 8, Paragraph two and Section 59, Paragraph one of this
Law.
(2) The policy holder shall express his or her consent to the
conclusion of an insurance contract in accordance with the
insurance offer by paying the insurance premium in the manner,
time period and amount specified in the insurance offer, or
express his or her consent to the conclusion of an insurance
contract in another way offered by the insurer. In case of a
dispute the insurer has the obligation to prove the fact of the
conclusion or failure to conclude an insurance contract.
Section 12. Conclusion of an
Insurance Contract Using Means of Distance Communication
(1) If an insurance contract is concluded by using means of
distance communication, prior to the conclusion of the insurance
contract an insurer shall notify the policy holder in writing or
by means of another durable medium available to the policy holder
of the provisions of the insurance contract.
(2) If an insurance contract is concluded upon a request of
the policy holder by using such means of distance communication
through which the provisions of the insurance contract could not
be sent in written form, or by means of another durable medium
available to the policy holder, the insurer shall send the
provisions of the insurance contract to the policy holder not
later than on the next working day after the conclusion of the
insurance contract.
Section 13. Conditions for Coming
into Effect of an Insurance Contract Depending on the Payment of
Insurance Premium
(1) Insurance shall come into effect on the first day of the
insurance period indicated in the insurance contract, but not
before the time when the insurance premium or its first part is
paid in full amount, except when it is otherwise provided for in
the insurance contract.
(2) If the parties agree that an insurance premium or its
first part will be paid after the commencement of the insurance
period, the insurance shall be in effect from the first day of
the insurance period. If the insurance premium or its first part
is not paid or is not paid in the amount laid down in the
insurance contract until the deadline specified in the insurance
contract, it shall be considered that the insurance contract is
not valid in conformity with the provisions of Paragraphs three,
four and five of this Section.
(3) If the insurance premium is not paid in the amount
specified in the insurance contract or the insurance premium or
its first part is paid after the deadline specified in the
insurance contract, the insurer has the right to reimburse the
paid insurance premium to the policy holder. If the insurer takes
the decision to reimburse the paid insurance premium, the insurer
has the obligation to reimburse the paid insurance premium or its
first part to the policy holder within 15 days after the day of
payment of the overdue insurance premium or its part, or to send
to the policy holder a request to notify the insurer of the
manner in which the policy holder wishes to receive the
reimbursement of the insurance premium or its part if the manner
in which the policy holder can receive the reimbursement of the
insurance premium or its part is not known to the insurer.
(4) If the insurer does not reimburse the paid insurance
premium to the policy holder within the time period specified in
Paragraph three of this Section or does not send the policy
holder a request to notify the insurer of the manner in which the
policy holder wishes to receive the reimbursement of the
insurance premium, it shall be considered that the insurer has
agreed to the overdue or incomplete payment of the insurance
premium, and the insurance shall be in effect during the
insurance period indicated in the insurance contract.
(5) If the insurance risk has set in and the insurance premium
or its first part is paid after the deadline specified in the
insurance contract for the payment of the premium or its first
part, and later than on the previous day before setting in of the
insurance risk, it shall be considered that the insurance
contract has not entered into effect and the insurer has an
obligation to notify the policy holder of the invalidity of the
contract and to reimburse the paid insurance premium or its first
part. In such case the insurer has the obligation to send to the
policy holder a notification of the invalidity of the contract
within 15 days after the day of the payment of the overdue
insurance premium or its first part and to reimburse the paid
insurance premium or its first part to him or her, or to send to
the policy holder a notification of the invalidity of the
insurance contract requesting to notify the manner in which the
policy holder wishes to receive the reimbursement of the
insurance premium or its first part, if the manner in which the
policy holder can receive the reimbursement of the insurance
premium or its first part is not known to the insurer. The
fulfilment of the obligation of the insurer to reimburse the
insurance premium shall not affect invalidity of the insurance
contract.
Section 14. Conclusion of an
Insurance Contract by Acting with Wrongful Intent or Gross
Negligence
If a wrongful intent (Section 1641 of the Civil Law) or gross
negligence (Section 1645 of the Civil Law) of a policy holder or
insured person has been the cause for the deception of the
insurer regarding the condition of the insurance object or
circumstances for the assessment of the probability of occurrence
of insurance risk and amount of potential losses, the insurance
contract shall become invalid from the moment it has been
concluded. The insurer shall not reimburse the paid insurance
premium, but it does not affect the receipt of surrender value in
respect of life insurance contracts with accumulation of
funds.
Section 15. Conclusion of an
Insurance Contract with Ordinary Negligence
(1) If ordinary negligence (Section 1646 of the Civil Law) of
a policy holder or the insured person has been the cause for the
deception of the insurer regarding the condition of the insurance
object or circumstances for the assessment of the probability of
the occurrence of insurance risk and amount of potential losses,
the insurance contract shall be in effect.
(2) An insurer shall, within 15 days from the day of becoming
familiar with the factual circumstances of the probability of the
occurrence of insurance risk, offer the policy holder to make
amendments to the provisions of the insurance contract.
Amendments to the provisions of the insurance contract shall come
into effect after agreement between the parties.
(3) If a policy holder has refused the amendments to the
insurance contract offered by the insurer or 15 days have passed
from the day of sending the insurance offer and consent of the
policy holder has not been received, the insurance contract shall
be regarded as terminated from the moment when the time period
for the insurance offer has expired, unless it is otherwise
provided for in the insurance contract or insurance offer. If the
contract is terminated, the insurer shall reimburse the policy
holder the part of the insurance premium which is calculated in
accordance with the provisions of Section 35, Paragraph five of
this Law.
(4) If an insurer proves that it would not have concluded the
insurance contract, if it had known the factual circumstances of
the assessment of the probability of the occurrence of insurance
risk and amount of potential losses, the insurer may terminate
the insurance contract by sending a notification thereon within
15 days from the day of becoming aware of these circumstances. If
the insurance contract is terminated. the insurer shall reimburse
the policy holder the part of the insurance premium which is
calculated in accordance with the provisions of Section 35,
Paragraph five of this Law.
(5) If the insurer has not terminated the insurance contract
within the time periods provided for in the Law or offered the
policy holder to make amendments to provisions of the insurance
contract within the time periods provided for in the Law, the
insurance contract shall remain in effect, and the insurer may
not henceforth use the fact of the failure to notify of the
assessment of the probability of the occurrence of insurance risk
and amount of potential losses as a reason for the termination of
the insurance contract or amendment of its provisions.
