Personal injury coverage: who bears the burden of proof?

In a very recent ruling, issued on 15 April, the Court of Perugia – on the subject of accident insurance – ruled that, in disputes concerning the recognition of the right to compensation, the burden of proof lies with the insured party, who must prove not only the dynamics of the accident and the resulting damage, but also the unfoundedness of the company’s objections of inapplicability.

The case at hand concerned an action brought by an insured for compensation of the damage suffered as a result of the accidental amputation of a finger of his hand.

The insurance company involved had denied coverage on the grounds that such damage was excluded by the terms of the policy and that, in any event, the insured had not clarified how the accident had occurred.

In rejecting the claim for compensation, the court accepted the insurance company’s theory, arguing that, on the basis of the burden of proof rule set out in Article 2697 of the Italian Civil Code, it was up to the insured to prove -not only the dynamics of the accident and the resulting damage- but also the existence of insurance cover and therefore his right to the compensation claimed.

The principle that may be deduced from the ruling of the Court of Perugia is that the insured party who wishes to obtain a specific indemnity is held to prove that the case falls within the risks covered under the policy and that any exclusion of liability is unfounded, while the insurance company invoking the exclusion of coverage must provide the corresponding proof.