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ÚRSKURÐARNEFND Í VÁTRYGGINGAMÁLUM Fjármálaeftirlitið · Suðurlandsbraut 32 · 108 Reykjavík · Sími: 525 2700 · Fax: 525 2727 ______ ÚRSKURÐARNEFND Í VÁTRYGGINGAMÁLUM Fjármálaeftirlitið · Suðurlandsbraut 32 · 108 Reykjavík · Sími: 525 2700 · Fax: 525 2727 ________________________________________________________________________________________________________________ Mál nr. 1/2007 M og vátryggingafélagið X v/ greiðslutryggingar. Ágreiningur um bótaskyldu úr greiðslutryggingu vegna sjúkdóms. Gögn. 1. Málskot, móttekið 3.1.2007, ásamt fylgigögnum. 2. Bréf X, dags. 17.1.2007, ásamt fylgigögnum. Málsatvik. Með skriflegri vátryggingarbeiðni, dags. 9.12.2004, sótti M um svokallaða greiðslutryggingu hjá vátryggingafélaginu X. Vátryggingin er tengd greiðsluþjónustusamningi hjá nánar tilgreindum banka og er annars vegar vátrygging vegna tímabundins starfsorkumissis af völdum slyss eða sjúkdóms og hins vegar líftrygging. Nánari fyrirmæli eru í skilmálum um greiðslu bóta úr vátryggingunni. Í fyrrnefndri vátryggingarbeiðni undirritaði M yfirlýsingu um að hann gerði sér grein fyrir að undanskilinn í vátryggingunni er starfsorkumissir sem rekja megi til ástands hans fyrir töku vátryggingarinnar. Jafnframt staðfesti M m.a. að við undirritun beiðninnar og síðustu sex mánuði á undan hafi hann verið heilsuhraustur og að fullu vinnufær. Þá er tekið fram í beiðninni að umsækjandi eigi ekki kost á vátryggingunni, ef hann fullnægir ekki þessum skilyrðum. Með tjónstilkynningu, dags. 20.2.2006, tilkynnti M til X að í mars 2005 hafi hann greinst með liðagigt eða iktsýki og sykursýki og í sama mánuði hafi verið fyrsti veikindadagur með fjarveru úr vinnu af völdum sjúkdómanna. Í læknisvottorði heilsugæslulæknis á heilsugæslustöðinni S, dags. 11.4.2006, kemur fram að M hafi greinst með liðagigt í febrúar 2005 og í byrjun sama árs hafi hann einnig greinst með sykursýki. Frá haustinu 2004 hafi hann verið með verki og bólgur í ýmsum liðum. Varðandi sjúkrasögu M síðustu sex mánuði áður en hann undirritaði vátryggingarbeiðnina eru eftirfarandi tilvik skráð í sjúkraskrá S: 20.7.2004: Hækkaður blóðþrýstingur, settur á lyfið Atenolol. 8.8.2004: Leitaði á slysadeild Landspítala –háskólasjúkarhúss (LSH) með frosna öxl. Mun hafa verið sprautaður í öxlina og settur á bólgueyðandi lyf. 6.10.2004: Hafði leitað til hjartalæknis vegna háþrýstings. Lögð hafi verið drög að áreynsluprófi sem M fór ekki í. 7.12.2004: Leitaði á bráðamóttöku LSH í Fossvogi með verk í vinstra hné og væga bólgu. Stungið var á liðnum og tappað af 15 ml af tærum liðvökva sem sendur var í rannsókn. Fékk bólgueyðandi töflu og átti tíma hjá heimilislækni daginn eftir og vísað til eftirlits hjá honum. 8.12.2004: Við skoðun á heilsusgæslustöðinni er lýst þreifieymslum og verkjum við hreyfingu, en ekki mikill vökvi. Var grunur um slitgigt í hnénu og var sprautað í það með sterum. Næst kom M til læknis þann 25.1.2005 vegna verkja í hæl og bólgu og verkja í hægri hendi. Við skoðun þá greindust liðbólgur og vaknaði grunur um liðagigt. Var honum vísað til gigtarlæknis. Í læknisvottorði sérfræðings í lyflækningum og gigtsjúkdómum, dags. 13.10.2006, segir að nálægt árinu 1978 hafi M byrjað að fá verki og þá mest á mjaðma- og axlasvæði og hafi þá verið