(6) If a policy holder has acted with ordinary negligence, and
the insurance event occurs before the termination of the
insurance contract or amendments to the provision of the
insurance contract comes into effect, the insurer has the
obligation to disburse the insurance benefit in the proportion
that exists between the insurance premium paid and the insurance
premium which should be paid by the policy holder if he or she
would have notified of the factual circumstances of the
assessment of the probability of the occurrence of insurance risk
and amount of potential losses.
(7) If an insurer proves that it would not have concluded the
insurance contract in any event if it had known of the factual
circumstances of the assessment of the probability of the
occurrence of insurance risk and amount of potential losses which
have appeared with the occurrence of insurance event, the
insurance benefit may not exceed the paid insurance premium.
(8) If after conclusion of the insurance contract the
circumstances which might have affected the conclusion of the
insurance contract and were not known by either of the parties
are discovered, Sections 21 and 22 of this Law shall be
applied.
Section 16. Non-existence of
Insurable Interest
(1) If at the time when the insurance comes into effect the
insurable interest does not exist, the insurance contract shall
not be in effect from the day of its conclusion.
(2) If an insurance contract has been concluded without an
insurable interest, or by the policy holder acting with wrongful
intent gross negligence, the insurer shall not reimburse the
insurance premium paid by the policy holder.
(3) In other cases when an insurance contract is concluded
without an insurable interest, the insurer shall reimburse the
policy holder the part of the insurance premium which is
calculated in accordance with the provisions of Section 35,
Paragraph five of this Law.
(4) If the insurable interest ceases to exist during the
insurance period, the insurance contract shall not be in effect
from the day on which the insurable interest ceases to exist. The
policy holder shall notify the insurer of the non-existence of
the insurable interest. After receipt of the notification, the
insurer shall reimburse the policy holder the part of the
insurance premium which is calculated in accordance with the
provisions of Section 35, Paragraph five of this Law.
(5) If upon the occurrence of the insurable event the
insurable interest does not exist, the insurer shall reimburse
the policy holder the part of the insurance premium which is
calculated in accordance with the provisions of Section 35,
Paragraph five of this Law.
Section 17. Improbability of the
Occurrence of Insurance Risk
(1) If by the start of the insurance period the probability of
the occurrence of insurance risk disappears or any of the
insurance risks has already occurred, the insurance contract
shall not be in effect from the day of its conclusion.
(2) If in the cases referred to in Paragraph one of this
Section the policy holder has concluded an insurance contract by
acting with wrongful intent or gross negligence, the insurer
shall not reimburse the insurance premium paid by the policy
holder.
(3) In other cases referred to in Paragraph one of this
Section, the insurer shall reimburse the policy holder the part
of the insurance premium which is calculated in accordance with
the provisions of Section 35, Paragraph five of this Law.
(4) If the probability of the occurrence of insurance risk
ceases to exist during the insurance period, the insurance
contract shall not be in effect from the day when the probability
of the occurrence of insurance risk ceased to exist. The insurer
shall reimburse the policy holder the part of the insurance
premium which is calculated in accordance with the provisions of
Section 35, Paragraph five of this Law.
Section 18. Exceptions
(1) Unless it is otherwise provided for in an insurance
contract, an insurer shall not be liable for the incurred losses
which have arisen:
1) due to warfare, terrorism, mass riots, radioactive
intoxication, radioactive pollution, natural disasters and other
similar events specified in the insurance contract;
2) due to wear and tear, depreciation or other similar
processes.
(2) The parties may provide other exceptional cases in the
insurance contract when the insurer does not reimburse
losses.
(3) In an exceptional case, the insurer has the obligation to
prove circumstances which release it from the fulfilment of the
commitments referred to in the insurance contract.
Section 19. Insurance Policy
An insurer, when concluding an insurance contract, shall issue
a confirmation of the conclusion of the insurance contract - an
insurance policy. If there are no signatures of the parties on
the insurance policy, it shall not affect the validity of the
insurance contract, provided that the provisions for coming into
effect of the insurance contract have been complied with.
Chapter
III
Increase and Decrease of the Probability of the Occurrence of
Insurance Risk
Section 20. Changes in Information
on Insurance Object
During the operation of an insurance contract, the policy
holder or insured person, in conformity with the requirements
laid down in Section 7 of this Law, has the obligation to notify,
as soon as it is possible, the insurer of all circumstances he or
she is aware of which may considerably increase the probability
of the occurrence of insurance risk or amount of potential
losses. The obligation of notification in personal insurance
shall not be applicable to changes in the health condition of the
insured person.
Section 21. Decrease of the
Probability of the Occurrence of Insurance Risk
(1) An insurer shall amend the provisions of an insurance
contract or conclude a new insurance contract, if the probability
of the occurrence of insurance risk or amount of the potential
loss has considerably decreased, and if it is requested by the
insured person or policy holder.
(2) If the parties cannot agree on the new provisions of an
insurance contract within 15 days from the day of submission of a
request by a policy holder or insured person for amending
provisions of the insurance contract due to the decrease of the
probability of the occurrence of insurance risk, the policy
holder may terminate the insurance contract. In such case the
insurer shall reimburse the policy holder the part of the
insurance premium which is calculated in accordance with the
provisions of Section 35, Paragraph five of this Law.
(3) If due to justifiable reasons the time period of 15 days
cannot be complied with, the insurer may extend it for a time
period not exceeding 30 days from the day when the policy holder
or insured person submitted a request for amending provisions of
the insurance contract due to the decrease of the probability of
the occurrence of insurance risk. Within 15 days from the day of
submission of a request of a policy holder or insured person for
amending the provisions of the insurance contract due to the
decrease of the probability of the occurrence of insurance risk,
the insurer shall send the policy holder or insured person a
motivated notification of extension of the time period.
Section 22. Increase of the
Probability of the Occurrence of Insurance Risk
(1) If the information regarding the probability of the
occurrence of insurance risk and amount of potential losses has
changed during the operation of an insurance contract and the
insurer can prove that, if such changes in this information had
been known to it, it would have concluded the insurance contract
on other insurance terms, the insurer may, within 30 days from
the day of discovering the increase of the probability of the
occurrence of insurance risk, offer the policy holder to make
amendments to the provisions of the insurance contract and
indicate the day of coming into effect thereof.
(2) If the information regarding the probability of the
occurrence of insurance risk and amount of potential losses have
changed during the operation of an insurance contract and the
insurer is can prove that , if such changes in this information
had been known to it, it would have not concluded the insurance
contract, the insurer may terminate the insurance contract by
notifying the policy holder thereof not later than within 30 days
from the day of discovering the increase of the probability of
the occurrence of insurance risk. In such case the insurer shall
reimburse the policy holder the part of the insurance premium
which is calculated in accordance with the provisions of Section
35, Paragraph five of this Law.
