Nullity of INS acts for failure to inform about contestability clause and award of damagesNulidad de actos del INS por incumplimiento del deber de informar sobre cláusula de disputabilidad y condena a daños

**IV.- REGARDING THE INESCAPABLE RELATIONSHIP BETWEEN INCONTESTABILITY CLAUSES (CLÁUSULAS DE DISPUTABILIDAD) AND THE RIGHT TO RECEIVE ADEQUATE, TRUTHFUL, AND TIMELY INFORMATION.** This Tribunal, in application of the provisions of articles 33 and 46, last paragraph, of the Political Constitution, the fundamental right to free contracting derived from article 28 of the Political Constitution, and articles 31 et seq. of the Law on the Promotion of Competition and Effective Consumer Defense, and 40 et seq. of the Regulation to that Law, considers the following: **1) Duty to inform the consumer adequately, timely, clearly, truthfully, and sufficiently.** The last paragraph of article 46 of the Political Constitution; subsections c) and d) of article 32 of the Law on the Promotion of Competition and Effective Consumer Defense; 41 and 43 of the Regulation to that Law, establish that the consumer must receive adequate, clear, truthful, timely, and sufficient information regarding all elements that directly affect their consumption decision. Therefore, it is essential that the person intending to take out insurance not only knows sufficiently and timely of its conditions and limitations, but also has a clear awareness that allows them to determine whether or not they can take out the policy and, consequently, whether or not it is viable to insure the person or the property intended. In this regard, the Constitutional Chamber of the Supreme Court of Justice has considered: "...it is notorious that the consumer is at the end of the chain formed by the production, distribution, and commercialization of the consumer goods they need to acquire for their personal satisfaction, and their participation in this process does not respond to technical or professional reasons, but rather to the constant celebration of contracts in a personal capacity. Therefore, their relationship in this commercial sequence is one of inferiority and requires special protection against the providers of goods and services, so that, prior to expressing their contractual consent, they have all the necessary elements of judgment that allow them to express it with complete freedom, and this implies thorough knowledge of the goods and services offered. Included in the foregoing, in a harmonious mix, are several constitutional principles, such as the state's concern for the broadest sectors of the population when they act as consumers, the reaffirmation of individual freedom by facilitating individuals' free disposition of their assets with the greatest possible knowledge of the good or service to be acquired, the protection of health when involved, the ordering and systematization of reciprocal relationships among interested parties, the alignment of international commercial practices with the domestic system, and, ultimately, the greater protection of the inhabitant's functioning in their means of subsistence..." (judgment number 1996-04463 of nine hours forty-five minutes of August thirty, nineteen ninety-six. See in a similar sense, judgment number 1992-01441 of fifteen hours forty-five minutes of June two, nineteen ninety-two). This Tribunal considers that this duty to inform is not fulfilled merely by the fact that the insurance entity and the policyholder state in the contract that the consumer will presumably sign, the text —in this case— of the incontestability clause. Rather, it must be explained beforehand in a timely, truthful, clear, detailed, and sufficient manner to the interested party, what the incontestability clause consists of, what its benefits and limitations are, why it is included in the group life policies that financial entities contract with the National Insurance Institute (Instituto Nacional de Seguros) and into which a person wishing to formalize a loan is automatically included, since ultimately all of this information will allow them to make the decision that best suits their economic interests, in exercise of their fundamental right to free choice, from which the principle of free contracting is derived, especially if, at the time the interested party was included in the group policy, the opening of the insurance market had not yet occurred and, therefore, the defendant entity retained the monopoly thereof; **2) The principle of freedom of contract for consumers in relation to contracts of adhesion.** In the first instance, it is necessary to establish what the essential content of this constitutional principle is, which constitutes the sine qua non requirement for the exercise of the rights established in articles 45 and 46 of the Political Constitution. In this sense, the Constitutional Chamber of the Supreme Court of Justice has established that the essential content of this principle is determined by four elements, namely: "...a) The Freedom to choose the co-contractor; b) The freedom to choose the object of the contract itself and, therefore, the main provision that materializes it; c) The Freedom to determine the price, content, or economic value of the contract stipulated as consideration; d) The equilibrium of the positions of both parties and between their mutual provisions; an equilibrium which demands, in turn, respect for the fundamental principles of equality, reasonableness, and proportionality, according to which the position of the parties and the content and scope of their reciprocal obligations must be reasonably equivalent to each other and, furthermore, proportionate to the nature, object, and purpose of the contract..." (Judgment number 1992-03495 of fourteen hours thirty minutes of November nineteen, nineteen ninety-two). In contracts of adhesion, these elements —which determine the essential content of the principle of freedom of contract— suffer a series of limitations, since the contracting party is limited to accepting or rejecting the conditions that have been previously stipulated by one of the parties, a “decision” that is usually determined by two aspects: that they are only offered that option and that they find themselves in a state of necessity such that they must resort to that sole possibility offered by the market, in order to cover the requirement that obliges them to sign the contract. It is precisely in protection of the safety and economic and social interests of the consumer —established as fundamental rights by the last paragraph of the Political Constitution— that it becomes necessary to effectively safeguard those rights against abusive clauses that adhesion contracts could contain, in order to ultimately guarantee freedom of choice and equality in contracting. In this sense, article 42 of the Law on the Promotion of Competition and Effective Consumer Defense establishes that —to the extent relevant—: "...In contracts of adhesion, their modifications, annexes, or addenda, the effectiveness of the general conditions is subject to the effective knowledge of them by the adhering party or the possibility of having known them through ordinary diligence…"; **3) The scope of incontestability clauses in the Law Regulating the Insurance Contract regarding the consumer's right to information.** It should be highlighted that paragraph 4 of article 7 of that legal body establishes that "...The insurance entity or the insurance intermediaries, as applicable, must provide the members of the insurable group and the insured person with the same information as to the insureds in individual insurance contracts, under the same terms and conditions. In particular, they must be informed about the incontestability clauses and the exclusions of the policy. Failure to comply with this duty to inform renders the application of said clauses ineffective against the insured person…". At this point, it must be noted that while it is true that Law 8956 entered into force as of September 12, 2011, it is also true that prior to its enactment, there already existed in the Costa Rican legal system, constitutional and legal provisions that imposed on the insurance entity or its intermediaries, since 1995 and 1996, the duty to inform the interested party in a timely, truthful, clear, detailed, and sufficient manner, of what the incontestability clause consists of, what its benefits and limitations are, why it is included in the group life policies that financial entities contract with the National Insurance Institute and into which a person wishing to formalize a loan is automatically included, since ultimately all of this information will allow them to make the decision that best suits their economic interests; **4) Corollary.** In summary, the effectiveness of the general conditions of a contract of adhesion is contingent upon the effective knowledge of them by the adhering party or the certain possibility of having known them through ordinary diligence. This aspect is fundamental if one takes into consideration that the aspects determining the essential content of the principle of free contracting are limited in this type of contract. Therefore, it is essential that the consumer has the necessary elements to decide whether or not to choose the option presented to them. For this reason, this Tribunal considers that this duty to inform is not fulfilled merely by the fact that the insurance entity and the policyholder state in the contract that the consumer will presumably sign, the text —in this case— of the incontestability clause. Rather, it must be explained beforehand in a timely, truthful, clear, detailed, and sufficient manner to the interested party, what the incontestability clause consists of and what its benefits and limitations are, since ultimately all of this information will allow them to make the decision that best suits their economic interests. Now, the problem lies not only in the consumer having timely, truthful, clear, and sufficient access to the information required to make their decision, but also in the fact that, in the insurance field, they were presented with only one option —as in this case—, given the monopoly regime that, until the entry into force of the Free Trade Agreement signed between Central America, the Dominican Republic, and the United States of America (December 19, 2008, Executive Decree 35001), the National Insurance Institute held regarding the commercialization of insurance, which prevented consumers from having the possibility of choosing and deciding —based on the information provided— the best option to protect their interests and rights. This was aggravated by the fact that the inclusion of the consumer in the group life policy contracted by the financial entity with the insurance entity is a sine qua non requirement to access a loan, as it constitutes a complementary guarantee to the loan contract (folios 22 and 11 of the administrative file of the general and specific conditions of the group life policy [Value 003]).

Vo.- ON THE SPECIFIC CASE [...] it is necessary to highlight that the administrative file on the general and specific conditions of the group life policy number [Value 003] does not contain any document bearing the signature of the plaintiff for the purpose of having her included in the indicated policy, or recording that she was informed about the content of said insurance contract, especially the incontestability clause. Likewise, it cannot be inferred that, by having signed other credit contracts with the Banco Popular y de Desarrollo Comunal and with Coocique R.L., which carried associated group life policies —in which she was included as of May 2005 and September 2006, respectively—, she was given truthful, timely, and adequate information regarding the scope, content, benefits, and limitations of the incontestability clause contained in those policies, which would have allowed her to have a clear awareness of what they consisted of. Moreover, in any case, these are different life policies (folios 44 to 46, 86 to 89 of the judicial file). Now, the omission to inform the plaintiff in a clear, truthful, and timely manner about the content and scope of the incontestability clause acquires relevance because, in the insurance field, the plaintiff was presented with only one option. Given that on September 16, 2007 —the date [Name 001] was included in the group life policy number [Value 003] (folios 24, 15 of the administrative file of the general and specific conditions of the group life policy [Value 003])— it is public and notorious that, by that date, the National Insurance Institute operated under a monopoly regime for everything related to the commercialization of insurance. This is because the opening of the insurance market only became effective upon the entry into force of the Free Trade Agreement signed between Central America, the Dominican Republic, and the United States of America (December 19, 2008, Executive Decree 35001). This circumstance prevented her from having the possibility of choosing and deciding —based on the information that should have been provided to her— the best option to protect her economic interests and her fundamental rights. This implies that, faced with the state of necessity to access a loan to acquire a vehicle, she was forced to accept the conditions of the group life policy —in which the incontestability clause is included—. This resulted in the essential content of her fundamental rights to protect her safety, her economic and social interests, to the freedom to choose the option that best protected those interests, and to equality in contracting, becoming nugatory. By reason of the foregoing, and given that in this specific case, the challenged actions, official letters INSCR-8118-2009 of December 23, 2009, and INSCR-4185-2010 of May 24, 2010, issued by the Executive Director of the INS Headquarters in Cartago, are based on the incontestability clause contained in the general and specific conditions of the group life policy number [Value 003] (folios 44 and 40 of the administrative file of the claim), this Tribunal declares the absolute nullity of said actions. This is because the defendant entity's breach of its duty to inform renders the application of said clauses ineffective to the detriment of the plaintiff, based on the provisions of articles 33 and 46, last paragraph, of the Political Constitution, the fundamental right to free contracting derived from article 28 of the Political Constitution, and articles 31 et seq. of the Law on the Promotion of Competition and Effective Consumer Defense, and 40 et seq. of the Regulation to that Law. […].

