{"id":21620,"date":"2026-06-29T07:46:26","date_gmt":"2026-06-29T06:46:26","guid":{"rendered":"https:\/\/belzuz.com\/?post_type=publicacion&p=21620"},"modified":"2026-06-26T10:09:53","modified_gmt":"2026-06-26T09:09:53","slug":"the-13-3-million-ruling-on-hypoxia","status":"publish","type":"publicacion","link":"https:\/\/belzuz.com\/en\/publicacion\/the-13-3-million-ruling-on-hypoxia\/","title":{"rendered":"The 13.3 million ruling on hypoxia: a turning point for healthcare liability and a mirror revealing the absurdity of Article 20 of the LCS"},"content":{"rendered":"

Introduction<\/strong><\/h2>\n

Much has been written in recent weeks regarding the much-discussed 13 million ruling (which is not actually 13), and here at the Insurance Department of Belzuz Abogados we did not want to be left out. However, the purpose of this article is not to analyse the grounds for this judgement \u2013 a judgement which, incidentally, nobody seems to have noticed is a first-instance ruling \u2013 but rather to draw attention to the award of interest under Article 20.<\/p>\n

It is necessary to reflect on the multiplier effect of the default interest under Article 20 of the Insurance Act (LCS), which pushes the final amount of the award to unprecedented levels. More than half of the award is not compensation, but a financial penalty. And this is where the system creaks.<\/p>\n

The real elephant in the room: the significance of Article 20 of the LCS in this type of award<\/strong><\/h2>\n

Article 20 of the LCS provides for a particularly severe regime of default interest in cases where the insurer fails to pay the due benefit on time. This mechanism, which originated in 1980, was intended to serve the legitimate purpose of combating unjustified delays in the payment of compensation and to strengthen the protection of the injured party against delaying tactics.<\/p>\n

However, the application of this regime in the field of healthcare civil liability now raises serious doubts from the perspective of proportionality and its compatibility with the current reality of the insurance market. Regulatory developments in the sector, increased supervisory and solvency standards, and the sophistication of claims management make it difficult to apply the rationale that inspired the provision in 1980 to the present day without qualification.<\/p>\n

Nor should we overlook the strict rigour with which insurers currently manage claims from the very first notification and the extremely high standards to which they are held.<\/p>\n

At present, this system of interest is seen as unfair, disproportionate and bordering on unjust enrichment, penalising insurers who have diligently carried out their duties from the very outset of the claims process.<\/p>\n

Added to this is a particularly relevant issue: in medical liability disputes, there are often elements of causal uncertainty, complex expert disputes and particularly difficult quantification processes. These are not, therefore, cases in which a failure to pay can automatically be equated with arbitrary or reluctant behaviour on the part of the insurer. In many cases, the dispute stems from the technical nature of the claim itself and from reasonable disagreement regarding the existence of the damage, its causation or its financial extent.<\/p>\n

Many commentaries on the judgement have been published, but no one seems to be up in arms about such a stratospheric award of interest. Is this figure, then, normal? Is it reasonable to double the amount of compensation?<\/p>\n

Precisely for this reason, it is legitimate to ask whether the current wording of Article 20 of the Insurance Act (LCS) continues to provide a balanced response in this area. Interest which, over the years, can lead to an extraordinary increase in the total award runs the risk of exceeding the system\u2019s compensatory purpose and of having a materially punitive effect, even in cases where there was an objectively well-founded dispute.<\/p>\n

This does not provide redress: it punishes. It is one thing for these interest payments to have a punitive nature \u2013 a feature that is, moreover, enshrined in the wording of the Act \u2013 but it is quite another for such punishment to be imposed, particularly when the insurer has acted correctly from the initial notification of the claim.<\/p>\n

This inevitably leads us to protest against the gradual hollowing out of the substance of Article 20(8). Is there, indeed, any valid ground for opposition by the insurer today? It is disheartening to invoke the justified grounds for opposition under Article 20(8) in a written submission or at a hearing, knowing that any such effort will be in vain.<\/p>\n

In this context, the increasingly restrictive approach with which, in practice, the \u2018justified grounds\u2019 referred to in paragraph 8 of Article 20 itself are being assessed also merits attention. Without questioning the established legal doctrine regarding its restrictive interpretation, it seems reasonable to open a debate on whether the scope currently recognised for excluding the penalty adequately addresses the complexity of certain claims, and in particular those relating to medical malpractice.<\/p>\n

We cannot penetrate the innermost thoughts of the legislator when he devised Article 20; he was probably thinking of motor vehicle claims, but we shall never know. What is abundantly clear, however, is that this regime was never intended for medical liability claims; just as, in 1980, few could have predicted that the Road Traffic Scale would continue to serve as the guiding scale for medical liability in the year 2026.<\/p>\n

Medical claims require complex expert assessments, conflicting reports, years of investigation and technical evidence. It is unreasonable to apply punitive interest to a process which, by its very nature, is slow and complex. And, let\u2019s be honest, nowadays, if an insurer decides not to pay, this is due to well-founded reasons and is in no way arbitrary or spurious.<\/p>\n

