In the judgment of Special Appeal 1.738.657/DF, the Third Panel of the Superior Court of Appeals (STJ) found that the insurer has no duty to render accounts as a result of life insurance and health insurance contracts.

The Court held that an action to demand accounts presupposes the existence of two elements:

  • the custody or administration of securities, assets, or interests by third parties; and
  • the need for clarification about this management, in the face of uncertainties regarding the balance resulting from the relationship between the parties.

The reporting judge of the appeal, Justice Moura Ribeiro, found that this essential factual premise also applies to health insurance and life insurance contracts, in the sense that there is no interest on the part of the insured to demand accounts, since there is no relationship of custody or administration of assets or interests of third parties by the insurer.

According to article 757 of the Civil Code, the insurance contract does not establish the obligation of the insurer for management of other people's property, but only to "guarantee the legitimate interest of the insured, related to person or thing, against predetermined risks", due to the payment of a premium.

Thus, the insurer's obligation is only to pay the compensation to the insured, upon occurrence of the loss, according to the amount previously established in the policy, with no duty to render accounts.

For the STJ, in life and health insurance contracts, "the amount of compensation to be received in the event of occurrence of the insured event is previously established in the contract and, therefore, there is no ‘custody' of the amounts resulting from the collection, that is, of the premiums.

There is, therefore, a distinction between the obligation to give and receive and the specific obligation to demand and render accounts, which shows the inappropriateness of the action of demanding accounts based on an insurance contract. In this case, the main obligation of the insurer is to pay compensation due to the occurrence of one of the events prefixed in the policy.

The conclusion is that there is no action to demand accounts based on an insurance contract, when there is no management of assets, nor are there complex debit and credit transactions linked to the contract.

For the Court, the claim for any clarification on the amount of the premium in the event of loss, due to uncertainty regarding the amount compensated in relation to the insured's contributions, should be carried out through the ordinary means and not through the special procedure of the action for demanding accounts.

This decision, which is already final and conclusive, established an important precedent as to the appropriate procedural means for clarifying the amount of compensation paid by the insurer. It also reinforced the legal nature of the insurance contract and the obligations assumed by the insurer, not admitting an expansive interpretation of the duties set in the policy and provided for by law.

The precedent also corroborates the already consolidated understanding of the case law that the action of demanding accounts is only applicable in the case in which there is administration or custody of assets and securities by others, and the holder has a legitimate interest in demanding accounts of this management, when there is uncertainty about the balance resulting from this relationship.

It is expected that the courts will observe the position adopted by the STJ and rule out the possibility for the insured to demand accounts from the insurer, given the legal nature of the insurance contract and the fact that the obligations assumed by the insurer are set forth in the policy and provided for by law. The decision precludes a broad and innovative interpretation of the duties of these companies, which would jeopardize the legal security of insurance relationships.