VIo.- REGARDING THE CLAIMS FOR DAMAGES FOR MATERIAL LOSS [...] Based on what was indicated in considerando V of this judgment, this Tribunal considers that, in accordance with the provisions of article 122.m.ii of the Contentious Administrative Procedure Code, it is appropriate to order the INS to pay the material damages caused to the plaintiff, given its refusal to apply in her favor the amount for which she was included in the group life policy number [Value 003], based on the incontestability clause of whose content she was not informed in a clear, timely, and truthful manner. These material damages consist of both the sums paid by the plaintiff up to the date of issuance of this judgment, and the amounts still pending payment (considerando II, separate section b of this judgment), originating from the credit transaction maintained with Credi Q Inversiones CR, S.A. […]

VIIo.- REGARDING SUBJECTIVE MORAL DAMAGES [...] Now, the radius of coverage of the rules and principles that comprise and constitute the system of administrative liability transcends the reparation of purely material damages to include within its area of protection damages of a non-pecuniary nature. This arises as a natural consequence of a type of liability that is anchored in damage and risk. The foregoing is based on the doctrine of canon 41 of the Constitution, by establishing the principle of full reparation of the damage, which is conferred as a right to individuals in their individual framework, in their property, or in their moral interests. It concerns the due protection against infringements upon the legal situation of the person, which includes their patrimonial assets, but also their inner sphere. This is indeed inferred from numeral 197 of the General Law of Public Administration, a provision that states: "Liability shall lie for damage to purely moral assets, as well as for the moral suffering and physical pain caused by death or by the injury inflicted, respectively." Thus, it is evident that moral damages are verified when the sphere of non-pecuniary interest of the individual is injured. However, keeping in mind that their violation can generate patrimonial consequences, they can certainly be quantified. Therefore, a distinction must be made between subjective moral damages and objective moral damages. On this subject, national jurisprudence is abundant. From this point, it is worth citing judgment 316-F-2006 of sixteen hours twenty minutes of June twenty-first, two thousand six, of the First Chamber of the Supreme Court of Justice, in which it states: "This Chamber has already had the opportunity to rule on the concept, scope, and legal nature of this type of damage. Thus, for example, in judgment no. 151 of 15 hours 20 minutes of February 14, 2001 (in which resolution no. 112 of 14 hours 15 minutes of July 15, 1992 is cited) it indicated: 'VIII.- Moral damages (also called incorporeal, non-pecuniary, affective, etc., in doctrine) are verified when the sphere of non-pecuniary interest of the individual is injured. However, as its violation can generate patrimonial consequences, it is appropriate to distinguish between "pure" subjective moral damages, or of affection, and objective or "objectivized" moral damages. Subjective moral damages occur when a non-pecuniary right has been injured, without affecting the patrimony, usually involving an unjust disturbance of the individual's mental conditions (displeasure, discouragement, despair, loss of satisfaction in living, etc., e.g., the offense against honor, dignity, privacy, the so-called damage to life in relation, affliction due to the death of a family member or loved one, etc.). Objective moral damages injure a non-pecuniary right with repercussions on the patrimony, that is, they generate economically assessable consequences (e.g., the case of the professional who, due to the attributed act, loses their clientele in whole or in part). This distinction serves to delineate the damage suffered by the individual in their social consideration (good name, honor, honesty, etc.) from that suffered in the individual field (affliction due to the death of a relative); thus, one refers to the social part and the other to the affective part of the patrimony. (…) In summary, moral damages consist of pain or physical, psychological, affective, or moral suffering inflicted by an unlawful act. Normally, the fertile field of moral damages is that of personality rights when they are violated.' In the same vein, one may consult, among many others, rulings numbers 280 of 15 hours 35 minutes of April 26, and no. 699 of 16 hours 5 minutes of September 20, both of 2000." Of interest for the present case is the subjective moral. Regarding its quantification and proof, by its very nature, it does not require direct proof; rather, it is subject to the prudential assessment of the judge. This is because it concerns an affectation that occurs within the internal sphere of the person. In relation to this, the First Chamber of the Supreme Court of Justice, in judgment no. 537 of 10 hours 40 minutes of September 3, 2003, stated: "…It is deduced through presumptions inferred from indications, since the unlawful generating act reveals the moral damages, because when the psyche, health, physical integrity, honor, intimacy, etc., are damaged, it is easy to infer the damage. For this reason, it is said that the proof of moral damages exists 'in re ipsa'. Nor must its value be proven because it has no concrete value. It is valued prudentially. It is not, then, about quantifying suffering, as it is priceless, but about setting a monetary compensation for its injury, the only mechanism to which the law can resort, in order to thus repair, at least in part, its offense." Even so, it is the criterion of this collegiate body that, although its granting is not conditioned or subject to evidentiary factors, the same is not true when it comes to establishing the causal link that allows it to be requested. That is to say, the causal relationship that would allow the occurrence of subjective moral damages to be understood must be accredited, at least, with the linking of public conduct or inertia as the causal source of the internal injury. On the other hand, despite this referred-to demonstrative dispensation —relative in principle to the amount—, its fixing is subject to the principles of reasonableness and proportionality. Hence, in each case, the jurisdictional authority must weigh the particularities and scope of the conflict, so that its granting and quantification conform to said guiding criteria and do not lead to excessive indemnifications resulting in unjustified benefits. Ergo, its fixing must maintain a fair balance derived from the specific factual framework. It is not enough to allege the existence of internal suffering; one must demonstrate, at a minimum, the facts that, in theory, have originated such detriment. In other words, while it is true that, in cases where subjective moral damages are alleged, it is not necessary to demonstrate their amount; it is also true that one must demonstrate not only the existence of the damage, but also the causal link with the conduct that presumably caused them. This is with the exception of those cases where, by human experience, the suffering, anguish, or pain caused as a consequence of a specific conduct is evident, such as, for example: the amputation of a limb; the death of a loved one; among others. Based on the foregoing, this Tribunal considers that in the specific case, and in application of logic, justice, and human experience, the suffering, anguish, or pain caused as a consequence of the omission attributed to the insurance entity is evident. Indeed, upon the INS declining the coverage of the debtor balance policy in which Mrs. [Name 001] had been included with respect to the debt with the company Credi Q Inversiones CR SA, in application of the incontestability clause despite not being able to do so, as has been indicated above, there is a causal link between the censured refusal and the effect produced. Namely, that the plaintiff, faced with the rejection of the claim based on said clause, lost the peace of mind that having said policy provided her. This produced an effort to continue honoring the debt despite the coverage to which she was entitled, and even more so taking into account that she had to do so with a disability pension she received from the CCSS, an amount which it is public knowledge does not amount to one hundred percent of what she received when she was an employee. This logically produced emotional instability and suffering, which this Tribunal values in re ipsa, thereby recognizing for this the sum of $3,500.00 (three thousand five hundred United States dollars).” The final paragraph of Article 46 of the Political Constitution; subsections c) and d) of Article 32 of the Law for the Promotion of Competition and Effective Defense of the Consumer; 41 and 43 of the Regulation to that Law, <u>establish that the consumer must receive adequate, clear, truthful, timely, and sufficient information regarding all elements that directly affect their consumption decision, and therefore, it is essential that the person intending to take out insurance not only knows sufficiently and timely the conditions and limitations thereof, but also has a clear awareness that allows them to determine whether or not they can take the policy and, consequently, whether or not it is viable to insure the person or property intended.</u> In that regard, the Constitutional Chamber of the Supreme Court of Justice has considered: <i><span style='font-size:11.0pt'>“... it is notorious that the consumer is at the end of the chain formed by the production, distribution, and marketing of consumer goods they need to acquire for personal satisfaction, and their participation in that process does not respond to technical or professional reasons, but rather to the constant execution of contracts in a personal capacity. <u>Therefore, their relationship in that commercial sequence is one of inferiority and requires special protection against the providers of goods and services, so that prior to expressing their contractual consent, they have all the necessary elements of judgment that allow them to express it freely, which implies full knowledge of the goods and services offered.</u> Included herein, in a harmonious mix, are several constitutional principles, such as the State's concern for the broadest sectors of the population when they act as consumers, the reaffirmation of individual freedom by facilitating private parties' free disposition of their assets with the greatest possible knowledge of the good or service to be acquired, the protection of health when involved, the ordering and systematization of reciprocal relations between interested parties, the harmonization of international commercial practices to the internal system, and ultimately, the greater protection of the inhabitant's functioning in their means of subsistence...”