Consequences for healthcare liability insurance<\/strong><\/h2>\n

The issue is not merely a matter of principle. The widespread occurrence of court rulings in which interest amounts equal or even exceed the principal sum of compensation introduces a factor of enormous strain into the underwriting of medical malpractice liability insurance. The greater the uncertainty regarding the final cost of a claim, the more difficult it is for insurers to assess the risk, set sustainable premiums and maintain a stable offering in particularly sensitive lines of business.<\/p>\n

This problem takes on particular significance in areas such as gynaecology and obstetrics, where the potential severity of harm and the complexity of establishing causation in claims already push premiums to high levels. If this is compounded by an interest regime capable of multiplying financial exposure over many years, the technical balance of the insurance can be seriously compromised.<\/p>\n

The foreseeable consequences of this situation are well known: rising premiums, greater difficulty in insuring certain risks and a potential withdrawal of cover in high-exposure segments. All of this has an impact not only on insurance companies, but also on healthcare professionals and, indirectly, on the stability of the healthcare system itself.<\/p>\n

From this perspective, the discussion regarding Article 20 of the LCS goes beyond the specific case and has implications for the future sustainability of professional civil liability insurance in the healthcare sector. Protecting the injured party remains an indispensable objective, but care must be taken to ensure that the design of the system does not generate structurally destabilising effects.<\/p>\n

Reforms warranting priority consideration<\/strong><\/h2>\n

Against this backdrop, two lines of thought seem particularly relevant. The first concerns the desirability of moving towards a specific healthcare compensation scale, capable of providing assessment criteria better suited to the unique nature of medical harm and the complexity of this type of claim. A tool of this nature could help to improve predictability, facilitate settlements and reduce litigation in a particularly technical field.<\/p>\n

The second involves reviewing the provisions of Article 20 of the LCS, not to render it meaningless or to weaken the protection afforded to the injured party, but to adapt its application in cases where there are technically complex disputes and the insurer has acted with due diligence . Such a review could include, amongst other issues, a consideration of the level of interest, its accumulation over time and the actual scope that should be recognised for the \u2018justified cause\u2019 referred to in paragraph 8.<\/p>\n

This is not a matter of questioning the need to penalise unjustified delaying tactics. Rather, it is a matter of assessing whether the current framework allows for an adequate distinction to be made between unfounded resistance to payment and the existence of a serious, reasonable and technically complex dispute, as is frequently the case in civil liability in the healthcare sector.<\/p>\n

In this regard, the recent judgement provides a timely opportunity to reopen a debate that has long called for a more nuanced approach, better aligned with the current reality of the sector. The issue does not merely concern the amount of a single award, but the way in which the legal system allocates costs and incentives within the insurance system.<\/p>\n

Conclusion<\/strong><\/h2>\n

At the Insurance Department<\/a> of Belzuz Abogados, S.L.P.<\/a>, as specialists in healthcare civil liability and insurance law, we consider that this ruling invites reflection that goes beyond the specific case. Without needing to anticipate a definitive assessment of the ruling, it does seem clear that the cumulative application of interest under Article 20 of the Insurance Act (LCS) over long periods of time can lead to outcomes of extraordinary financial severity in a field characterised by technical complexity, uncertainty regarding causation and protracted proceedings.<\/p>\n

For this reason, the ruling presents an opportunity to reconsider, with calm and technical rigour, whether the current legal framework continues to strike an appropriate balance between the protection of the injured party, the deterrent function of the system and the sustainability of healthcare civil liability insurance. Postponing this debate indefinitely no longer seems a advisable option.<\/p>\n","protected":false},"featured_media":18937,"template":"","categories":[514],"area-de-practica":[225],"publicaciones":[516],"idioma-publicacion":[71],"areas-practica-publicacciones":[],"class_list":["post-21620","publicacion","type-publicacion","status-publish","has-post-thumbnail","hentry","category-sin-categorizar","area-de-practica-insurance-law","publicaciones-ignacio-montero-pujante","idioma-publicacion-ingles"],"acf":[],"_links":{"self":[{"href":"https:\/\/belzuz.com\/en\/wp-json\/wp\/v2\/publicacion\/21620","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/belzuz.com\/en\/wp-json\/wp\/v2\/publicacion"}],"about":[{"href":"https:\/\/belzuz.com\/en\/wp-json\/wp\/v2\/types\/publicacion"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/belzuz.com\/en\/wp-json\/wp\/v2\/media\/18937"}],"wp:attachment":[{"href":"https:\/\/belzuz.com\/en\/wp-json\/wp\/v2\/media?parent=21620"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/belzuz.com\/en\/wp-json\/wp\/v2\/categories?post=21620"},{"taxonomy":"area-de-practica","embeddable":true,"href":"https:\/\/belzuz.com\/en\/wp-json\/wp\/v2\/area-de-practica?post=21620"},{"taxonomy":"publicaciones","embeddable":true,"href":"https:\/\/belzuz.com\/en\/wp-json\/wp\/v2\/publicaciones?post=21620"},{"taxonomy":"idioma-publicacion","embeddable":true,"href":"https:\/\/belzuz.com\/en\/wp-json\/wp\/v2\/idioma-publicacion?post=21620"},{"taxonomy":"areas-practica-publicacciones","embeddable":true,"href":"https:\/\/belzuz.com\/en\/wp-json\/wp\/v2\/areas-practica-publicacciones?post=21620"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}