They refuse your life cover over the health questionnaire
Last updated 2026-09-01 · Reviewed by Jaime Piñeira Pardo, registered with the ICAM bar, no. 138826
The short answer
Leaving out a health detail is not enough to lose the cover. The insurer is released only if it proves intent or gross fault and only if the questionnaire asked specifically about that circumstance. In every other case the benefit is reduced in proportion, not lost. The action is time barred after five years, because this is personal insurance.
Your husband took out life cover tied to the mortgage. At the branch he filled in an eight question general form that the employee ticked as they talked, and he signed at the foot without keeping a copy. Four years later he dies and the insurer refuses to pay the 180,000 euros, saying he failed to declare high blood pressure treated before the policy began. Meanwhile the bank keeps demanding the loan instalments from you. Nobody has yet shown you the questionnaire with the questions that were actually asked.
The case, in five lines
- What is brought
- An action to enforce the life insurance contract: the beneficiary claims the agreed benefit plus the insurer's late payment interest, disputing that there was any intent or gross fault in the health declaration.
- Before which court
- The Civil section of the Tribunal de Instancia (the first-instance court), through whichever declaratory route matches the amount claimed under the Ley de Enjuiciamiento Civil (the Spanish civil litigation statute).
- Deadline
- Five years from the moment the action could be brought, because life cover is personal insurance under Article 23 of the Insurance Contract Act. Running against the insurer there is also the one year period of Article 89 for challenging the contract.
- Who can bring it
- The beneficiary named in the policy and, where the cover secures a loan, also the policyholder or the heirs for whatever exceeds the outstanding debt.
- Financial risk
- If the court finds intent or gross fault in the declaration, the claim is dismissed and you may bear the costs. The medical report assessing how the condition affected the risk is paid up front and is not always recovered.
With no specific questionnaire there is no duty to breach
Article 10 of the Insurance Contract Act does not require you to declare everything you know about your health. It requires you to declare, before the contract is concluded and in accordance with the questionnaire submitted by the insurer, the known circumstances that may affect the assessment of the risk. The scope of the duty is set by the questionnaire, and it is the insurer, not you, that drafts and submits it.
The same paragraph closes the circle with two express exemptions. The policyholder is released from the duty if the insurer submits no questionnaire at all, and also where, even having submitted one, the circumstances that may affect the assessment of the risk are not covered by it. A general question about whether you enjoy good health does not cover a specific condition that nobody asked about.
That is why the decisive document in the matter is the questionnaire itself, with its questions and its answers, and not the summary the company transcribes into its rejection letter. If the form was filled in by the employee while they talked and the insured merely signed at the foot, what must be shown is exactly what was asked, and that proof falls on the party alleging the breach.
The general rule is to reduce the benefit, not to refuse it
Article 10 draws a sharp distinction between two consequences. If the loss occurs before the insurer declares the contract rescinded, the benefit is reduced in proportion to the difference between the premium agreed and the one that would have applied had the true extent of the risk been known. Only where there was intent or gross fault by the policyholder is the insurer released from payment. Outright refusal is the exception.
That rule turns the case into an arithmetical exercise that insurers tend to avoid. They must be asked what premium they would have charged had they known of the condition, because the percentage of reduction comes out of that figure. In many policies the honest answer is that they would have accepted it with a modest surcharge, and the beneficiary then receives almost all of what was agreed rather than nothing.
Article 10 also fixes how and when the insurer may rescind: by a declaration addressed to the policyholder within one month of learning of the reticence or inaccuracy. If the company learnt of the fact earlier and stayed silent while continuing to collect premiums, the rescission comes too late and the benefit is owed in full.
After one year the life contract can no longer be challenged
Article 89 is the beneficiary's strongest defence and the one most often overlooked. For life insurance it provides that the insurer may not challenge the contract once one year has passed from the date it was concluded, unless the parties fixed a shorter period in the policy and, in any event, unless the policyholder acted with intent.