</span></i> <b>(Judgment number 1996-04463 of nine hours forty-five minutes of August thirtieth, nineteen ninety-six. See in a similar vein, judgment number 1992-01441 of fifteen hours forty-five minutes of June second, nineteen ninety-two).</b> This Tribunal considers that this duty of information is not fulfilled merely by the fact that the insurance entity and the policy contractor set forth in the contract that the consumer will presumably sign, the text –in this case– of the contestability clause (cláusula de disputabilidad), <u>but rather that the interested party must previously be informed in a timely, truthful, clear, detailed, and sufficient manner about what the contestability clause consists of, what its benefits and limitations are, why it is included in the group life insurance policies (pólizas de vida colectiva) that financial institutions contract with the National Insurance Institute (Instituto Nacional de Seguros) and to which a person wishing to formalize a loan is automatically included</u>, since all this data will ultimately allow them to make the decision that best suits their economic interests, in the exercise of their fundamental right to free choice, from which the principle of freedom of contract (libre contratación) is derived, <u>even more so if, at the time the interested party was included in the group policy, the opening of the insurance market had not yet occurred and, therefore, the defendant entity retained the monopoly thereof</u>; <b>2) The principle of freedom of contract for consumers regarding adhesion contracts. </b>First, it is necessary to establish the essential content of this constitutional principle that constitutes the sine qua non requirement for the exercise of the rights established in Articles 45 and 46 of the Political Constitution. In that regard, the Constitutional Chamber of the Supreme Court of Justice has established that the essential content of this principle is determined by four elements, namely: <i><span style='font-size:11.0pt'>“...a) Freedom to choose the co-contractor; b) Freedom in choosing the very object of the contract and, therefore, the main provision that concretizes it; c) Freedom in determining the price, content, or economic value of the contract stipulated as compensation; d) <u>The balance of the positions of both parties and between their mutual provisions; a balance that requires, in turn, respect for the fundamental principles of equality, reasonableness, and proportionality, according to which the position of the parties and the content and scope of their reciprocal obligations must be reasonably equivalent to each other, and also proportionate to the nature, object, and purposes of the contract</u>...”</span></i> <b>(Judgment number 1992-03495 of fourteen hours thirty minutes of November nineteenth, nineteen ninety-two).</b> <u>In adhesion contracts, these elements –which determine the essential content of the principle of freedom of contract– suffer a series of limitations, as the contractor is limited to accepting or not the conditions that one of the parties has previously stipulated, a "decision" that is usually determined by two aspects: that only that option is offered to them and that they are in such a state of necessity that they must resort to that sole possibility offered by the market, in order to meet the requirement that obliges them to sign the contract. It is precisely in protection of the safety and the economic and social interests of the consumer –established as fundamental rights by the final paragraph of the Political Constitution– that it becomes necessary to effectively safeguard those rights against abusive clauses that adhesion contracts could contain, in order to ultimately guarantee freedom of choice and equality in contracting.</u> In that regard, Article 42 of the Law for the Promotion of Competition and Effective Defense of the Consumer establishes that –in what is relevant–: <i><span style='font-size:11.0pt'>“...In adhesion contracts, their modifications, annexes, or addenda, <u>the effectiveness of the general conditions is subject to the effective knowledge of them by the adhering party or the possibility of having known them through ordinary diligence</u>…”; </span></i><b>3) The scope of contestability clauses in the Regulatory Law of the Insurance Contract regarding the consumer's right to information. </b>It should be noted that the 4th paragraph of Article 7 of that legal body establishes that <i><span style='font-size:11.0pt'>“…The insurance entity or insurance intermediaries, as applicable, must provide the members of the insurable group and the insured</span></i><b><span style='font-size:11.0pt'> </span></b><i><span style='font-size:11.0pt'>person, with the same information as that provided to insured parties in individual insurance contracts, under the same terms and conditions. <u>In particular, they must be informed about the contestability clauses and policy exclusions. Failure to comply with this duty of information renders the application of such clauses ineffective against the insured person</u>…”. </span></i>At this point, it is necessary to indicate that although it is true that Law 8956 came into effect as of September 12, 2011, it is also true that <b>prior to its enactment, constitutional and legal norms already existed in the Costa Rican legal system that, from 1995 and 1996, imposed</b> upon the insurance entity or its intermediaries the duty to inform the interested party in a timely, truthful, clear, detailed, and sufficient manner about what the contestability clause consists of, what its benefits and limitations are, why it is included in the group life insurance policies that financial institutions contract with the National Insurance Institute and to which a person wishing to formalize a loan is automatically included, since all this data will ultimately allow them to make the decision that best suits their economic interests; <b>4)</b> <b>Corollary. </b>In summary, the effectiveness of the general conditions of an adhesion contract is subject to the effective knowledge of them by the adhering party or to the real possibility of having known them through ordinary diligence, an aspect that is fundamental, considering that the aspects determining the essential content of the principle of freedom of contract are limited in this type of contracts, and therefore, it is essential that the consumer has the necessary elements to decide whether or not to choose the option presented to them, for which reason this Tribunal considers that this duty of information is not fulfilled merely by the fact that the insurance entity and the policy contractor set forth in the contract the consumer will presumably sign, the text –in this case– of the contestability clause, but rather that the interested party must previously be informed in a timely, truthful, clear, detailed, and sufficient manner about what the contestability clause consists of and what its benefits and limitations are, since all this data will ultimately allow them to make the decision that best suits their economic interests. However, <u>the problem lies not only in whether the consumer has timely, truthful, clear, and sufficient access to the information required to make their decision, but also in the fact that, in insurance matters, only one single option was presented to them</u> <i><span style='font-size:11.0pt'>–as in this case–</span></i>, <u>given the monopoly regime that, until the entry into force of the Free Trade Agreement entered into by Central America, the Dominican Republic, and the United States of America (December 19, 2008, Decreto Ejecutivo 35001), the National Insurance Institute exercised in the marketing of insurance, which prevented consumers from having the possibility of choosing and deciding –based on the information provided– the best option to protect their interests and rights, aggravated by the fact that the inclusion of the consumer in the group life insurance policy that the financial institution contracts with the insurance entity is a sine qua non requirement for accessing a loan, as it is constituted as a complementary guarantee of the loan contract</u> <i><span style='font-size:11.0pt'>(folios 22 and 11 of the administrative file of the general and particular conditions of the group life policy [Valor 003]).</span></i> <b>Vo.- ON THE SPECIFIC CASE </b><span style='font-size: 11.0pt'>[…] </span>it is necessary to highlight that there is no record in the administrative file regarding the general and particular conditions of the group life insurance policy number [Valor 003], of any document bearing the plaintiff's signature for the purpose of considering her included in the indicated policy, or stating that she was informed about the content of said insurance contract, especially regarding the contestability clause. Likewise, it cannot be inferred that having signed other loan contracts with Banco Popular y de Desarrollo Comunal and with Coocique R.L., which entailed group life insurance policies <i><span style='font-size:11.0pt'>–in which she was included starting May 2005 and September 2006, respectively–,</span></i> she was given truthful, timely, and adequate information about <b>the scope, content, benefits, and limitations of the contestability clause contained in those policies, </b>that would allow her to have a clear awareness of what they consisted of, especially since, in any case, these are different life insurance policies <i><span style='font-size:11.0pt'>(folios 44 a 46, 86 a 89 of the judicial file)</span></i>. Now then, the omission in informing the plaintiff clearly, truthfully, and timely about the content and scope of the contestability clause becomes relevant because, in insurance matters, only one single option was presented to the plaintiff, given that as of September 16, 2007 –the date on which [Name 001] was included in group life insurance policy number [Valor 003] <i>(</i><span style='font-size:11.0pt'> <i>folios 24, 15 of the administrative file</i></span> <i><span style='font-size:11.0pt'>of the general and particular conditions of the group life policy [Valor 003])</span>-</i> <b>it is public and notorious that at that date,</b> the National Insurance Institute (INS) operated under a monopoly regime for everything related to the marketing of insurance, given that <u>the opening of the insurance market became effective only upon the entry into force of the Free Trade Agreement entered into by Central America, the Dominican Republic, and the United States of America (December 19, 2008, Decreto Ejecutivo 35001)</u>, a circumstance that prevented her from having the possibility of choosing and deciding –<b><i><span style='font-size:11.0pt'>based on the information that should have been provided to her</span></i></b>- the best option to protect her economic interests and fundamental rights, which implies <u>that, faced with the state of necessity of accessing a loan to acquire a vehicle, she was forced to accept the conditions of the group life insurance policy </u><i><u><span style='font-size:11.0pt'>–which includes the contestability clause–</span></u></i><u>, which consequently rendered nugatory the essential content of her fundamental rights to protect her safety, her economic and social interests, the freedom to choose the option that best protected those interests, and equality in contracting.