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Home / Insurance / Should an insurance company pay adjustable claims that are not controversial while another amount is still? | Legal insurance blog for property insurance

Should an insurance company pay adjustable claims that are not controversial while another amount is still? | Legal insurance blog for property insurance



Although appeals decisions do not take precedence in Puerto Rico, they are highlighted as very important persuasive authorities when the Supreme Court has not ruled on the issue in controversy. Recently, two Boards of Appeal ruled on the issue of adjusted amounts that are not controversial in an insurance claim. Both court panels decided that the insurance companies would pay these amounts.

In one of the cases Gonzalez v. MAPFRE . 1 The plaintiff alleged that MAPFRE (insurance company) had breached the insurance. and had not followed Puerto Rico's insurance code when she adjusted her Hurricane Maria claim. The plaintiff then filed a request for a partial summary judgment for the adjusted amount that was not in dispute and claimed that when MAPFRE made the offer, they acknowledged that they owed the amount of $ 7,852.57 for Hurricane Maria damages, therefore this was a settled and

the plaintiff requested the trial court to pay the amount immediately or a precautionary measure to secure payment. MAPFRE filed an opposition to this claim that the main controversy in this case was the amount to be paid, therefore that amount ($ 7,852.57) was not a settled and overdue payment, only the final bid adjustment was made in this claim and if there was no controversy with that amount, a summary judgment should be given in their favor (not the plaintiff's). The plaintiff filed a motion in opposition claiming that MAPFRE's adjustment meant that they acknowledged or acknowledged their guilt and that they could not withdraw from it. The trial court ruled that even if there was no controversy over the amount offered, it could not be considered settled and due because the plaintiff had not accepted it as the total amount of property damage. The trial court denied both parties' requests for summary judgments. The plaintiff requested that the Court of Appeal set aside the decision of the trial court.

The Court of Appeal found that an insurance company during a legal process cannot withdraw or deny the initial adjusted amounts that have been recognized and understood are owed to the insured. 2 This is because they were not in a negotiating position or a possible transaction agreement, on the contrary, it was an offer made as part of their obligation under the insurance code. The Board of Appeal also cited Article 1

123 of the Puerto Rican Civil Code, which states: 3

[W] when a debt has a fixed and unreconciled amount, the creditor may request that the debtor pay the first without waiting for the second to be

the Court of Appeal also considered that "A debt is deemed to be settled when the amount owed is certain and fixed" 4 and "it would be considered a claim that can be claimed when the obligation is not subject to any invalidity and you can demand compliance." 5 Therefore, the Court concluded that the amount claimed by the plaintiff was partly decided and partly unfair. was not invalid and was therefore considered a claim that could be claimed.The plaintiff was entitled to payment of the amount offered without having to wait for the decision on the amount under consideration overs and MAPFRE can not deny or withdraw it, as it is their duty to make the payment as a duty required under the Insurance Code. The Court of Appeal ordered MAPFRE to pay the plaintiff $ 7,852.57 and to continue the legal process against the second amount in controversy. Panel, KLCE2020001033.
2 Carpets & Rugs v. Tropical Reps 175 DPR 615 (2009).
3 Art. 1123 Civil Registry of Puerto Rico, 31 L.P.R.A. sec. 3173.
4 Ramos de Szendrey v Colon Figueroa 153 D.P.R.534 (2001).
5 Guadalupe v. Rodriguez 70 D.P.R. 958 (1950).


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