The case in question
The judgement analyses a claim for alleged medical malpractice, in which the relatives of the deceased patient, having exhausted the administrative remedies for financial liability against the Castilla-La Mancha Health Service (SESCAM) and obtained a final decision dismissing their claim, turned to the civil courts to bring a claim directly against the Health Service’s insurer pursuant to Article 76 of the Insurance Contracts Act.
The Provincial Court applied the established case law of the Supreme Court and dismissed the civil action on three grounds. Firstly, if the injured party opts for the administrative route and allows the decision rejecting the claim to become final by failing to appeal it before the contentious-administrative courts, they cannot subsequently turn to the civil courts to seek compensation or have the liability that has already been denied reviewed. Secondly, a direct claim against the insurer cannot succeed if the Administration’s liability has been ruled out by a final administrative decision. Finally, allowing such a review in the civil courts would encroach upon powers reserved for the contentious-administrative courts and would violate the principle of legal certainty.
The judgement is based primarily on Plenary Supreme Court Judgment 321/2019 of 5 June. In accordance with the legal principle established in that judgment, an aggrieved party who has opted for the administrative route and allowed the decision reached therein to become final cannot subsequently bring a direct civil action against the Administration’s insurer to review the administrative decision.
In the case in question, the claimants initially brought the relevant financial liability proceedings, which concluded with a decision dismissing their claim. As they did not challenge this decision before the administrative courts, the decision became final. Despite this, they subsequently brought a direct action before the civil courts against the insurer of the health authority. The Provincial Court, following the Supreme Court’s case law, dismissed the claim, ordered the claimants to pay the costs, and emphasised that the matter had been settled by Supreme Court Judgment 321/2019.
More than seven years on from that ruling, the recurrence of litigation of this nature confirms the advisability of carefully assessing the procedural consequences of opting for the administrative route and of not challenging the decision dismissing the claim before the administrative courts.
The continuity of this doctrine is evident in various recent rulings. Among these, the following may be cited:
- Provincial Court of Navarre, 3rd Section, 8 July 2026, No. 931/2026, Rec. 481/2024.
- Provincial Court of Madrid, 11th Section, 29 June 2026, No. 274/2026, Rec. 750/2025.
- SAP Madrid, 10th Section, 23 June 2026, No. 229/2026, Rec. 62/2025.
- STS (Civil), 1st Section, 11 December 2025, No. 1820/2025, Rec. 3090/2021
- Supreme Court Ruling (Civil), 1st Chamber, 27 October 2025, No. 1501/2025, Rec. 5617/2020
- Provincial Court of Appeal, Alicante, 4th Chamber, 29 February 2024, No. 64/2024, Rec. 140/2023.
Conclusion
For insurers, this case law provides legal certainty and limits the risk of duplicate or unfounded litigation. The civil courts do not constitute a channel for reviewing a final administrative decision: if the injured party opts to pursue a claim for financial liability and does not challenge its dismissal before the administrative courts, a direct civil action against the insurer cannot succeed.
From the Insurance Department of Belzuz Abogados, S.L.P., as specialists in Healthcare Civil Liability and Insurance Law, we emphasise that this legal principle, reaffirmed in numerous subsequent rulings, must be incorporated into claims management and the definition of the litigation strategy of insurers in the public healthcare sector. In particular, it is essential to verify whether the injured party had previously brought a claim for financial liability, what the outcome was, and whether the decision has become final. The Supreme Court’s doctrine and its application by the Provincial Court of Madrid thus strengthen the defence against claims seeking to reopen, through civil proceedings, matters that have already been definitively resolved in the administrative courts.