(3) The provisions of Paragraph one and two of this Section
shall not be applicable to personal insurance if the probability
of the occurrence of insurance risk has increased due to the
health condition of the insured person.
(4) If a policy holder has rejected the amendments to the
provisions of an insurance contract offered by the insurer or the
15-day time period of the insurance offer has expired and the
offer has not been accepted by the policy holder, the insurer may
terminate the insurance contract. The insurer may exercise these
rights within 15 days from the date of receipt of rejection or
the date of expiry of the time period of the insurance offer. In
such case the insurer shall reimburse the policy holder the part
of the insurance premium which is calculated in accordance with
the provisions of Section 35, Paragraph five of this Law.
(5) If an insurer has not terminated an insurance contract or
has not offered the policy holder to make amendments in the
provisions of the insurance contract within the time periods laid
down in Paragraphs one, two and four of this Section, it may not
henceforward use the fact that the circumstances of the increase
of the probability of the occurrence of insurance risk have not
been notified as the reason for the termination of the insurance
contract or amendment of its provisions.
(6) If an insurance event occurs prior to the amendment of the
provisions of the insurance contract or prior to the termination
thereof, and the policy holder or insured person has fulfilled
the requirements laid down in Section 20 of this Law, the insurer
shall disburse the insurance benefit provided for in the
contract.
(7) If the insurance event occurs prior to the amendment of
the provisions of an insurance contract or prior to its
termination, and the policy holder or insured person has not
fulfilled the requirements laid down in Section 20 of this Law,
the insurer shall disburse:
1) the insurance benefit provided for in the insurance
contract - if the policy holder or insured person is not at fault
for the failure to notify of the fact of increase of the
probability of the occurrence of insurance risk;
2) the insurance benefit provided for in the insurance
contract in such proportion which exists between the paid
insurance premium and the insurance premium which the policy
holder should have paid if he or she had notified of the factual
circumstances of the increase of the probability of the
occurrence of insurance risk - if reason for the failure to
notify is ordinary negligence of the policy holder.
(8) If a policy holder or insured person has not fulfilled the
requirements laid down in Section 20 of this Law due to wrongful
intent or gross negligence , the insurer has the right not to
disburse the insurance benefit. In such case the insurer may
terminate the insurance contract by ignoring the time period laid
down in Section 38, Paragraph one of this Law, and need not
reimburse the insurance premium paid by the policy holder.
(9) If a policy holder, insured person or beneficiary has
performed actions or permitted inaction which increases the
probability of the occurrence of insurance risk due to wrongful
intent or gross negligence, the insurer has the right to
terminate the insurance contract by ignoring the time period laid
down in Section 38, Paragraph one of this Law, and need not
reimburse the insurance premium paid.
Chapter
IV
Rights and Obligations of a Policy Holder, Insured Person, and
Beneficiary, and Insurer
Section 23. Mutual Obligations of a
Policy Holder, Insured Person and Beneficiary
(1) Mutual obligations of a policy holder and insured person,
unless the policy holder is concurrently also the insured person,
shall be determined in conformity with this Law and the insurance
contract.
(2) A policy holder is obliged to inform the insured person of
the fact that he or she is insured. The insured person is obliged
to inform the beneficiary of the concluded insurance contract and
insurance provisions in respect of the beneficiary.
(3) An insured person has the right to request from the policy
holder information on the insurance contract, and the policy
holder is not entitled to refuse the provision of such
information. A beneficiary has the right to request from the
insured person the information regarding the insurance contract,
and the insured person is not entitled to refuse the provision of
such information.
(4) The information provided by a policy holder to an insurer
shall be equalled to the information provided by the insured
person or beneficiary himself or herself. The insured person or
beneficiary may not gain an advantage from the fact that the
policy holder has provided incomplete, false or misleading
information.
Section 24. Payment of Insurance
Premium
A policy holder has the obligation to pay the insurance
premium in the manner, time periods and amount specified in the
insurance contract.
Section 25. Failure to Pay Insurance
Premium or Incomplete Payment Thereof
If a policy holder fails to pay insurance premium or the first
part thereof in conformity with the provisions of the insurance
contract, it shall be recognised that the insurance contract is
not in effect in conformity with the provisions of Section 13 of
this Law. In other cases of failure to pay insurance premium or
incomplete payment thereof, the insurer is entitled to terminate
insurance contract in accordance with the procedures laid down in
Section 26 of this Law.
Section 26. Consequences of the
Failure to Pay the Current Part of the Insurance Payment or
Incomplete Payment Thereof
(1) If a policy holder has failed to pay the current part of
the insurance premium or has paid only a part thereof, an insurer
shall send a warning to the policy holder on the late payment of
the insurance premium by inviting to pay the delayed insurance
premium in conformity with the provisions of the insurance
contract and indicating the time period for the payment of the
insurance premium and possible consequences of failing to pay
it.
(2) The time period for the payment of the current part of the
insurance premium laid down in the warning sent by the insurer
may not be less than 15 days and more than six months from the
day of sending the warning.
(3) If an insurance event occurs within the time period for
the payment of the current part of the insurance premium laid
down in the warning, the insurer shall disburse the insurance
benefit if the current part of the insurance premium has been
paid within the time period for the payment of the premium and in
the amount laid down in the warning.
(4) If a policy holder fails to pay the current part of the
insurance premium within the payment period and in the amount
specified in the warning, the insurance contract shall be
regarded as terminated from the first day following the deadline
for the payment of the current part of the insurance premium
which is laid down in the insurance contract. Termination of the
life insurance contract with accumulation of funds in accordance
with the procedures laid down in this Section shall not affect
the right of the policy holder to receive a surrender value if
any is due in accordance with the provisions of the insurance
contract.
Section 27. Obligations of a Policy
Holder, Insured Person and Beneficiary after Occurrence of
Insurance Risk
(1) An insured person shall, without delay at the earliest
opportunity, notify an insurer of the occurrence of an insurance
risk, take all possible reasonable measures in order to reduce
the losses, and comply with the instructions of the insurer, if
any have been given.