</u> <b>By reason of the foregoing and given that in the instant case</b>, the challenged acts, official letters INSCR-8118-2009 of December 23, 2009, and INSCR-4185-2010 of May 24, 2010, issued by the Executive Director of the INS Branch in Cartago, are based on the contestability clause contained in the general and particular conditions of group life insurance policy number [Valor 003] <i><span style='font-size:11.0pt'>(folios 44 and 40 of the administrative claim file), </span></i><u>this Tribunal declares the absolute nullity of said acts, given that the failure to comply with the duty of information by the defendant entity renders the application of such clauses ineffective to the detriment of the plaintiff</u>, based on the provisions of Articles 33 and 46, final paragraph of the Political Constitution, the fundamental right to freedom of contract derived from Article 28 of the Political Constitution, and Articles 31 and following of the Law for the Promotion of Competition and Effective Defense of the Consumer, and 40 and following of the Regulation to that Law.<span style='font-size:11.0pt'> […]</span> <b>VIo.- AS TO THE CLAIMS FOR COMPENSATION FOR MATERIAL DAMAGE </b><span style='font-size:11.0pt'>[…].</span><b> </b>Based on what is indicated in Considerando V of this judgment, this Tribunal finds that, in accordance with the provisions of Article 122.m.ii of the Administrative Litigation Procedure Code (Código Procesal Contencioso Administrativo), <u>it is appropriate to order the INS to pay the material damages caused to the plaintiff,</u> due to its refusal to apply in her favor the amount for which she was included in group life insurance policy number [Valor 003], based on the contestability clause of whose content she was not informed in a clear, timely, and truthful manner; <b>material damages consisting of both the sums paid by the plaintiff as of the date of issuance of this judgment, and the amounts still pending payment </b><i><span style='font-size:11.0pt'>(Considerando II, section b of this judgment)</span></i><b>, </b>originating from the credit transaction maintained with Credi Q Inversiones CR, S.A.<span style='font-size:11.0pt'> […]</span> <b>VIIo.- IN RELATION TO SUBJECTIVE MORAL DAMAGE (DAÑO MORAL SUBJETIVO) </b><span style='font-size:11.0pt'>[…]. </span>Now, the coverage radius of the norms and principles that integrate and constitute the system of administrative liability transcends the reparation of eminently material damages, to include within its area of protection, damages of a non-pecuniary nature, which arises as a natural consequence of a type of liability that is grounded in damage and risk. The foregoing is based on the doctrine of constitutional precept 41, which establishes the principle of integral reparation of damage (reparación integral del daño), which is conferred as a right to individuals within their personal sphere, their property, or their moral interests. It concerns the due protection against infringements to the legal situation of the person, which includes their assets, but also their inner sphere. This is indeed inferred from numeral 197 of the General Law of Public Administration (Ley General de la Administración Pública), a norm that dictates: <i><span style='font-size:11.0pt'>“Liability shall lie for damage to purely moral assets, as well as for the moral suffering and physical pain caused by death or by the injury inflicted, respectively.”</span></i> Thus, it is evident that moral damage is verified when the sphere of extra-patrimonial interest of the individual is harmed. However, being clear that its violation can generate patrimonial consequences, it can certainly be quantified. Therefore, a distinction must be made between subjective moral damage (daño moral subjetivo) and objective moral damage (daño moral objetivo).<i> </i>On this topic, national jurisprudence is abundant. From this perspective, it is worth citing judgment 316-F-2006 of sixteen hours twenty minutes of June twenty-first, two thousand six, of the First Chamber of the Supreme Court of Justice, insofar as it states: <span style='font-size:11.0pt'>“ <i>This Chamber has already had the opportunity to rule on the concept, scope, and legal nature of this type of damage. Thus, for example, in judgment no. 151 of 15 hours 20 minutes of February 14, 2001 (which cites ruling no. 112 of 14 hours 15 minutes of July 15, 1992) it indicated: "VIII.- Moral damage (also called in doctrine incorporeal, extra-patrimonial, affective, etc.) is verified when the sphere of extra-patrimonial interest of the individual is harmed, however, as its violation can generate patrimonial consequences, a distinction must be made between subjective moral damage, 'pure,' or of affection, and objective or 'objectified' moral damage. Subjective moral damage is produced when an extra-patrimonial right has been harmed, without affecting the patrimony, normally involving an unjust disturbance of the psychic conditions of the individual (displeasure, discouragement, desperation, loss of satisfaction in living, etc., e.g., the offense against honor, dignity, intimacy, the so-called damage to life in relation, affliction for the death of a family member or loved one, etc.). Objective moral damage harms an extra-patrimonial right with repercussions on the patrimony, that is, it generates economically assessable consequences (e.g., the case of the professional who, due to the attributed act, loses their clientele in whole or in part). This distinction serves to separate the damage suffered by the individual in their social standing (good name, honor, honesty, etc.) from that suffered in the private field (affliction for the death of a relative), as one refers to the social part and the other to the affective part of the patrimony. (…) In sum, moral damage consists of pain or physical, psychic, or moral suffering inflicted by an illicit act. Normally, the fertile field of moral damage is that of personality rights when they are violated.” In the same vein, one may consult, among many others, rulings numbers 280 of 15 hours 35 minutes of April 26 and no. 699 of 16 hours 5 minutes of September 20, both of <st1:metricconverter ProductID="2000.”" w:st="on">2000.”</st1:metricconverter></i></span> Of interest for the present case is <b>subjective moral damage (moral subjetivo)</b>. <u>Regarding its quantification and proof, by its very nature, it does not require direct proof; rather, it is subject to the prudential assessment of the judge. This is because it is an affectation that occurs in the inner core of the person.</u> In relation to this, the aforementioned First Chamber, in judgment no. 537 of 10 hours 40 minutes of September 3, 2003, stated: <span style='font-size:11.0pt'>“…<i>It is deduced through presumptions inferred from clues, since the unlawful generating act makes the moral damage evident, for when the psyche, health, physical integrity, honor, intimacy, etc., are damaged, it is easy to infer the damage; therefore, it is said that proof of moral damage exists 'in re ipsa'. Nor must its value be proven because it does not have a concrete value. It is assessed prudentially. It is not a matter, then, of quantifying suffering, as it is inappreciable, but of fixing monetary compensation for its injury, the only mechanism to which law can resort, in order to repair, at least in part, its offense.”.</i></span> Even so, it is the criterion of this collegiate body that while its granting is not conditioned on or subject to evidentiary factors, <b>the same does not apply when it comes to establishing the causal link that allows it to be claimed.</b> That is to say, <u>the causal relationship that would allow understanding subjective moral damage to have occurred must be credited, at least, by linking a public action or inaction as the causing source of the internal injury.</u> <b>On the other hand, despite this aforementioned demonstrative dispensation –relative in principle to the amount–, its determination is subject to the principles of reasonableness and proportionality.</b> Hence, in each case, the jurisdictional authority must weigh the particularities and scope of the conflict, so that its granting and quantification conform to said guiding criteria and do not result in excessive compensations leading to unjustified benefits. Ergo, its determination must maintain a fair balance derived from the specific factual matrix. <u>It is not enough to allege the existence of internal suffering; one must demonstrate, at least, the facts that, in theory, have caused such detriment.

In other words, while it is true that in cases where subjective moral damages (daño moral subjetivo) are alleged, it is not necessary to demonstrate the amount thereof; it is also true that not only the existence of the damage must be demonstrated, but also the causal link with the conduct that presumably caused it, with the exception of those cases where, based on human experience, the suffering, anguish, or pain caused as a result of a specific conduct is evident, such as: the amputation of a limb; the death of a loved one; among others.

Based on the foregoing, this Court considers that in the specific case, it is evident, in application of logic, justice, and human experience, the suffering, anguish, or pain caused as a result of the omission attributed to the insurance entity, since, effectively, when INS declined coverage under the outstanding balance policy in which Mrs. [Name 001] had been included regarding the debt with the company Credi Q Inversiones CR SA, applying the contestability clause even though it could not do so, as indicated above, there is a causal link between the reproached refusal and the effect produced, meaning that the plaintiff, upon the rejection of the claim based on said clause, lost the peace of mind that having said policy provided her, which resulted in an effort to continue honoring the debt despite the coverage that was available to her, and even more so considering that she had to do so with a disability pension she received from the CCSS, an amount which, as is public knowledge, is not one hundred percent of what she received when she was a salaried employee, which logically produced emotional instability and suffering, which this Court assesses as self-evident (in re ipsa), recognizing for this reason the sum of $3,500.00 (three thousand five hundred United States dollars).