The practical effect is simple: on a policy signed four years ago, arguing reticence is no longer enough. The insurer has to allege and prove intent, that is, a conscious concealment aimed at obtaining cover it knew would have been refused. Gross fault, which sufficed during the first year, no longer avails it once the period has passed.
The article itself refers otherwise to the general provisions of the Act and carves out a single question, an inaccurate declaration about the insured's age, which has its own rule in the following article. Outside that case, the one year period applies to any reticence or inaccuracy affecting the assessment of the risk.
Cancer overcome five years ago no longer has to be declared
Article 10 incorporates a recent and very specific rule: the policyholder of a life insurance contract is not obliged to declare whether he or the insured has suffered cancer once five years have passed since the end of radical treatment without any subsequent relapse. This is not a recommendation, it is a statutory exemption from the duty to declare.
The provision goes further and ties the company's hands: once that period has passed, the insurer may not take oncological history into account for the purposes of taking out the insurance, and any discrimination or restriction on that ground is prohibited. If the refusal rests on such a history, there is no reticence to argue about, there is a refusal contrary to the law.
Relying on it requires two dates from the medical records: the date radical treatment ended and confirmation that there was no later relapse. With those two facts the argument is raised in the very first letter, because it changes the ground of the matter entirely and does not depend on what the questionnaire said.
Five years to claim, with interest running from the loss
Article 23 provides that actions arising from an insurance contract are time barred after two years for property insurance and after five for personal insurance. Life cover is personal insurance, so the beneficiary has the longer period, which matters when the estate becomes complicated or when the policy only surfaces months after the death.
To the benefit is added the default interest of Article 20, which expressly names the beneficiary in life insurance. The insurer is in default if it fails to perform within three months of the loss or to pay the minimum sum owed within forty days of the notice, and the interest is the statutory rate increased by fifty per cent, which after two years does not fall below twenty per cent.
It is also worth demanding the complete contract. Article 5 requires the insurance contract and any amendments to be made in writing, and requires the insurer to hand the policyholder the policy or at least the provisional cover document. If the company cannot produce the document it says was signed, its account of what was declared stands on nothing.
How we run the case, step by step
- 1
Demanding the complete file from the insurer
We demand the signed questionnaire itself, the policy, the insurance application and the rejection letter with its date. Whatever the company fails to produce when asked in good time will hardly be produced later with any credibility.
- 2
Reconstructing the medical history
We obtain the dates of diagnosis, treatment and discharge, and set them against the date the contract was concluded. The chronology decides whether a known circumstance existed before signing and whether the questionnaire asked about it.
- 3
Medical assessment of the effect on the risk
A doctor reports on whether the undeclared condition bore any relation to the cause of death and what premium surcharge it would have meant. That report supports proportional reduction against the outright refusal the company is seeking.
- 4
Formal demand and prior negotiation
A reasoned letter is sent relying on the Article 89 period, demanding the proportional reduction figure and warning of default interest. It also serves as a documented attempt at agreement before going to court.
- 5
Claim before the Civil section
We claim the full benefit and, in the alternative, the proportionally reduced one, plus interest from the date of death. The burden of establishing intent or gross fault is placed where it belongs, on the insurer.
- 6
Applying the payment and closing the loan
If the policy secured a mortgage, we ensure the payment is applied to cancel the debt and that any surplus reaches the beneficiaries, and we also claim back the instalments overpaid while the refusal lasted.
The evidence that decides the case
- The health questionnaire itself, with the questions as they were put and the answers ticked, not the summary transcribed by the company.
- The medical records with the dates of diagnosis, treatment and completion, set against the date the contract was concluded.
- The dated rejection letter, which allows us to check whether the insurer respected the one month period for declaring rescission.
- The receipts for premiums collected after the company had access to the insured's medical data.
- An independent medical report on the relationship between the undeclared condition and the cause of the loss.
- The death certificate and the register of death cover policies, which reveal policies the family did not know existed.
What closes the door
- Accepting the refund of premiums the insurer offers. That payment is later presented as agreement with the rescission of the contract and makes claiming the benefit harder.
- Arguing only about whether the insured concealed something. The decisive question is twofold: whether the questionnaire asked about that circumstance and whether there was intent or gross fault, which the company must prove.