(2) A policy holder, insured person and beneficiary may not
object to the request of the insurer to establish and assess the
amount of losses, circumstances of their emergence, and also to
the request to submit to the insurer all the documents at his or
her disposal which characterise the occurrence of the insurance
risk and losses caused thereby, including the documents which
contain health data of persons and a commercial secret. The
policy holder, insured person and beneficiary shall provide also
other information at his or her disposal which refers to the
occurrence of the insurance risk and which has been requested by
the insurer, and also fulfil other obligations provided for in
the insurance contract. The policy holder, insured person and
beneficiary shall be responsible for the veracity of that
information which is provided by each of them to the insurer, and
also none of them may gain an advantage due to the fact that
others have provided incomplete, false or misleading
information.
(3) The provision of the information laid down in Paragraph
two of this Section shall not be considered to be an violations
of the Law and other laws and regulations, as well as a violation
of the provisions of the contract, and it shall not cause a
civil, administrative or criminal liability of the policy holder,
insured person and beneficiary.
Section 28. Right of an Insurer to
Verify Information on the Occurrence of the Insurance Risk
(1) In order to verify the occurrence of the insurance risk
and amount of losses, an insurer has the right to verify the
information necessary for the fulfilment of its commitments in
relation to the insurance contract by requesting information from
the State and local government institutions or other persons who
can have such information at their disposal.
(2) If, in the case of occurrence of the insurance risk, the
necessary information contains health data of the person and is
necessary to take a decision on the disbursement of the insurance
benefit, an insurer is entitled to request the information form
medical treatment institutions and persons in accordance with Law
on the Rights of Patients.
(3) In the case of occurrence of the insured risk, an insurer
is entitled to process the information received in accordance
with Section 7, Paragraphs one and six of this Law which contains
the health data of the person if such information is necessary to
take a decision on the disbursement of the insurance benefit or
determine the amount of insurance benefit.
(4) The information laid down in Paragraphs one and two of
this Section shall not be provided if the provision of such
information is restricted by the Criminal Procedure Law.
Section 29. Consequences of the
Failure to Fulfil the Obligations of a Policy Holder, Insured
Person and Beneficiary
(1) An insurer may refuse to disburse insurance benefit if a
policy holder, an insured person or beneficiary has not fulfilled
any of the obligations laid down in Section 27 of this Law due to
wrongful intent or gross negligence. In such case the insurer has
the right to unilaterally terminate the insurance contract from
the moment of the occurrence of the insurance risk without
reimbursing the insurance premium.
(2) An insurer may reduce the insurance benefit, but for not
more than 50 per cent, if a policy holder, insured person or
beneficiary has not fulfilled any of the obligations laid down in
Section 27 of this Law due to ordinary negligence.
Section 30. Rescue Expenditures
(1) An insurer shall cover all the notified and verifiable
reasonable expenditures that have incurred due to emergency
measures for reduction and elimination of damage which have been
taken upon the initiative of the insured person or request of the
insurer, even when these measures have not been successful.
(2) Rescue expenditures may not exceed the amount of losses,
unless otherwise provided for by the insurance contract.
Section 31. Taking of a Decision on
Insurance Benefit and Disbursement of Benefit
(1) Upon the occurrence of an insurance event, an insurer
shall disburse the insurance benefit to the person specified in
the insurance contract.
(2) An insurer does not have the right to:
1) take the decision to disburse insurance benefit without
having ascertained of the occurrence of the insurance risk and
amount of losses;
2) refuse to disburse the insurance benefit without verifying
all the available information;
3) refuse to disburse the insurance benefit within the time
period specified in the insurance contract if evidence of the
occurrence of insurance event is received;
4) disburse the insurance benefit to a person who is claiming
the insurance benefit if the occurrence of insurance risk has
been caused by such person acting with wrongful intent or gross
negligence;
5) disburse the insurance benefit if the occurrence of
insurance risk has been caused by the policy holder or insured
person acting with wrongful intent.
(3) Before complete calculation of damages, an insurer may
disburse a part of the insurance benefit in the amount which
neither of the parties disputes.
(4) After the occurrence of insurance risk, an insurer has the
right to inspect how the policy holder, insured person or
beneficiary has complied with the provisions of an insurance
contract.
(5) The insurer has the obligation to prove any circumstances
which form the basis for refusal to disburse the insurance
benefit or to reduce it.
(6) If an insurer has taken the decision to refuse to disburse
insurance benefit, it shall send a motivated notification to the
the person who is entitled to apply for the insurance benefit
within 10 days after the day of taking the decision.
(7) If in accordance with the provisions of the insurance
contract the insurance benefit should be disbursed to a natural
person, the insurer shall disburse the insurance benefit within
15 days after taking the decision to disburse the insurance
benefit, except when:
1) the time period for the disbursement of the insurance
benefit depends on the setting in of the conditions laid down in
the insurance contract;
2) the disbursement of the insurance benefit in intended in
the form of regular payments or services to be ensured;
3) the insurer and beneficiary of the insurance benefit have
agreed on other procedures for the disbursement of the insurance
benefit after occurrence of the insurance event.
(8) When deciding on the refusal to disburse the insurance
benefit or on its reduction , an action or failure to act of the
persons sharing the household with the insured person or lawful
user of the insurance objects shall equate to the action or
failure to act of the insured person himself or herself Service
providers who are temporarily staying in an immovable property
and visitors of the places accessible to the general public shall
not be regarded as the lawful users. The provisions of this
Paragraph shall not be applicable to personal insurance.
(9) In the class of security insurance, an insurer need not to
apply the provisions referred to in Paragraph two, Clauses 4 and
5 of this Section if the following conditions have been included
in the insurance contract:
1) irrevocable commitment of the insurer to disburse the
insurance benefit upon the first request of the insured
person;
2) incontestability of the request to disburse the insurance
benefit;
3) an obligation of the policy holder to pay the insurer
without any objections a sum of money in the amount which the
insurer has disbursed upon the request of the insured person.
Section 32. Time Period for Taking a
Decision by the Insurer
(1) If the policy holder or insured person is a natural
person, an insurer has the obligation to inform the policy
holder, insured person or beneficiary, or third person not later
than within 30 days from the day when an application for
insurance benefit is received of the documents which are
necessary in order to take a decision on the disbursement of the
insurance benefit. If after receipt of any requested document or
all requested documents the insurer finds that additional
documents are still required, the insurer has an obligation to
notify of the necessity of additional documents within one months
after the day of receipt of the documents.
(2) If the policy holder or insured person is a natural
person, an insurer shall take the decision on the disbursement of
insurance benefit within 30 days after the day of receipt of all
the necessary documents requested thereby. If an insurer cannot
comply with this time period due to objective reasons, it may be
extended for a time period not longer than six months from the
date of receipt of an application for insurance benefit.