**IV.- REGARDING THE UNAVOIDABLE RELATIONSHIP BETWEEN CONTESTABILITY (DISPUTABILIDAD) CLAUSES AND THE RIGHT TO RECEIVE ADEQUATE, TRUTHFUL, AND TIMELY INFORMATION.** This Tribunal, in application of the provisions of articles 33 and the last paragraph of 46 of the Political Constitution, of the fundamental right to free contracting derived from article 28 of the Political Constitution, and of articles 31 and following of the Ley de Promoción de la Competencia y Defensa Efectiva del Consumidor, and 40 and following of the Regulation to that Law, considers the following: **1) Duty to inform the consumer adequately, timely, clearly, truthfully, and sufficiently.** The last paragraph of article 46 of the Political Constitution; subsections c) and d) of article 32 of the Ley de Promoción de la Competencia y Defensa Efectiva del Consumidor; 41 and 43 of the Regulation to that Law, <u>establish that the consumer must receive adequate, clear, truthful, timely, and sufficient information on all elements that directly affect their consumption decision; therefore, it is essential that the person intending to take out insurance not only knows sufficiently and timely the conditions and limitations thereof, but also has a clear awareness that allows them to determine whether or not they can take the policy and, consequently, whether or not it is viable to insure the person or asset intended.</u> In this regard, the Constitutional Chamber of the Supreme Court of Justice has considered: *"... it is notorious that the consumer is at the end of the chain formed by the production, distribution, and commercialization of consumer goods they need to acquire for their personal satisfaction, and their participation in that process does not respond to technical or professional reasons, but rather to the constant execution of contracts on a personal basis. <u>Therefore, their relationship in this commercial sequence is one of inferiority and requires special protection against the suppliers of goods and services, so that prior to expressing their contractual consent, they have all the necessary elements of judgment that allow them to express it with complete freedom, and this implies full knowledge of the goods and services offered.</u> Included by what has been expressed, in a harmonious mix, are various constitutional principles, such as the state's concern for the broadest sectors of the population when they act as consumers, the reaffirmation of individual freedom by facilitating private parties' free disposition of their assets with the broadest possible knowledge of the good or service to be acquired, the protection of health where involved, the ordering and systematization of reciprocal relations between the interested parties, the alignment of international commercial practices with the internal system, and finally, the greater protection of the inhabitant's functioning in their means of subsistence..."* **(Voto number 1996-04463 of nine hours forty-five minutes of August thirtieth, nineteen ninety-six. See in a similar sense, Voto number 1992-01441 of fifteen hours forty-five minutes of June second, nineteen ninety-two).** This Tribunal considers that this duty of information is not only fulfilled by the mere fact that the insurer and the policy contractor include in the contract that the consumer will presumably sign, the text –in this case– of the contestability (disputabilidad) clause, <u>but rather that the interested party must be explained beforehand in a timely, truthful, clear, detailed, and sufficient manner, what the contestability (disputabilidad) clause consists of, what its benefits and limitations are, why they are included in group life (vida colectiva) policies that financial institutions contract with the Instituto Nacional de Seguros and to which a person wishing to formalize a credit is automatically included</u>, since ultimately all this information will allow them to make the decision that best suits their economic interests, in exercise of their fundamental right to free choice, from which the principle of free contracting derives, <u>especially if at the time the interested party was included in the group (colectiva) policy, the opening of the insurance market had not yet occurred and therefore, the defendant entity retained the monopoly thereof</u>; **2) The principle of freedom of contract for consumers in the face of adhesion contracts.** Firstly, it is necessary to establish the essential content that this constitutional principle, which constitutes the sine qua non requirement for the exercise of the rights established in articles 45 and 46 of the Political Constitution, comprises. In this sense, the Constitutional Chamber of the Supreme Court of Justice has established that the essential content of this principle is determined by four elements, namely: *"...a) The Freedom to choose the co-contractor; b) The freedom to choose the object of the contract itself and, therefore, the main provision that concretizes it; c) The Freedom to determine the price, content, or economic value of the contract stipulated as consideration; d) <u>The balance of the positions of both parties and between their mutual provisions; a balance that demands, in turn, respect for the fundamental principles of equality, reasonableness, and proportionality, according to which the position of the parties and the content and scope of their reciprocal obligations must be reasonably equivalent to each other and, additionally, proportionate to the nature, object, and purposes of the contract</u>..."* **(Voto number 1992-03495 of fourteen hours thirty minutes of November nineteenth, nineteen ninety-two).** <u>In adhesion contracts, these elements –which determine the essential content of the principle of freedom of contract– suffer a series of limitations, because the contractor is limited to accepting or not the conditions that one of the parties has previously stipulated, a "decision" that is usually determined by two aspects: that only that option is offered to them and that they are in a state of need such that they must resort to that only possibility offered by the market, in order to cover the requirement that forces them to sign the contract. It is precisely in protection of the security and the economic and social interests of the consumer –established as fundamental rights by the last paragraph of the Political Constitution– that it becomes necessary to effectively protect those rights against abusive clauses that adhesion contracts could contain, in order to ultimately guarantee freedom of choice and equality in contracting.</u> In that sense, article 42 of the Ley de Promoción de la Competencia y Defensa Efectiva del Consumidor establishes that –as relevant–: *"...In adhesion contracts, their modifications, annexes, or addenda, <u>the effectiveness of the general conditions is subject to the effective knowledge of them by the adhering party or the possibility of having known them through ordinary diligence</u>…";* **3) The scope of contestability (disputabilidad) clauses in the Ley Reguladora del Contrato de Seguros regarding the consumer's right to information.** It should be noted that paragraph 4 of article 7 of that legal body establishes that *"…The insurance entity or insurance intermediaries, as applicable, must provide the members of the insurable group and the insured person* *the same information as to the insureds in individual insurance contracts, under the same terms and conditions. <u>In particular, they must be informed about the contestability (disputabilidad) and exclusion clauses of the policy. Failure to comply with this duty of information renders the application of said clauses ineffective against the insured person</u>…".* At this point, it is necessary to state that while it is true that Ley 8956 came into force as of September 12, 2011, it is also true that <b>prior to its enactment, there already existed in the Costa Rican legal system, constitutional and legal norms that imposed on the insurance entity or its intermediaries since 1995 and 1996</b>, the duty to inform the interested party in a timely, truthful, clear, detailed, and sufficient manner, what the contestability (disputabilidad) clause consists of, what its benefits and limitations are, why they are included in group life (vida colectiva) policies that financial institutions contract with the Instituto Nacional de Seguros and to which a person wishing to formalize a credit is automatically included, since ultimately all this information will allow them to make the decision that best suits their economic interests; **4) Corollary.** In summary, the effectiveness of the general conditions of an adhesion contract is subject to the effective knowledge of them by the adhering party or to the certain possibility of having known them through ordinary diligence, an aspect that is fundamental, if one takes into consideration that the aspects determining the essential content of the principle of free contracting are limited in this type of contract; therefore, it is essential that the consumer has the necessary elements to decide whether or not to choose the option presented to them, reason for which this Tribunal considers that this duty of information is not only fulfilled by the mere fact that the insurer and the policy contractor include in the contract that the consumer will presumably sign, the text –in this case– of the contestability (disputabilidad) clause, but rather that the interested party must be explained beforehand in a timely, truthful, clear, detailed, and sufficient manner, what the contestability (disputabilidad) clause consists of and what its benefits and limitations are, since ultimately all this information will allow them to make the decision that best suits their economic interests. Now then, <u>the problem lies not only in whether the consumer has timely, truthful, clear, and sufficient access to the information they need to make their decision, but also in the fact that in insurance matters, they were presented with only a single option</u> *–as in this case–*, <u>given the monopoly regime that, until the entry into force of the Tratado de Libre Comercio suscrito entre Centroamérica, República Dominicana y los Estados Unidos de América (December 19, 2008, Decreto Ejecutivo 35001), the Instituto Nacional de Seguros exercised in the area of insurance commercialization, which prevented consumers from having the possibility to choose and decide –based on the information provided– the best option to protect their interests and rights, with the aggravating factor that the inclusion of the consumer in the group life (vida colectiva) policy contracted by the financial institution with the insurance entity is a sine qua non requirement for accessing a credit, as it constitutes a complementary guarantee of the loan contract</u> *(folios 22 and 11 of the administrative file of the general and specific conditions of the group life (vida colectiva) policy [Valor 003]).* **Vo.- ON THE SPECIFIC CASE** [...] it is necessary to emphasize that there is no document in the administrative file on the general and specific conditions of the group life (vida colectiva) policy number [Valor 003] in which the plaintiff's signature appears for the purpose of considering her included in the indicated policy, or in which it is recorded that she was informed about the content of said insurance contract, especially regarding the contestability (disputabilidad) clause. Likewise, it cannot be inferred that by having signed other credit contracts with Banco Popular y de Desarrollo Comunal and with Coocique R.L., which included group life (vida colectiva) policies *–in which she was included as of May 2005 and September 2006, respectively–,* she was given truthful, timely, and adequate information on **the scope, content, benefits, and limitations of the contestability (disputabilidad) clause that those policies contained,** that would have allowed her to have a clear awareness of what they consisted of, especially since, in any case, these are different life policies *(folios 44 to 46, 86 to 89 of the judicial file)*.

Now, the omission to inform the plaintiff clearly, truthfully, and in a timely manner about the content and scope of the incontestability clause (cláusula de disputabilidad) becomes relevant because in insurance matters, the plaintiff was presented with only a single option, given that as of September 16, 2007—the date on which [Name 001] was included in group life policy number [Value 003] *(folios 24, 15 of the administrative file of the general and specific conditions of group life policy [Value 003])*—it is publicly and notoriously known that as of that date, the Instituto Nacional de Seguros was operating under a monopoly regime in all matters related to the marketing of insurance, given that the opening of the insurance market became effective only upon the entry into force of the Free Trade Agreement signed between Central America, the Dominican Republic, and the United States of America (December 19, 2008, Decreto Ejecutivo 35001), a circumstance that prevented her from having the possibility to choose and decide—***based on the information that should have been provided to her***—the best option to protect her economic interests and fundamental rights, which implies that, faced with the state of necessity of accessing a loan to acquire a vehicle, she was forced to accept the conditions of the group life policy—*in which the incontestability clause is included*—which consequently rendered the essential content of her fundamental rights to protect her security, her economic and social interests, the freedom to choose the option that best protected those interests, and equality in contracting, nugatory. For the stated reasons, and given that in the specific case, the challenged acts, official letters INSCR-8118-2009 of December 23, 2009, and INSCR-4185-2010 of May 24, 2010, issued by the Executive Director of the INS Office in Cartago, are based on the incontestability clause contained in the general and specific conditions of group life policy number [Value 003] *(folios 44 and 40 of the administrative claim file)*, this Court declares the absolute nullity of said acts, given that the breach of the duty to inform by the defendant entity renders the application of said clauses against the plaintiff ineffective, based on the provisions of articles 33 and 46, last paragraph, of the Political Constitution, the fundamental right to free contracting derived from article 28 of the Political Constitution, and articles 31 and following of the Ley de Promoción de la Competencia y Defensa Efectiva del Consumidor, and 40 and following of the Reglamento a esa Ley. […].