- Forgetting the one year period of Article 89 in older policies. Without proven intent, the challenge to the contract comes too late and the debate about reticence becomes pointless.
- Signing a form filled in by someone else and keeping no copy. Without the document there is no way to establish what was asked, and that is the heart of the whole matter.
- Letting the five years of Article 23 slip by because the estate drags on. The beneficiary's period runs regardless of how the inheritance is progressing.
The law that applies
- Art. 10 LCS. Before contracting, the policyholder must declare, in accordance with the questionnaire submitted by the insurer, the known circumstances affecting the assessment of the risk, and is released if there is no questionnaire or if the circumstances are not covered by it. The insurer may rescind within one month of learning of the inaccuracy. If the loss occurs first, the benefit is reduced in proportion, save for intent or gross fault, which release the insurer. Cancer overcome five years earlier with no relapse need not be declared. BOE-A-1980-22501
- Art. 89 LCS. In life insurance, reticence or inaccuracy by the policyholder is governed by the general provisions of the Act, but the insurer may not challenge the contract once one year has passed since it was concluded, unless the policy sets a shorter period and, in any event, unless the policyholder acted with intent. An inaccurate declaration about the insured's age is excepted and governed by the following article. BOE-A-1980-22501
- Art. 5 LCS. The insurance contract and any amendments or additions must be made in writing, and the insurer is obliged to hand the policyholder the policy or at least the provisional cover document, except in classes where special provisions do not require a policy to be issued. BOE-A-1980-22501
- Art. 20 LCS. It governs the insurer's default, which reaches in particular the beneficiary of life cover. Default arises if performance does not come within three months of the loss or the minimum sum owed is not paid within forty days of the notice. Interest is imposed by the court of its own motion, is the statutory rate increased by fifty per cent and after two years may not fall below twenty per cent, save for a justified reason or one not attributable to the insurer. BOE-A-1980-22501
- Art. 23 LCS. Actions arising from an insurance contract are time barred after two years for property insurance and after five for personal insurance, the category that includes life cover. BOE-A-1980-22501
Each article checked against the consolidated text published in the BOE (the Spanish official gazette).
Frequently asked questions
The bank employee filled in the questionnaire. Does that harm me?
On the contrary, it usually helps. Article 10 measures the duty by the questionnaire the insurer submits, and if the questions were generic or were never really put, circumstances not covered by it fall outside the duty to declare. The first step is to obtain the document itself: when the form appears with boxes ticked mechanically and no specific questions, the accusation of reticence loses its basis.
Can the insurer end up paying nothing at all?
Only if it proves intent or gross fault by the policyholder. Outside that case, Article 10 requires the benefit to be reduced in proportion to the difference between the premium agreed and the one that would have applied had the true risk been known. That is why it should be asked from the outset to quantify that surcharge: if it does not, the only alternative to paying in full is left unsupported.
The policy was signed six years ago. Can they still dispute it?
Only by alleging and proving intent. Article 89 prevents the insurer from challenging a life contract once a year has passed since it was concluded, the only exceptions being the policyholder's intent and a shorter period fixed in the policy. Gross fault, which would have sufficed during that first year, no longer avails it, and that distinction usually decides the matter.
I had cancer and recovered. Did I have to declare it?
If five years had passed at the time of contracting since the end of radical treatment with no later relapse, no. Article 10 expressly exempts you from declaring it and further prohibits the insurer from taking oncological history into account for the purposes of contracting, along with any discrimination or restriction on that ground. A refusal resting on that history is not a contractual defence, it is a refusal contrary to the law.
The cover secured the mortgage. Who claims, the bank or me?
The claim belongs to whoever is named beneficiary in the policy, which in these products is usually the lender up to the outstanding debt. That does not leave you out: the policyholder or the heirs keep an interest in the surplus and in the instalments that went on being paid during the refusal. Both claims are brought together so the cover does the job it was bought for.
This guide explains how the action works in general. It does not replace the study of your own case: deadlines depend on when things happened and on what you have done since.