(3) If criminal proceedings or administrative proceedings or
proceedings in an administrative violation case have been
initiated regarding the event occurred and the establishment of
circumstances in accordance with the procedures of criminal
proceedings or administrative proceedings, or proceedings in an
administrative violation case is significant for the insurer to
take a decision, the time period laid down in Paragraph two of
this Section shall not be applied, and the respective policy
holder, insured person, beneficiary or third party shall be
informed thereof. The insurer shall take a decision not later
than within 30 days from the day when the final ruling is
received.
Section 33. Obligation of an Insurer
to Make Acquainted with the Documents Justifying the Decision of
the Insurer and Obligation to Provide Information
(1) If a person who has the right to claim the insurance
benefit in accordance with the concluded insurance contract
submits a relevant request, the insurer shall make this person
acquainted with the documents at its disposal which justify the
decision to disburse the insurance benefit due to this person or
to refuse to disburse the insurance benefit, or issue copies
thereof. A person who has the right to claim the insurance
benefit in accordance with the concluded insurance contract has
the right to receive the copies of the documents indicated in
this Paragraph for a fee which does not exceed the costs of
making the copies of the documents.
(2) An insurer has no obligation to make acquainted with
documents and issue copies of the documents in accordance with
the procedures laid down in Paragraph one of this Section if:
1) in relation to the circumstances of occurrence of the
insurance risk, the insurer has submitted the documents to law
enforcement institutions within the framework of criminal
proceedings;
2) the documents contain commercial secrets or personal data
of other persons which the person indicated in Paragraph one of
this Section is not entitled to acquire.
(3) An insurer, after making acquainted with the documents
which justify the decision thereof to disburse an insurance
benefit due or to refuse to disburse an insurance benefit, has
the right to request that the person who has the right to claim
the insurance benefit in accordance with the concluded insurance
contract shall sign a written confirmation in which the documents
with which such person has become acquainted are indicated. If
the person who has the right to claim the insurance benefit in
accordance with the concluded insurance contract refuses to sign
the confirmation laid down in this Paragraph, it shall be signed
by the insurer by indicating in the field for special notes that
the aforementioned person has refused to sign the
confirmation.
(4) Upon the request of a policy holder who in conformity with
the concluded insurance contract is not a beneficiary of
insurance benefit at the same time, an insurer has the obligation
to provide information regarding the amount of disbursed
insurance benefits at least once a year, except when the
provision of such information may infringe the rights and lawful
interests of another person.
Chapter V
Term of Validity of an Insurance Contract and Termination of
Contract
Section 34. Term of Validity of an
Insurance Contract
Term of validity of an insurance contract shall be determined
by agreement between the parties.
Section 35. Termination or
Invalidity of an Insurance Contract
(1) An insurance contract shall terminate when:
1) the insurer has completely fulfilled its commitments,
unless it is otherwise provided for in the insurance
contract;
2) the insured natural person and beneficiary indicated in the
insurance contract have died and heirs have not applied;
3) the insured legal person and beneficiary indicated in the
insurance contract have been liquidated and they do not have any
successor in interest.
(2) If insurance risk occurs due to wrongful intent of a
policy holder, insured person or beneficiary, the insurance
contract shall be deemed to be terminated from the moment of
occurrence of the insurance risk. In such case the insurer shall
not reimburse the paid insurance premium. If several insured
persons are insured under one insurance contract or there are
several beneficiaries, the insurance contract shall remain valid
in respect of other insured persons and beneficiaries who are not
guilty of the occurrence of the insured risk, provided that the
validity of the insurance contract can be retained.
(3) An insurance contract may be terminated early in the cases
provided for in Section 15, Paragraphs three and four, Section
21, Paragraph two, Section 22, Paragraphs two, four, eight and
nine, Section 25, Section 26, Paragraph four, Section 29,
Paragraph one, Section 36, Paragraphs one, two and four, Section
42, Paragraph three, and Section 52, Paragraph five of this Law
or other laws and regulations.
(4) An insurer and policy holder are entitled to agree on the
termination of an insurance contract without the consent of the
insured person and beneficiary, except when:
1) it is otherwise provided for in the insurance contract;
2) the insurance event has occurred, and as a result of the
termination of the insurance contract the insurer would be
released from the obligation to disburse the insurance
benefit.
(5) Upon termination of an insurance contract, the insurer
shall reimburse the policy holder the part of the insurance
premium the amount of which is determined by deducting the part
of the insurance premium for the period of time when the
insurance contract was in effect and the expenses of the insurer
in the amount of 15 per cent of the remaining insurance premium,
however not more than of the insurance premium per one year. The
procedures for this calculation shall not be applied in the case
of a life insurance contract with accumulation of funds and in
the cases an insurance contract is terminated in accordance with
Paragraph two of this Section and Section 22, Paragraphs eight
and nine, Section 29, Paragraph one, Section 36, Paragraphs one
(if the insurance contract is terminated by an insurer) and four,
and Section 52, Paragraph five of this Law.
(6) An insurance contract shall be regarded as invalid in the
cases provided for in Section 13, Paragraph two, Section 14,
Section 17, Paragraphs one and four, Section 25 of this Law and
other laws and regulations.
Section 36. Special Cases of
Termination of an Insurance Contract
(1) An insurer and policy holder may terminate an insurance
contract between the day when the insurance contract is concluded
and the day when the insurance comes into effect. The other party
shall be notified of such termination of the insurance contract
not later than within 15 days before its entry into effect. If
the insurance contract is terminated upon the initiative of a
policy holder, the insurer shall reimburse the policy holder the
part of the insurance premium which is calculated in accordance
with the provisions of Section 35, Paragraph five of this Law. If
the insurance contract is terminated upon the initiative of the
insurer, the insurer shall refund the policy holder the paid
insurance premium.
(2) If an insurance contract provides for the right to
terminate this contract after the disbursement of the insurance
benefit, any of the parties may unilaterally terminate the
insurance contract. The insurance contract shall be terminated on
the basis of the notification of the relevant party on the day
indicated in the notification, however not earlier than after 15
days from the day when the relevant party has sent the
notification on the termination of the insurance contract.
(3) In the case provided for in Paragraph one of this Section
all the obligations arising from an insurance contract shall be
terminated for a policy holder from the day when the termination
of the contract is notified to the insurer. The policy holder
shall be obliged to prove the fact of sending the notification on
the termination of the contract.
