Failure to disclose known coronary disease to insurer

ATA/130/1997Court of Justice / Administrative ChamberFeb 18, 1997

Extracted by Omnilex

Omnilex summary

The case concerns an insured who failed to notify his health insurer of a coronary disease. The central question was whether he had breached the duty to report despite the absence of a formal diagnosis communicated to the insurer. The court’s reasoning turns on whether the insured could not reasonably have ignored the existence of the illness. If that threshold is met, nondisclosure constitutes a breach of the reporting obligation.

Omnilex headnote

LAMA 5; duty to report and insurance reservation in social insurance: an insured breaches the obligation to disclose a disease when, in light of the circumstances, he could not reasonably have been unaware of its existence. The decisive criterion is not the insurer’s formal knowledge but the insured’s own awareness or unavoidable awareness of the relevant medical condition.

Full text

Descripteurs

ASSURANCE SOCIALE; AM; RESERVE D'ASSURANCE; VIOLATION DE L'OBLIGATION D'ANNONCER; ASSU

Normes

LAMA.5

Résumé

Assuré qui n'informe pas sa caisse de l'existence d'une maladie coronarienne. Cas dans lequel l'assuré ne pouvait pas ignorer l'existence de sa maladie.

Keywords

social insuranceduty to reportreservationnondisclosurecoronary disease

Extracted by Omnilex

Key legal questions extracted by Omnilex

Key legal question

Whether the insured violated the duty to report a coronary disease to the insurer.

Extracted holding

A violation exists where the insured could not have ignored the existence of the disease and nonetheless failed to disclose it.

Extracted reasoning

The decisive point is the insured's knowledge, or at least unavoidable awareness, of the illness; if this condition is met, the reporting obligation is breached.

Failure to disclose known coronary disease to insurerAI generated