**VI.- AS TO THE CLAIMS FOR INDEMNIFICATION FOR MATERIAL DAMAGE** […]. Based on what is indicated in Considerando V of this judgment, this Court considers that in accordance with the provisions of article 122.m.ii of the Código Procesal Contencioso Administrativo, it is appropriate to order the INS to pay the material damages caused to the plaintiff, given its refusal to apply in her favor the amount for which she was included in group life policy number [Value 003], based on the incontestability clause of whose content she was not informed clearly, timely, and truthfully; material damages consisting of both the sums paid by the plaintiff as of the date of issuance of this judgment, and the amounts still pending payment *(Considerando II, section b of this judgment)*, arising from the credit transaction maintained with Credi Q Inversiones CR, S.A. […]

**VII.- REGARDING SUBJECTIVE MORAL DAMAGE** […]. Now, the coverage radius of the norms and principles that comprise and constitute the system of administrative liability transcends the reparation of eminently material damages to include, within its area of protection, damages of a non-economic nature, which arises as a natural consequence of a type of liability anchored in damage and risk. The foregoing is grounded in the doctrine of constitutional canon 41, establishing the principle of full reparation of damage (principio de reparación integral del daño), which is conferred as a right upon individuals in their individual sphere, their property, or their moral interests. This concerns the due safeguarding of infringements upon the legal situation of the person, which includes their patrimonial assets, but also their internal sphere. This is indeed deduced from numeral 197 of the Ley General de la Administración Pública, a norm which stipulates: *"Liability shall apply for damage to purely moral assets, as well as for the moral suffering and physical pain caused by death or by the injury inflicted, respectively."* Thus, it is evident that moral damage occurs when the sphere of the extra-patrimonial interest of the individual is injured. However, keeping in mind that its infringement can generate patrimonial consequences, it may well be quantified. Therefore, a distinction must be made between subjective moral damage and objective moral damage. On this subject, national jurisprudence is abundant. From this perspective, it is worth citing judgment 316-F-2006 at sixteen hours twenty minutes of June twenty-first, two thousand six, of the First Chamber of the Supreme Court of Justice, in which it states: *"This Chamber has already had the opportunity to rule on the concept, scope, and legal nature of this type of damage. Thus, for example, in judgment no. 151 at 15 hours 20 minutes of February 14, 2001 (which cites resolution no. 112 at 14 hours 15 minutes of July 15, 1992), it indicated: 'VIII.- Moral damage (also called incorporeal, extra-patrimonial, of affection, etc., in doctrine) is verified when the sphere of the extra-patrimonial interest of the individual is injured; however, since its infringement can generate patrimonial consequences, a distinction must be made between "pure" subjective moral damage, or of affection, and objective or "objectified" moral damage. Subjective moral damage is produced when an extra-patrimonial right has been injured, without repercussions on the patrimony, normally involving an unjust disturbance of the individual's mental conditions (displeasure, discouragement, despair, loss of satisfaction in living, etc., e.g., the offense against honor, dignity, intimacy, so-called damage to relational life, affliction for the death of a family member or loved one, etc.). Objective moral damage injures an extra-patrimonial right with repercussions on the patrimony, that is, it generates economically assessable consequences (e.g., the case of the professional who, due to the attributed act, loses his clientele in whole or in part). This distinction serves to separate the damage suffered by the individual in their social consideration (good name, honor, honesty, etc.) from that suffered in the individual field (affliction for the death of a relative), as one refers to the social part and the other to the affective part of the patrimony. (…) In sum, moral damage consists of physical, psychological, affective, or moral pain or suffering inflicted by a wrongful act. Normally, the fertile field for moral damage is that of personality rights when they are violated.' In the same sense, see, among many others, rulings number 280 at 15 hours 35 minutes of April 26 and no. 699 at 16 hours 5 minutes of September 20, both of 2000."* Relevant to the present case is **subjective moral damage**. Regarding its quantification and proof, by its very nature, it does not require direct proof; that is, it is subject to the prudential assessment of the judge. This is because it is an affectation that occurs within the inner core of the person. In relation to this, the previously mentioned First Chamber, in judgment no. 537 at 10 hours 40 minutes of September 3, 2003, stated: *"…It is deduced through presumptions inferred from indications, since the unlawful generating event reveals the moral damage, because when the psyche, health, physical integrity, honor, intimacy, etc., are damaged, it is easy to infer the damage; for this reason, it is said that the proof of moral damage exists 'in re ipsa'. Nor must its value be proven because it has no concrete value. It is valued prudentially. It is not, then, a matter of quantifying suffering, as it is inestimable, but of fixing monetary compensation for its injury, the only mechanism to which the law can resort, in order to repair, at least in part, the offense."* Even so, it is the criterion of this collegiate body that while its granting is not conditioned upon or subject to evidentiary factors, **the same does not hold true when it comes to establishing the causal link that permits requesting it.** That is, the causal relationship that would allow the subjective moral damage to be deemed as having occurred must be accredited, at least, by linking a public act or omission as the causative source of the internal injury. **On the other hand, despite this evidentiary dispensation referred to—relative, in principle, to the amount—its assessment is subject to the principles of reasonableness and proportionality.** Hence, in each case, the jurisdictional authority must weigh the particularities and scope of the conflict so that its granting and quantification conform to these guiding criteria and do not result in excessive indemnifications leading to unjustified benefits. Ergo, its assessment must maintain a fair balance derived from the specific factual situation. It is not enough to allege the existence of internal suffering; the facts that, in theory, have caused such detriment must at least be demonstrated. In other words, while it is true that in cases where subjective moral damage is alleged, it is not necessary to prove its amount, it is also true that one must demonstrate not only the existence of the damage but also the causal link with the conduct that allegedly caused it, except in those cases where, through human experience, the suffering, anguish, or pain caused as a consequence of a determined conduct is evident, such as, for example: the amputation of a limb; the death of a loved one; among others. Based on the foregoing, this Court considers that in the specific case, **and in application of logic, justice, and human experience, the suffering, anguish, or pain caused as a consequence of the omission attributed to the insurance entity is evident,** because indeed, when the INS declined the coverage of the outstanding balance policy in which Mrs. [Name 001] had been included regarding the debt with the company Credi Q Inversiones CR SA, applying the incontestability clause despite not being able to do so, as has been indicated above, there exists a causal link between the reproached refusal and the effect produced, namely, that the plaintiff, upon the rejection of the claim based on said clause, lost the peace of mind afforded by having said policy, which produced an effort to continue honoring the debt despite the coverage that assisted her, and even more so considering that she had to do so with a disability pension she received from the CCSS, an amount which is publicly known to not be one hundred percent of what she received when she was salaried, which logically produced emotional instability and suffering, all of which this Court assesses in re ipsa, therefore recognizing for this the sum of $3,500.00 (three thousand five hundred US dollars)."

“ IV.- RESPECTO A LA INELUDIBLE RELACIÓN ENTRE CLÁUSULAS DE DISPUTABILIDAD Y EL DERECHO A RECIBIR INFORMACIÓN ADECUADA, VERAZ Y OPORTUNA. Este Tribunal en aplicación de lo dispuesto en los artículos 33 y 46 párrafo último de la Constitución Política, del derecho fundamental a la libre contratación derivado del artículo 28 de la Constitución Política y de los artículos 31 y siguientes de la Ley de Promoción de la Competencia y Defensa Efectiva del Consumidor, y 40 y siguientes del Reglamento a esa Ley, considera lo que de seguido se expone: 1) Deber de informar adecuada, oportuna, clara, veraz y suficientemente al consumidor. El párrafo último del artículo 46 de la Constitución Política; los incisos c) y d) del artículo 32 de la Ley de Promoción de la Competencia y Defensa Efectiva del Consumidor; 41 y 43 del Reglamento a esa Ley, establecen que el consumidor debe recibir información adecuada, clara, veraz, oportuna y suficiente de todos los elementos que incidan de forma directa en su decisión de consumo, por lo que, es esencial que la persona que pretende tomar un seguro no sólo conozca suficiente y oportunamente las condiciones y limitaciones del mismo, sino que además, tenga una conciencia clara que le permita determinar si puede o no tomar la póliza y por ende, si es viable o no asegurar a la persona o al bien que se pretende. En ese sentido, la Sala Constitucional de la Corte Suprema de Justicia, ha considerado: “... es notorio que el consumidor se encuentra en el extremo de la cadena formada por la producción, distribución y comercialización de los bienes de consumo que requiere adquirir para su satisfacción personal, y su participación en ese proceso, no responde a razones técnicas ni profesionales, sino en la celebración constante de contratos a título personal. Por ello su relación en ese secuencia comercial es de inferioridad y requiere de una especial protección frente a los proveedores de los bienes y servicios, a los efectos de que previo a externar su consentimiento contractual cuente con todos los elementos de juicio necesarios, que le permitan expresarlo con toda libertad y ello implica el conocimiento cabal de los bienes y servicios ofrecidos. Van incluidos por lo expresado, en una mezcla armónica, varios principios constitucionales, como la preocupación estatal a favor de los más amplios sectores de la población cuando actúan como consumidores, la reafirmación de la libertad individual al facilitar a los particulares la libre disposición del patrimonio con el concurso del mayor posible conocimiento del bien o servicio a adquirir, la protección de la salud cual está involucrada, el ordenamiento y la sistematización de las relaciones recíprocas entre los interesados, la homologación de las prácticas comerciales internacionales al sistema interno y en fin, la mayor protección del funcionamiento del habitante en los medios de subsistencia...” (sentencia número 1996-04463 de las nueve horas cuarenta y cinco minutos del treinta de agosto de mil novecientos