(4) A policy holder - natural person - has the right to
terminate a life insurance contract with accumulation of funds
within 15 days from the day of concluding such contract. In such
case the insurer shall reimburse all the insurance premium paid
in by the policy holder. If a policy holder - natural person -
has entered into a unit-linked life insurance contract with
accumulation of funds, an insurer shall refund the policy holder
the amount of money which is calculated from the paid insurance
premium by taking into account the value of the investment
instrument selected by the policy holder on the day when these
instruments are sold in accordance with the provisions of the
insurance contract on the time periods for the purchase and sale
of investment instruments. The insurer has the obligation to take
the actions necessary for the sale of investment instruments
without delay, as soon as it is possible.
(5) The provisions of Paragraph four of this Section shall not
apply to life insurance contracts with accumulation of funds if
insurance period is shorter than six months.
Section 37. Restrictions for the
Termination of an Insurance Contract in Case of Liquidation or
Insolvency Proceedings of a Policy Holder
Administrator of insolvency proceedings or liquidator is not
entitled to terminate or contest an insurance contract if:
1) in classes of personal insurance, the validity of the
insurance contract does not depend on payment of new insurance
premiums;
2) insurance period is applicable to a warranty period if a
security insurance contract or civil liability insurance contract
has been concluded in mandatory classes of insurance.
Section 38. Procedures for the
Termination of an Insurance Contract
(1) If an insurance contract is terminated unilaterally in the
cases laid down in this Law or other laws and regulations, the
relevant party shall send a notification on the termination of
the insurance contract to the other party. The insurance contract
shall be terminated on the day indicated in the notification,
however not earlier than 15 days from the day of sending the
notification.
(2) The provisions set out in Paragraph one of this Section
shall not be applicable in cases where this Law or other laws and
regulations provide for other procedures for the termination of
an insurance contract.
(3) If the insurance benefit is less than the difference
between the paid insurance premium and the part of the insurance
premium for the remaining insurance period, the insurer shall,
within 15 days after termination of the contract, reimburse the
policy holder the part of the insurance premium which is
calculated in accordance with the provisions of Section 35,
Paragraph five of this Law, and from which the insurance benefit
has been deducted.
(4) If a life insurance contract with accumulation of funds or
a unit-linked life insurance contract with accumulation of funds
is terminated early, the insurer shall, within 15 days after the
termination of the contract, disburse the surrender value to the
policy holder. If the surrender value cannot be disbursed within
15 days due to circumstances beyond the insurer's control, the
insurer shall notify the policy holder of the reasons for the
delay in disbursement of the surrender value and time period
within which it will be disbursed.
Section 39. Lapsing of Claims
(1) The claims arising from an insurance contract shall lapse
within three years. The right to submit a notification to an
insurer on the occurrence of an insurance risk shall terminate if
the person who has the right to claim the insurance benefit does
not exercise it within three years from the day of occurrence of
the insurance event.
(2) If the insurer executes a lapsed claim, he or she does not
have a right to reclaim the executed from the person.
Chapter
VI
Co-insurance and Leading Insurer
Section 40. Co-insurance
In co-insurance, all insurers who conclude an insurance
contract shall sign the insurance contract. Rights and
obligations of the parties shall be determined in conformity with
the insurance contract. If the insurance contract does not
provide for special agreement between the insurers, co-insurance
shall not give rise to full (joint) liability of the
insurers.
Section 41. Leading Insurer
(1) The leading insurer shall be indicated in an insurance
contract. The rights and obligations thereof shall be laid down
in the contract which has been concluded by the insurers. The
leading insurer shall be authorised to represent all other
insurers. The leading insurer has the obligation to undertake the
leading role in ensuring legal relations with a policy
holder.
(2) A policy holder or an insured person shall address all the
notifications related to an insurance contract to the leading
insurer, unless otherwise provided by the insurance contract.
(3) The leading insurer shall inform a policy holder of the
distribution of rights and obligations between the insurers, all
changes in the distribution of these rights and obligations, and
also of all changes in the composition of insurers.
Chapter
VII
Insurance against Losses
Section 42. Compensation
Principle
(1) The insurance benefit disbursed in accordance with the
compensation principle may not exceed the losses caused in the
insurance event.
(2) Parties may agree on the method for the assessment of
losses, and also the value of specially irreplaceable object in
the insurance contract.
(3) Parties have the right, by mutual agreement, to reduce the
initial value of the insurance object if a specially
irreplaceable object considerably loses its initial value. If
such agreement cannot be reached, any of the parties has the
right to unilaterally terminate the insurance contract.
Section 43. Over-insurance
(1) If the sum insured in insurance against losses in
accordance with one or several insurance contracts regarding the
same insurance risk exceeds the value of the insurance object
(over-insurance), upon the request of any party, it shall be
reduced in chronological order of the conclusion of contracts,
starting from the last insurance contract, until this sum does
not exceed the value of the insurance object. If necessary, one
or several insurance contracts shall be terminated.
(2) The parties may agree on other procedures for the
reduction of the sum insured.
(3) If an insurance event has occurred before the sum insured
is reduced in conformity with Paragraph one of this Section, an
insurer shall disburse the insurance benefit in compliance with
the compensation principle.
(4) If, in accordance with one or several insurance contracts
which have been concluded with one or several insurers, the sum
insured exceeds the value of the insurance object by more than 50
per cent, those insurance contracts which have been concluded due
to the policy holder acting with wrongful intent or gross
negligence shall not be in force from the moment of their
conclusion. In such cases the paid insurance premium shall not be
reimbursed.
Section 44. Cost Allocation of
Insurance Benefit if Several Insurance Contracts have been
Concluded
(1) If in insurance against losses one and the same insurance
object is insured with several insurers in one and the same class
of insurance, each insurer shall disburse the insurance benefit
in proportion to the sum insured that is specified in each
insurance contract.
(2) None of the insurer may use the existence of other
insurance contracts as grounds for full or partial rejection of
the payment of insurance benefit, except in the cases of
fraud.
(3) Insurers may agree on other procedures for the
disbursement of the insurance benefit if the person who claims
the insurance benefit agrees thereto.
Section 45. Subrogation Right
(1) An insurer who has disbursed insurance benefit has the
subrogation right, except in the cases of personal insurance.
(2) If the insurance benefit disbursed by an insurer covers
only a part of the loses caused, and the insurer brings an action
against the person who is responsible for the caused losses
within one year from the day of disbursement of the insurance
benefit, the insurer has the obligation to inform the insured
person of the use of the subrogation right. In such case the
insured person has the right to submit its claim as a
co-plaintiff or bring a separate action.