greindur með “slitgigt í mjöðm”. Eftir það hafi hann haft verki hér og þar og á árinu 1993 hafi hann dvalist á Reykjalundi og farið í ítarlegar rannsóknir. Frá hausti 2004 hafi honum farið versnandi ÚRSKURÐARNEFND Í VÁTRYGGINGAMÁLUM 2 af einkennum, aðallega verkjum í hálsi, herðasvæði og í öxlum, en síðan í vaxandi mæli frá desember 2004 vegna verkja í hné og í kjölfar þess í tábergi og smáliðum handa. Álit. Samkvæmt gögnum málsins er ljóst að frá haustinu 2004 bjó M við versnandi heilsu vegna einkenna í hálsi, herðasvæði og í öxlum. Þann 7.12.2004, eða tveimur dögum áður en hann sótti um vátrygginguna, leitaði hann á bráðamóttöku Landspítala –háskólasjúkrahúss vegna verkja og bólgu í vinstra hné. Hann hafði ekki verið heilsuhraustur síðustu sex mánuði fyrir töku vátryggingarinnar. Af þeim sökum uppfyllti hann ekki skilyrði, sem fram koma í vátryggingarbeiðninni, til að eiga kost á vátryggingunni. Hefði X því ekki tekið á sig vátrygginguna hefði það haft vinteskju um hvernig heilsufari M var háttað síðustu sex mánuði áður en hún var tekin. Samkvæmt 1. mgr. 6. gr. laga nr. 20/1954 um vátryggingarsamninga, sem í gildi voru er vátryggingin var tekin, telst X þegar á því tímamarki hafa verið laust undan vátryggingarsamningnum. Af því leiðir að M á ekki rétt til bóta úr vátryggingunni. Niðurstaða. M á ekki rétt til bóta úr greiðslutryggingu hjá X. Reykjavík, 30. janúar 2007. Rúnar Guðmundsson hdl. Valgeir Pálsson hrl. Jón Magnússon hrl. ÚRSKURÐARNEFND Í VÁTRYGGINGAMÁLUM Fjármálaeftirlitið · Suðurlandsbraut 32 · 108 Reykjavík · Sími: 525 2700 · Fax: 525 2727 ________________________________________________________________________________________________________________ Mál nr. 2/2007 M og Vátryggingafélagið X v/A og Vátryggingfélagið Y v/B Árekstur við bensínstöð að Ártúnshöfða þann 18.11. 2006 Gögn. 1. Málskot móttekið 04.01. 2007, ásamt fylgiskjölum. 2. Bréf vátryggingafélags B til nefndarinnar, dags. 10.01. 2007. 3. Bréf vátryggingafélags A til nefndarinnar, dags. 15.01. 2007. Málsatvik. Fyrirliggjandi gögn upplýsa um aðdraganda máls þessa. Áreksturinn varð þegar A var ekið af stað frá bensíndælu í þann mund sem B var ekið vinstra megin framhjá A og beygt til hægri. Vátryggingafélögin telja að ökumaður A beri ábyrgð á árekstrinum fyrir að gæta ekki nægjanlegrar varúðar er hann ók af stað úr kyrrstöðu sbr. 3. mgr. 25. gr. umferðarlaga nr. 50/1987. M telur að ökumaður B hafi ekið óvarlega, hann hafi ekið á ”nokkurri ferð og svínaði fyrir mig...” Álit. Þegar tekið er mið af fyrirliggjandi gögnum ber ökumaður A ábyrgð á árekstrinum fyrir að gæta ekki nægjanlega að annarri umferð er hann ók af stað sbr. 3. mgr. 25. gr. umferðarlaga. Fyrirliggjandi frásögn starfsmanns bensínstöðvarinnar gefur ekki tilefni til að leggja ábyrgð á B þrátt fyrir að starfsmaðurinn telji að B hafi verið á ”þónokkurri ferð”. Niðurstaða. Ökumaður A ber ábyrgð á árekstrinum. Reykjavík 30. janúar 2007 ___________________________ Rúnar Guðmundsson hdl. ___________________________ ___________________________ Valgeir Pálsson hrl. Jón Magnússon hrl. ÚRSKURÐARNEFND Í VÁTRYGGINGAMÁLUM Fjármálaeftirlitið · Suðurlandsbraut 32 · 108 Reykjavík · Sími: 525 2700 · Fax: 525 2727 ________________________________________________________________________________________________________________ Mál nr. 3/2007 M og Vátryggingafélagið X v/ bifreiðarinnar A. Ágreiningur um bótaskyldu vegna tjóns á eftirvagni. Gögn. 1. Málskot, móttekið 4.1.2007, ásamt fylgigögnum. 