noventa y seis. Véase en sentido similar, la sentencia número 1992-01441 de las quince horas cuarenta y cinco minutos del dos de junio de mil novecientos noventa y dos). Este Tribunal considera que ese deber de información no sólo se cumple con el sólo hecho de que el ente asegurador y el contratante de la póliza consignen en el contrato que presuntamente firmará el consumidor, el texto –en este caso- de la cláusula de disputabilidad, sino que de previo debe explicársele de forma oportuna, veraz, clara, detallada y suficiente al interesado, en qué consiste la cláusula de disputabilidad, cuáles son sus beneficios y limitaciones, porqué se incluyen en las pólizas de vida colectiva que las entidades financieras contratan con el Instituto Nacional de Seguros y a las que automáticamente se incluye a una persona que desea formalizar un crédito, puesto que en definitiva todos estos datos le permitirán tomar la decisión que mejor convenga a sus intereses económicos, en ejercicio de su derecho fundamental a la libre elección, del cual se deriva el principio de la libre contratación, más si al momento de incluirse al interesado en la póliza colectiva, aún no había operado la apertura del mercado de seguros y por ende, la entidad demandada conservaba el monopolio del mismo; 2) El principio de libertad de contratación de los consumidores frente a los contratos de adhesión. En primera instancia, es necesario establecer cuál es el contenido esencial que este principio constitucional que constituye el requisito sine qua non para el ejercicio de los derechos establecidos en los artículos 45 y 46 de la Constitución Política. En ese sentido, la Sala Constitucional de la Corte Suprema de Justicia, ha establecido que el contenido esencial de este principio se encuentra determinado por cuatro elementos, a saber: “...a) La Libertad para elegir al cocontrantante; b) La libertad en la escogencia del objeto mismo del contrato y, por ende, de la prestación principal que lo concreta; c) La Libertad en la determinación del precio, contenido o valor económico del contrato que se estipula como contraprestación; d) El equilibrio de las posiciones de ambas partes y entre sus mutuas prestaciones; equilibrio que reclama, a su vez, el respeto a los principios fundamentales de igualdad, razonabilidad y proporcionalidad, según los cuales la posición de las partes y el contenido y alcances de sus obligaciones recíprocas han de ser razonablemente equivalente entre sí y, además, proporcionadas a la naturaleza, objeto y fines del contrato...” (Sentencia número 1992-03495 de las catorce horas treinta minutos del diecinueve de noviembre de mil novecientos noventa y dos). En los contratos de adhesión estos elementos -que determinan contenido esencial del principio de libertad de contratación-, sufren una serie de limitaciones, pues el contratante se limita a aceptar o no las condiciones que previamente ha estipulado una de las partes, “decisión” que usualmente está determinada por dos aspectos: que sólo se le ofrezca esa opción y que se encuentre en un estado de necesidad tal que debe recurrir a esa única posibilidad que le brinda el mercado, a efecto de cubrir el requerimiento que lo obliga a suscribir el contrato. Es precisamente en protección de la seguridad y los intereses económicos y sociales del consumidor –establecidos como derechos fundamentales por el párrafo último de la Constitución Política- que se hace necesario tutelar de forma efectiva esos derechos frente las cláusulas abusivas que podrían contener los contratos de adhesión, a fin de garantizar en última instancia la libertad de escogencia y la igualdad en la contratación. En ese sentido, el artículo 42 de la Ley de Promoción de la Competencia y Defensa Efectiva del Consumidor establece que –en lo que interesa- que: “...En los contratos de adhesión, sus modificaciones, anexos o adenda, la eficacia de las condiciones generales está sujeta al conocimiento efectivo de ellas por parte del adherente o la posibilidad de haberlas conocido mediante una diligencia ordinaria…”; 3) Los alcances de las cláusulas de disputabilidad en la Ley Reguladora del Contrato de Seguros respecto al derecho a la información del consumidor. Cabe resaltar que el párrafo 4º del artículo 7 de ese cuerpo legal establece que “…La entidad aseguradora o los intermediarios de seguro, según corresponda, deberán brindar a los integrantes del grupo asegurable y a la persona asegurada, la misma información que a los asegurados en los contratos de seguro individual, en iguales términos y condiciones. En especial, deberá informárseles acerca de las cláusulas de disputabilidad y de exclusiones de la póliza. El incumplimiento de este deber de información genera la ineficacia de la aplicación de dichas cláusulas frente a la persona asegurada…”. En este punto es menester indicar, que si bien es cierto la Ley 8956 entró en vigencia a partir del 12 de setiembre del 2011, también lo es, que con anterioridad a su promulgación ya existían en el ordenamiento jurídico costarricense, normas constitucionales y legales que imponían a la entidad aseguradora o a sus intermediarios desde 1995 y 1996, el deber de informar forma oportuna, veraz, clara, detallada y suficiente al interesado, en qué consiste la cláusula de disputabilidad, cuáles son sus beneficios y limitaciones, porqué se incluyen en las pólizas colectiva de vida que las entidades financieras contratan con el Instituto Nacional de Seguros y a las que automáticamente se incluye a una persona que desea formalizar un crédito, puesto que en definitiva todos estos datos le permitirán tomar la decisión que mejor convenga a sus intereses económicos; 4) Corolario. En síntesis, la eficacia de las condiciones generales de un contrato de adhesión, está supeditada al conocimiento efectivo de ellas por parte del adherente o a la posibilidad cierta de haberlas conocido mediante una diligencia ordinaria, aspecto que resulta fundamental, si se toma en consideración que los aspectos que determinan el contenido esencial del principio de libre contratación están limitados en este tipo de contratos, por lo que, es esencial que el consumidor cuente con los elementos necesarios para decidir si escoge o no la opción que se le presenta, razón por la cual, este Tribunal considera que ese deber de información no sólo se cumple con el sólo hecho de que el ente asegurador y el contratante de la póliza consignen en el contrato que presuntamente firmará el consumidor, el texto –este caso- de la cláusula de disputabilidad, sino que de previo debe explicársele de forma oportuna, veraz, clara, detallada y suficiente al interesado, en qué consiste la cláusula de disputabilidad y cuáles son sus beneficios y limitaciones, puesto que en definitiva todos estos datos le permitirán tomar la decisión que mejor convenga a sus intereses económicos. Ahora bien, el problema no sólo radica en que el consumidor tenga acceso oportuno, veraz, claro y suficiente a la información que requiere para tomar su decisión, sino también, en el hecho de que en materia de seguros sólo se le presentaba una única opción –como en este caso- , dado el régimen de monopolio que hasta la entrada en vigor del Tratado de Libre Comercio suscrito entre Centroamérica, República Dominicana y los Estados Unidos de América (19 de diciembre del 2008, Decreto Ejecutivo 35001), ejerció el Instituto Nacional de Seguros en materia de comercialización de seguros, que le impedía a los consumidores tener la posibilidad de escoger y decidir –con base en la información suministrada-, la mejor opción para proteger sus intereses y derechos, con el agravante de que la inclusión del consumidor en la póliza colectiva de vida que contrata la entidad financiera con el ente asegurador, es un requisito sine qua non para acceder a un crédito, pues se constituye como una garantía complementaria del contrato de préstamo (folios 22 y 11 del expediente administrativo de las condiciones generales y particulares de la póliza colectiva de vida [Valor 003]).

Vo.- SOBRE EL CASO CONCRETO […] es menester resaltar que no consta en el expediente administrativo sobre las condiciones generales y particulares de la póliza colectiva de vida número [Valor 003], ningún documento en que aparezca la firma de la accionante a efectos de tenerla por incluida en la póliza indicada, o bien, en que se haga constar que se le informó sobre el contenido de dicho contrato de seguros en especial de la cláusula de disputabilidad. Asimismo, tampoco puede inferirse que al haber suscrito otros contratos de crédito con el Banco Popular y de Desarrollo Comunal y con Coocique R.L., que llevaban aparejadas pólizas de vida colectiva –en las cuales, se le incluyó a partir de mayo del 2005 y de setiembre del 2006, respectivamente-, se le diera información veraz, oportuna y adecuada sobre los alcances, contenido, beneficios y limitaciones de la cláusula de disputabilidad que contenían esas pólizas, que le permitieran tener una conciencia clara de en qué consistían, más que en todo caso, se trata de pólizas de vida distintas (folios 44 a 46, 86 a 89 del expediente judicial). Ahora bien, la omisión en informar de manera clara, veraz y oportuna a la actora sobre el contenido y alcances de la cláusula de disputabilidad, adquiere relevancia porque en materia de seguros, a la demandante sólo se le presentaba una única opción, dado que al 16 de setiembre del 2007 –fecha en que se incluye a [Nombre 001] en la póliza colectiva de vida número [Valor 003] ( folios 24, 15 del condiciones generales y particulares de la póliza colectiva de vida [Valor 003])- es público y notorio que para esa fecha, el Instituto Nacional de Seguros operaba en régimen de monopolio todo lo relacionado con la comercialización de seguros, dado que la apertura del mercado de seguros se hizo efectiva hasta la entrada en vigor del Tratado de Libre Comercio suscrito entre Centroamérica, República Dominicana y los Estados Unidos de América (19 de diciembre del 2008, Decreto Ejecutivo 35001), circunstancia que le impidió tener la posibilidad de escoger y decidir –con base en la información que le debió haber sido suministrada- la mejor opción para proteger sus intereses económicos y sus derechos fundamentales, lo cual implica, que ante el estado de necesidad de tener acceso a un crédito para adquirir un vehículo, se vio obligada a aceptar las condiciones de la póliza colectiva de vida –en la que se incluye la cláusula de disputabilidad- , lo cual, trajo como consecuencia que se tornara nugatorio el contenido esencial de sus derechos fundamentales a proteger su seguridad, sus intereses económicos y sociales, a la libertad de escoger la opción que mejor protejiera esos intereses y a la igualdad en la contratación. En razón de lo INSCR-8118-2009 del 23 de diciembre del 2009 e INSCR-4185-2010 del 24 de mayo del 2010, dictados por la Directora Ejecutiva de la Sede del INS en Cartago, se basan en la cláusula de disputablidad contenida en las condiciones generales y particulares de la póliza colectiva de vida número [Valor 003] (folios 44 y 40 del expediente administrativo del reclamo), este Tribunal declara la nulidad absoluta de dichos actos, dado que el incumplimiento del deber de información por parte de la entidad accionada genera la ineficacia de la aplicación de dichas cláusulas en perjuicio de la demandante, con base en lo dispuesto en los artículos 33 y 46 párrafo último de la Constitución Política, del derecho fundamental a la libre contratación derivado del artículo 28 de la Constitución Política y de los artículos 31 y siguientes de la Ley de Promoción de la Competencia y Defensa Efectiva del Consumidor, y 40 y siguientes del Reglamento a esa Ley. […].

