MEXICO Law and Practice Contributed by: Carlos de la Garza, Raúl Acosta and Enrique Tamez, De la Garza & Acosta Abogados, S.C.
1. Key Drivers and Resolution of Insurance Disputes
insurance policies contain exclusions for moral dam- ages, Supreme Court jurisprudence has held that such exclusions may be unconstitutional where they undermine compulsory liability coverage, while recov- ery remains subject to the applicable insured limit. Claimants also increasingly seek punitive damages in disputes involving insurers. Recent Supreme Court jurisprudence has increased attention to this issue, particularly where insurance relates to life, health or physical integrity; however, punitive damages remain exceptional and require circumstances going materi- ally beyond an ordinary disagreement as to coverage. Property and Casualty Insurance In property and casualty insurance, the principal areas of contention include causation, the extent and valu- ation of physical damage, the insured’s interest in the affected property and whether the claimed loss resulted from a covered event. Large losses frequent- ly require engineering, accounting or other technical expert evidence. Claimant-Side Litigation Trends A further development has been the growth of a claim- ant-side insurance litigation practice. Policyholders are increasingly represented by counsel specifically pursuing insurance claims, a trend that appears to have been encouraged, at least in part, by a percep- tion of increasingly policyholder-protective judicial approaches in certain areas. This growth has not necessarily been accompanied by a corresponding increase in technical specialisation in insurance law, and claims are sometimes advanced on broad con- sumer-protection or civil-liability theories rather than on a detailed analysis of the insurance contract. Claims are also becoming more ambitious. Disputes that would traditionally have been confined to contrac- tual policy benefits now increasingly include claims for moral and punitive damages, materially increas- ing insurers’ potential exposure. These developments have contributed to a more contentious claims envi- ronment and make early assessment of coverage, documentary evidence and claims-handling decisions increasingly important.
1.1 Common Triggers of Insurance Disputes Insurance disputes in Mexico most frequently arise from disagreements concerning the scope and appli- cation of coverage. Typical issues include whether a loss falls within the insured risk, the application of exclusions, deductibles and co-insurance, compli- ance with notice and other policy obligations, causa- tion and the quantification of the loss. Disputes may also arise from the claims-handling process itself, particularly as to the information required from the insured and the factual or technical basis supporting a denial of coverage. Life and Health Insurance Life and health insurance generate a significant volume of contentious matters. In major medical expenses insurance, disputes commonly concern pre-existing conditions, waiting periods, medical necessity and the distinction between traumatic events and underlying or degenerative conditions. These cases are increas- ingly evidence-intensive and frequently depend on specialised medical, radiological and actuarial evi- dence rather than on policy interpretation alone. Policy Delivery and Intermediaries Another recurring issue is whether the insurer can establish that the policyholder received, or otherwise had proper access to, the general conditions con- taining the relevant exclusions and limitations. This has become particularly important as policies and contractual documentation are increasingly delivered electronically. Related disputes may also involve the role of insurance agents or intermediaries in placing the insurance, transmitting contractual documentation and communicating the scope of coverage. The rel- evance of this issue is that, if the insurer cannot prove that it delivered the general conditions of the policy to the insured, those conditions may not be enforceable
against the insured. Liability Insurance
Liability insurance disputes frequently concern the existence and extent of the insured’s liability, causa- tion, policy limits and the treatment of claims for non- material or moral damages. Although many liability
176 I NSURANCE L I T IGATI O N 2026
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