Claims Made Clauses

The “claims made” clauses in civil liability insurance contracts are regulated in article 73, paragraph 2, of the Spanish Insurance Contract Law (Law 50/1980 of October 8th). This paragraph contains two subsections that describe two types of temporary delimitation clauses, i.e., claims occurring clauses and claims made clauses.

The first of these clauses circumscribes the coverage of the insurer to the cases in which the damage has occurred during the policy period but claim of the injured party has taken place within a period of time, not less than one year, from the termination of the contract. In other words, these clauses determine that the coverage of the policy is limited to those events that occurred during the term of the contract if the claim can be made in a period of no less than a year from the termination of the insurance contract.

The second would be the one that circumscribes the coverage of the insurer to the cases in which the claim of the injured party is made during the term of the policy provided that, in this case, such coverage extends to incidents that take place during the policy or a retroactive date that cannot be less than one year. Therefore, in this type of clause the claim must be made within the validity of the contract although the fact that gives rise to the responsibility may have occurred previously.

In other words, in a civil liability policy, an error or omission occurred during the term of the policy will remain covered even if its harmful effects are discovered and communicated to the insurance company after the expiration of the policy but within the term agreed upon in the claims made clause (which cannot be less than one year). However, under a claims occurrence clause, losses will only be covered as a result of an error or negligence when they have been claimed to the insurer during the term of the policy, but in such case the error may have taken place at least one year before the entry into force of the policy.

Given that these clauses limit the rights of the insured, their validity is conditional on including an the extended period to make the claim or including a retroactive date, whatever the case may be, and also on their being specially highlighted in the policy and being expressly accepted in writing, as required by Article 3 of the Insurance Contract Law.

Having examined the question of whether the requirements of both subsections must be met cumulatively, the Supreme Court, in judgment No. 185/2019 of March 26, 2019, has determined that it is not necessary for a temporary delimitation clause to simultaneously meet the requirements of both subsections. The Supreme Court has interpreted that each subsection regulates a different type clause, with its own coverage requirements.