VIo.- EN CUANTO A LAS PRETENSIONES INDEMNIZATORIAS POR DAÑO MATERIAL […]. A partir de lo indicado en el considerando V de esta sentencia, este Tribunal estima que de conformidad con lo dispuesto en el artículo 122.m.ii del Código Procesal Contencioso Administrativo, resulta procedente condenar al INS al pago de los daños materiales causados a la demandante, ante su negativa de aplicar a su favor, el monto por el que fue incluida en la póliza colectiva de vida número [Valor 003], con base en la cláusula de disputabilidad de cuyo contenido no fue informada de manera clara, oportuna y veraz; daños materiales que consisten tanto en las sumas pagadas por la actora a la fecha de emisión de esta sentencia, como los montos que aún se encuentren pendientes de cancelar (considerando II aparte b de esta sentencia), originados en la operación crediticia mantenida con Credi Q Inversiones CR, S.A. […]

VIIo.- CON RELACIÓN AL DAÑO MORAL SUBJETIVO […]. Ahora bien, el radio de cobertura de las normas y principios que integran y constituyen el sistema de responsabilidad administrativa, trasciende la reparación de daños eminentemente materiales, para incluir dentro de su área de tutela, los daños de naturaleza extra patrimonial, lo que surge como consecuencia natural de un tipo de responsabilidad que se afinca en el daño y el riesgo. Lo anterior encuentra fundamento en la doctrina del canon 41 constitucional, al establecer el principio de reparación integral del daño, que a modo de derecho se confiere a las personas en su marco individual, en su propiedad o bien, en sus intereses morales. Se trata del resguardo debido de las infracciones a la situación jurídica de la persona, que incluye, su haber patrimonial, pero además, su esfera interna. Así en efecto se colige del numeral 197 de la Ley General de la Administración Pública, norma que dispone: “Cabrá responsabilidad por el daño de bienes puramente morales, lo mismo que por el padecimiento moral y el dolor físico causados por la muerte o por la lesión proferida, respectivamente.” Así las cosas, es evidente que el daño moral se verifica cuando se lesiona la esfera de interés extra patrimonial del individuo. Sin embargo, teniendo en claro que su vulneración puede generar consecuencias patrimoniales, bien puede ser cuantificado. Por tanto, ha de distinguir entre daño moral subjetivo y daño moral objetivo. Sobre el tema, es abundante la jurisprudencia patria. Desde este plano, vale traer a colación la sentencia 316-F-2006 de las dieciséis horas veinte minutos del veintiuno de junio del dos mil seis, de la Sala Primera de la Corte Suprema de Justicia, en cuanto señala: “ Esta Sala, ha tenido ya oportunidad de pronunciarse sobre el concepto, alcances y naturaleza jurídica de este tipo de daño. Así, por ejemplo, en la sentencia no. 151 de las 15 horas 20 minutos del 14 de febrero del 2001 (en la que se cita la resolución no. 112 de las 14 horas 15 minutos del 15 de julio de 1992) indicó: “VIII.- El daño moral (llamado en doctrina también incorporal, extra patrimonial, de afección, etc.) se verifica cuando se lesiona la esfera de interés extra patrimonial del individuo, empero como su vulneración puede generar consecuencias patrimoniales, cabe distinguir entre daño moral subjetivo "puro", o de afección, y daño moral objetivo u "objetivado". El daño moral subjetivo se produce cuando se ha lesionado un derecho extra patrimonial, sin repercutir en el patrimonio, suponiendo normalmente una perturbación injusta de las condiciones anímicas del individuo (disgusto, desánimo, desesperación, pérdida de satisfacción de vivir, etc., vg. el agravio contra el honor, la dignidad, la intimidad, el llamado daño a la vida en relación, aflicción por la muerte de un familiar o ser querido, etc.). El daño moral objetivo lesiona un derecho extra patrimonial con repercusión en el patrimonio, es decir, genera consecuencias económicamente valuables (vg. el caso del profesional que por el hecho atribuido pierde su clientela en todo o en parte). Esta distinción sirve para deslindar el daño sufrido por el individuo en su consideración social (buen nombre, honor, honestidad, etc.) del padecido en el campo individual (aflicción por la muerte de un pariente), así uno refiere a la parte social y el otro a la afectiva del patrimonio. (…) En suma el daño moral consiste en dolor o sufrimiento físico, psíquico, de afección o moral infligido con un hecho ilícito. Normalmente el campo fértil del daño moral es el de los derechos de la personalidad cuando resultan conculcados.” En igual sentido, pueden consultarse, entre muchos otros, los fallos números 280 de las 15 horas 35 minutos del 26 de abril y no. 699 de las 16 horas 5 minutos del 20 de septiembre, ambas del 2000.” Interesa para la presente, el moral subjetivo. Sobre su cuantificación y prueba, por su naturaleza misma, no requiere de una prueba directa, sea, es de valoración prudencial del juzgador. Esto obedece a que se trata de una afectación que se produce en el seno interno de la persona. En relación, la Sala Primera de previa mención, en sentencia no. 537 de las 10 horas 40 minutos del 3 de septiembre del 2003, señaló: “…Se deduce a través de las presunciones inferidas de indicios, ya que, el hecho generador antijurídico pone de manifiesto el daño moral, pues cuando se daña la psiquis, la salud, la integridad física, el honor, la intimidad, etc. es fácil inferir el daño, por ello se dice que la prueba del daño moral existe “in re ipsa”. Tampoco se debe probar su valor porque no tiene un valor concreto. Se valora prudencialmente. No se trata, entonces, de cuantificar el sufrimiento, pues es inapreciable, sino de fijar una compensación monetaria a su lesión, único mecanismo al cual puede acudir el derecho, para así reparar, al menos en parte, su ofensa.”. Aún esto, es criterio de este órgano colegiado que si bien su otorgamiento no se encuentra condicionado o sujeto a factores probatorios, no sucede lo mismo cuando se trata de establecer el nexo causal que permite solicitarlo. Es decir, la relación de causalidad que permitiría entender por ocurrido el daño moral subjetivo, debe ser acreditada, al menos, con la vinculación de un proceder o inercia pública como fuente causante de la lesión interna. Por otra parte, pese a esta dispensa demostrativa aludida -relativa en principio a la cuantía-, su fijación está sujeta a los principios de razonabilidad y de proporcionalidad. De ahí que en cada caso, la autoridad jurisdiccional debe ponderar las particularidades y alcances del conflicto, a efectos de que su otorgamiento y cuantificación se ajuste a dichos criterios rectores y no desemboque en indemnizaciones excesivas que lleven a beneficios injustificados. Ergo, su fijación ha de guardar un justo equilibrio derivado del cuadro fáctico específico. No basta alegar la existencia de padecimientos internos, debe demostrarse al menos, los hechos que en teoría, han originado tal detrimento. En otras palabras, si bien es cierto, en los supuestos en que se alegue un daño moral subjetivo, no es necesario demostrar su cuantía; también lo es, que sí debe demostrarse no sólo la existencia del daño, sino el nexo de causalidad con la conducta que presuntamente los provocó, con excepción de aquellos casos en que por la ocasionado a consecuencia de una determinada conducta, como por ejemplo: la amputación de una extremidad; el fallecimiento de un ser querido; entre otros. A partir de lo anterior, considera este Tribunal que en el caso concreto, y en aplicación de la lógica, la justicia y la experiencia humana, es evidente el sufrimiento, la angustia o el dolor ocasionado a consecuencia de la conducta omisiva imputada al ente asegurador, pues efectivamente, al declinar el INS la cobertura de la póliza de saldos deudores en la que se había incluido a la señora [Nombre 001] respecto de la deuda con la empresa Credi Q Inversiones CR SA, en aplicación de la cláusula de disputabilidad a pesar de que no podía hacerlo, tal y como se ha indicado líneas arriba, existe un nexo causal entre la negativa reprochada y el efecto producido, sea que la demandante ante el rechazo del reclamo con base en dicha cláusula perdiera la tranquilidad que le producía contar con dicha póliza, lo que produjo un esfuerzo para seguir honrando la deuda pese a la cobertura que le asistía y más aún tomando en cuenta que lo debió realizar con una pensión por invalidez que recibía de la CCSS, monto que es de conocimiento público no resulta ser el cien por ciento de lo que recibía cuando era asalariada, lo que de lógica produjo una inestabilidad emocional y sufrimiento, lo cual lo valora este Tribunal in re ipsa, reconociéndole por ello la suma de $ 3.500,00 (tres mil quinientos dólares americanos).”