2. Bréf X, dags. 18.1.2007, ásamt fylgigögnum. Málsatvik. Þann 4.10.2006 var vörubifreiðinni A ekið norður þjóðveg nr. 76, Siglufjarðarveg. A dró eftirvagn í eigu M. Á vagninum var beltagrafa, um 36 tonn að þyngd. Á móts við Mánárskriður varð eldur laus í hjólabúnaði eftirvagnsins. Skemmdir urðu á eftirvagninum auk skemmda á hjólabúnaðinum. Eigandi og ökumaður A kvaðst hafa verið að koma frá Reykjavík. Hafi hann stöðvað bifreiðina um leið og hann varð eldsins var og tekið beltagröfuna ofan af vagninum til að forða henni frá skemmdum. Hann hafi haft vagninn að láni hjá M. Ökmaðurinn taldi að legur í hjólabúnaði eftirvagnsins hafi gefið sig og við það myndast mikill hiti sem hafi leitt til þess að eldur kviknaði í dekkjum og loftpúðum. Í málskoti segir að færa megi sterk rök að því að lega hafi gefið sig og það hafi valdið tjóninu. A var vátryggð lögboðinni ábyrgðartryggingu hjá Vátryggingafélaginu X. Hefur félagið fallist á að greiða bætur vegna tjóns á eftirvagninum að undanskildum kostnaði við viðgerð á öxli sem bilunin er rakin til. M krefst þess að kostnaður verði einnig bættur úr ábyrgðartryggingu A, auk bóta fyrir afnotamissi “þar sem viðgerð hefur dregist allt of lengi”. Álit. Ekki virðist deilt um það með aðilum að eldinn, sem kviknaði í hjólabúnaði eftirvagnsins, megi rekja til bilunar í legu í hjólinu. Deilt er hins vegar um það hvort tjón á öxli eftirvagnsins skuli bætt úr ábyrgðartryggingu A á grundvelli ábyrgðarreglu 1. mgr. 88. gr. umferðarlaga nr. 50/1988, en þar er mælt fyrir um það að sá sem ber ábyrgð á skráningarskyldu vélknúnu ökutæki skuli bæta það tjón sem hlýst af notkun þess enda þótt tjónið verði ekki rakið til bilunar eða galla á tækinu eða ógætni ökumanns. Eftirvagn, eins og hér um ræðir, er ökutæki sem er hannað til að vera dregið af öðru ökutæki og aðallega er ætlað til vöruflutninga, sbr. skilgreiningu á slíku tæki í 2. gr. ufl. Örsök eldsins er bilun í legu í hjólabúnaði eftirvagnsins. Þegar litið er til þess að vagninn er hannaður sérstaklega til að vera dreginn af öðru ökutæki, verður eins og hér stóð á ekki fallist á að tjónið verði rakið til notkunar A í skilningi 1. mgr. 88. gr. ufl. Tjón það, sem deilt er um í málinu, verður því ekki bætt úr ábyrgðartryggingu A. Þegar af þeirri ástæðu verður afnotamissiskrafa M heldur ekki tekin til greina. Niðurstaða. Tjón á eftirvagni í eigu M, sem deilt er um í máli þessu, bætist ekki úr ábyrgðartryggingu A. Reykjavík, 7. febrúar 2007. Rúnar Guðmundsson hdl. Valgeir Pálsson hrl. Jón Magnússon hrl. ÚRSKURÐARNEFND Í VÁTRYGGINGAMÁLUM Fjármálaeftirlitið · Suðurlandsbraut 32 · 108 Reykjavík · Sími: 525 2700 · Fax: 525 2727 ________________________________________________________________________________________________________________ Mál nr. 4/2007 M og Vátryggingafélagið X v/A sem var með hjólhýsi og v/B sem var með tjaldvagn Árekstur við mætingu bifreiða á Þjóðvegi 1 um Berufjörð 06.07. 2006 Gögn. 1. Málskot móttekið 05.01. 2007, ásamt fylgiskjölum. 2. Bréf vátryggingafélagsins til nefndarinnar, dags. 22.01. 2007.
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