(3) If it is not or will not be possible to bring an action in
favour of an insured person against the person who is responsible
for the caused losses due to the insured person acting with
wrongful intent or gross negligence, the insurer may refrain from
disbursing the benefit in such amount for which the action cannot
be brought or will be impossible to be brought, or, if the
benefit has been disbursed, request the insured person to refund
the disbursed insurance benefit.
(4) By using the subrogation right, an insurer cannot bring an
action against the children, parents or spouse of the insured
person even if they are guilty of causing the losses. Such
insurance events when the perpetrator has caused them due to
wrongful intent or gross negligence shall be exemptions.
(5) In terms of civil legal consequences, the subrogation
right of an insurer shall be equated to cessation which is
carried out in accordance with the provisions of this Section.
The limitation period specified for the claim of the insured
person against the person who caused the losses shall be applied
to the subrogation right of an insurer.
(6) An insurer has the right to cede the right of claim taken
over in the result of subrogation to other persons and transfer
these persons such information regarding the ceded right of claim
which may facilitate the recovery of losses.
Section 46. Under-insurance
If the sum insured in the insurance against losses in
accordance with one or several insurance contracts regarding one
and the same insurance risk is less than the value of the
insurance object (under-insurance), an insurer shall pay
insurance benefit in the proportion which exists between the sum
insured and this value, unless it is otherwise provided for in
the insurance contract.
Section 47. Change of Owner
(1) If the owner of an insured immovable property changes, the
insurance contract shall be in force in favour of the new owner
one month after the change of the owner of the immovable property
is registered with the Land Registry.
(2) The provision referred to in Paragraph one of this Section
shall not be in force in cases of expiry of the term of a
contract before the documents necessary for the change of
ownership rights are drawn up or before the new owner has entered
into another insurance contract prior to the expiry of the term
of validity of the abovementioned contract.
(3) If the owner of an insured movable property changes and
there is no other agreement in effect with the insurer, the
insurance contract shall expire at the moment when the movable
property is transferred to its new owner.
(4) If the owner of the movable or immovable property dies,
the insurance contract shall remain in effect until the
confirmation of an heir in inheritance law, except when the
insurance period expires earlier or the insurance contract has
been terminated in the cases provided for in this Law.
Chapter
VIII
Civil Liability Insurance
Section 48. Retroactive Period
A civil liability insurance contract may provide that the
losses caused by an event causally linked to the losses which has
occurred in the retroactive period, i.e. prior to the beginning
of the insurance period, shall be compensated if neither of the
parties had been aware of the possibility of occurrence of such
losses at the moment of concluding the contract.
Section 49. Compensation of Losses
after the End of the Insurance Period
A civil liability insurance contract can provide that an
insurer shall compensate the losses which are causally linked to
the event in a retroactive period or insurance period, if a third
party has submitted a claim against the insured person for the
compensation of losses within the time period specified in the
insurance contract after the end of the insurance period.
Section 50. Representation in Civil
Liability Insurance
(1) An insurer has the right to act in favour of an insured
person and represent the interests of the insured person within
the scope of liability limit laid down in the insurance contract
from the moment when an action for the recovery of losses can be
brought against the insured person.
(2) Assuming of the representation obligations shall not imply
that an insurer automatically acknowledges the liability of an
insured person, and it shall not impose a commitment on the
insurer or insured person to reimburse the losses caused to the
third party.
(3) An insurer may not assume the representation obligations
in cases when such fulfilment of obligations can have a direct or
indirect adverse effect on the interests of the insured
person.
Section 51. Agreement with a Third
Person in Civil Liability Insurance
(1) If an insured person has in any way reimbursed or given a
promise to reimburse a third party without the consent of an
insurer, the expenditures that are or possibly can be incurred as
a result of the actions of the insured person shall not be
binding on the insurer.
(2) If, in the occurrence of the insurance risk, the insured
person has taken measures to reduce losses or provided emergency
assistance to the injured person, the insurer shall not therefore
have the right to waive the commitments determined for it in the
insurance contract.
Section 52. Payments of Insurance
Benefit and Other Expenditures in Civil Liability Insurance
(1) An insurer shall disburse insurance benefit to a third
party or insured person in accordance with the provisions of an
insurance contract, if the insured person has compensated losses
to the third party, and this benefit may not exceed the liability
limit laid down in the insurance contract. The insurance benefit
shall be disbursed in accordance with the compensation
principle.
(2) The insurance contract may provide that also expenditures
associated with legal proceedings, expert-examination or other
activities related to the protection of the interests of the
insured person shall be compensated.
(3) In civil liability insurance, the insurance benefit does
not cover the fine, late payment charge or other sanctions
imposed on the insured person.
(4) If an insured person has not participated in the
procedural investigation activities or court proceedings due to
him or her acting with wrongful intent or gross negligence, the
insured person shall reimburse to the insurer all losses caused
by this action or lack thereof.
(5) An insurer may refuse to disburse insurance benefit and
unilaterally terminate an insurance contract without reimbursing
the insurance premium, if the insured person has not performed
any of the activities referred to in Paragraph four of this
Section due to wrongful intent or gross negligence, and therefore
the following actions cannot be taken:
1) the circumstances of the accident which were the basis for
the claim by the third party cannot be fully established;
2) the procedural actions necessary to justifiably reject the
claim of the third party cannot be taken.
(6) If in civil liability insurance one and the same person
has insured his or her liability with several insurers, each
insurer shall pay insurance benefit in proportion to the
liability limit determined in the insurance contracts. Insurers
may agree on other procedures for the disbursement of the
insurance benefit if the person who claims the insurance benefit
agrees thereto.
Section 53. Right of the Third Party
to Bring Action to Court
The third party has the right to bring an action directly
against an insurer only when the laws and regulations
specifically provide such rights for the person.
Section 54. Subrogation Action
(1) In civil liability insurance, an insurer is entitled to
bring a subrogation action against the insured person in the
cases laid down in the laws and regulations governing civil
liability insurance and in the insurance contract. A subrogation
action against an insured person shall lapse within three years
from the day when the insurance benefit is disbursed.
(2) An insurer has the right to cede the right of subrogation
action to other persons and transfer these persons such
information regarding the ceded right of subrogation action which
may facilitate the recovery of losses.
Chapter
IX
Personal Insurance
Section 55. Classes of Personal
Insurance
(1) Life assurance, accident insurance and health insurance
are classes of the personal insurance.
(2) Other classes of insurance related to the physical
condition or health of the person may be additionally included in
a life insurance contract.
