This page is part of the overview of Estonian Supreme Court insurance case law. It collects 4 decisions of the Civil Chamber of the Supreme Court (Riigikohus) on this topic, in chronological order, with a short synthesis of the direction of the case law. The summaries are written in our own words; the judgments themselves are available in Estonian only. Abbreviations and citation conventions are explained on the overview page.
Synthesis
VÕS § 452(1) releases the insurer where the insured event was caused intentionally; the provision protects the insurer and does not prohibit agreeing on release for gross negligence as well. In liability insurance VÕS § 513 (intentional and unlawful causation) is the special rule, but the contract may extend the grounds of release; such standard terms are reviewed under VÕS §§ 37-44. Limitations on the scope of cover must be expressed clearly: if a cost covered by default under the statute (e.g. medical expenses) is to be excluded, this must be evident. Conflicting terms are construed in the policyholder's favour.
Decisions
RKTKo 19.12.2005, 3-2-1-144-05
Judgment · paras 11-12 · VÕS § 452(1); gross negligence; liability insurance; VÕS § 513 as lex specialis
The purpose of VÕS § 452(1) is to exclude the insurer's liability for intentionally caused insured events; it does not prohibit agreements releasing the insurer also for the policyholder's gross negligence. In liability insurance VÕS § 513 is a special rule in relation to VÕS § 452(1). The Supreme Court has repeatedly followed this judgment (e.g. 3-2-1-70-11, 3-2-1-150-15, 3-2-1-171-13).
Judgment on riigikohus.ee (Estonian)
RKTKo 22.04.2009, 3-2-1-24-09
Judgment · paras 12 · home insurance; water entering through the sewer; conflicting terms; interpretation in the consumer's favour
One clause of a home insurance policy excluded flood water entering through the sewerage system, while another defined water entering through the sewerage as a result of rising groundwater or flooding as an insured event. The Supreme Court held that the clauses contradicted each other and that the appellate court had failed to apply consumer protection rules requiring unclear terms to be construed in the consumer's favour.
Judgment on riigikohus.ee (Estonian)
RKTKo 07.06.2011, 3-2-1-35-11
Judgment · paras 9, 11-13 · motor own-damage cover; gross negligence exclusion; icy road; speeding; burden of proof; causation
A truck combination left an icy road. The standard terms excluded cover where an employee of the policyholder caused the loss intentionally or by gross negligence.
The Chamber restated the burden of proof: the policyholder proves the insured event; the insurer proves the facts releasing it. Exceeding the speed limit on an icy road is gross negligence (VÕS § 104(4)), but the insurer is released only if causation between the speed and the accident is established (conditio sine qua non).
Procedurally, a court may not refuse the insurer's requests to take evidence (witnesses) and then hold that the insurer failed to prove its defence. One judge dissented on the assessment of gross negligence where road conditions changed abruptly.
Judgment on riigikohus.ee (Estonian)
RKTKo 06.02.2013, 3-2-1-178-12
Judgment · paras 14, 16-18 · travel insurance; medical expenses abroad; VÕS § 476(1); clarity of limitation
The insured injured a knee while skiing in Switzerland; the local doctor considered surgery urgent, but the insurer and its assistance provider took the view that he could return to Estonia for the operation. The Supreme Court held that accident-related medical expenses are, as direct pecuniary loss, covered under VÕS § 476(1), and any exclusion must be clearly stated in the conditions, which it was not. The chamber gave a new judgment itself and awarded the indemnity.
Judgment on riigikohus.ee (Estonian)