(3) Parties to the insurance contract may provide, that, upon
the occurrence of the insurance event, an insurer shall disburse
the sum insured or other sum provided for in the insurance
contract the amount of which or provisions for the calculation of
the amount of which are provided when concluding the insurance
contract. In such cases the compensation principle laid down in
Section 42 of this Law shall not be applied.
(4) In personal insurance, except for life assurance, the
parties may agree in an insurance contract on the application of
the compensation principle to the disbursement of insurance
benefit. In such case the provisions of Section 44 of this Law
shall also be complied with.
Section 56. Insurance Benefit and
Diversity of Payments
(1) If the parties have not agreed in the insurance contract
on the application of the compensation principle, the payments
which an insured person or beneficiary has received from other
sources shall not reduce the commitments of the insurer.
(2) In life insurance contracts with accumulation of funds,
the insurance benefit at the end of the insurance period shall be
formed by the funds accrued in accordance with the provisions of
the insurance contract, but if an insurance event occurs within
the insurance period - the insurance benefit shall be formed by
the funds accrued in accordance with the provisions of the
insurance contract and sum for which the life is insured that is
specified in the insurance contract, unless it is otherwise
agreed upon by the parties in the insurance contract.
Section 57. Beneficiary
(1) In life and accident insurance contracts, an insured
person has the right to indicate one or several persons -
beneficiaries who will receive the insurance benefit in the event
of the death of the insured person, and also to refuse from a
beneficiary or to substitute these persons with other persons
during term of validity of the insurance contract by notifying
the insurer thereof.
(2) If an insured person, upon conclusion of an insurance
contract or within the term of validity of this insurance
contract, has not indicated a beneficiary, it shall be determined
at the moment of bringing a claim.
(3) If an insured person has not indicated a beneficiary or at
the moment of bringing a claim it cannot be determined, the
insurance benefit shall be disbursed to the heirs of the insured
person in accordance with the procedures prescribed by the Civil
Law.
(4) A beneficiary has the right to decline this status.
Section 58. Right of a Beneficiary
to Become Acquainted with Insurance Contract
When claiming the insurance benefit after the occurrence of
the insurance event, a beneficiary has the right to request from
an insurer information regarding the insurance contract and
become familiar with it.
Section 59. Additional Requirements
for a Life Insurance Contract
(1) In addition to the requirements laid down in Section 8 of
this Law, a life insurance contract shall indicate:
1) the surrender value or procedures for the calculation of
this value, and provisions for its receipt if the life insurance
contract with accumulation of funds has been concluded;
2) the right of the policy holder to amend the contract by
changing the insured sum, insurance premium and procedures for
its payment;
3) additional benefits to be granted by the insurer (money
funds) and procedures for their calculation and granting if the
life insurance contract with accumulation of funds has been
concluded;
4) in a unit-linked life insurance contract with accumulation
of funds - assets corresponding thereto and the procedures for
the calculation of accumulated funds.
(2) If the term of validity of the life insurance contract
with accumulation of funds is longer than one year, an insurer
shall, not less than once in 12 months, inform a policy holder of
additionally granted benefits (funds), if any are provided for in
the contract, during the term of validity of such insurance
contract.
(3) An insurer shall immediately inform a policy holder and
insured person (unless it differs from the policy holder) of the
following during the term of validity of a life insurance
contract:
1) changes in the firm name, contact details and other similar
information of the insurer which is necessary for the fulfilment
of the contractual commitments of the policy holder and insured
person (unless it differs from the policy holder);
2) changes in insurance provision or laws applicable to the
insurance contract, if they are related to:
a) the time periods for the payment of insurance premiums and
procedures thereof;
b) the procedures for the calculation and granting of benefits
to be granted additionally (funds);
c) the procedures for determining the amount of the surrender
value and amount of accumulated funds and provisions for their
guaranteed disbursement;
d) the insurance premium and sum insured separately for each
insurance risk, as well as the insurance benefit or the
procedures for its determination for each insurance event;
e) in the unit-linked life insurance contract with
accumulation of funds - assets corresponding thereto and the
procedures for the calculation of the sum insured;
f) the procedures for the application of the notice period of
the life insurance contract.
(4) If a life insurance contract with accumulation of funds
has been concluded which provides for profit participation, the
insurer shall, at least once in a year, inform the policy holder
of the accumulated amount of funds (including of profit
participation). If the insurer provides information on the
probable further development of profit participation, it shall
inform the policy holder of differences between actual and
initial data.
(5) If amendments are made to the provisions for operations
with the assets linked to the unit-linked life insurance contract
with accumulation of funds, an insurer shall, after their coming
into effect, ensure that these amendments are available for a
policy holder. The provisions for operations with assets shall be
regarded as available to a policy holder when they are published
in electronic format on the website of the insurer, and the
insurer has indicated the address of the website where such
information is available.
Section 60. Death of the Policy
Holder
In personal insurance in the case of the death of a policy
holder, if the insured person is another person, the commitments
of the policy holder may be taken over by the insured person or
other successor of the commitments of the policy holder by
notifying the insurer thereof within 15 days after the day of
succession of the commitments. The insurer is not entitled to
terminate an insurance contract due to the change of the policy
holder.
Section 61. Harm Caused to Life,
Health or Physical State of a Person
If upon the occurrence of an insurance event the insured
person has died or harm has been caused to his or her health or
physical state, insurance benefit shall be disbursed in
accordance with all concluded insurance contracts which provide
disbursement for such event, except for those cases when the
insurance contract provides for the use of the compensation
principle.
Transitional
Provisions
1. With the coming into force of this Law, the law On
Insurance Contracts (Latvijas Republikas Saeimas un Ministru
Kabineta Ziņotājs, 1998, No. 15; 2000, No. 13, 2002; No. 22;
Latvijas Vēstnesis, 2007, No. 56) is repealed.
2. Section 28, Paragraph two of this Law shall come into force
concurrently with coming into force of the amendment to the Law
on the Rights of Patients (in respect of the rights of a medical
treatment institution to provide information to the insurer.
Informative
Reference to European Union Directives
This Law contains legal norms arising from:
1) Directive 2002/83/EC of the European Parliament and of the
Council of 5 November 2002 concerning life assurance;
2) Directive 2009/138/EC of the European Parliament and of the
Council of 25 November 2009 on the taking-up and pursuit of the
business of Insurance and Reinsurance (Solvency II) (text with
EEA relevance).
This Law has been adopted by the Saeima on 3 May
2018.
President R. Vējonis
Riga, 18 May 2018
1 The Parliament of the Republic of
Latvia
Translation © 2019 Valsts valodas centrs (State
Language Centre)