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Non-disclosure in health insurance questionnaire by parent

ATA/445/1997Court of Justice / Administrative ChamberAug 5, 1997

Open source

Extracted by Omnilex

Omnilex summary

During a change of health-insurance contract, the insured disclosed only a lumbago check-up in the accompanying questionnaire, although the real condition was a spinal disorder treated by a chiropractor. The court held that this omission constituted reticence. It also held that a parent who fills in the questionnaire for a child must answer for the inaccuracy just as the child would.

Omnilex headnote

O III/LAMA 2 al. 2; in the context of an amendment of a health-insurance contract, the insured's failure to disclose a relevant vertebral disorder when only a lumbago consultation is mentioned in the questionnaire constitutes reticence. The duty of truthful disclosure is breached where information material to the insurer's risk assessment is withheld or inaccurately minimized. Where a parent completes the questionnaire on behalf of a child, the parent is responsible for the false statement to the same extent as the insured child, since the disclosure obligation is not attenuated by representation.

Full text

Descripteurs

ASSURANCE SOCIALE; AM; LESION DE LA COLONNE VERTEBRALE; LOMBALGIE; VIOLATION DE L'OBLIGATION D'ANNONCER; ATTEINTE A LA SANTE; CAS GRAVE; ETAT ANTERIEUR; CONTRAT; MODIFICATION(EN GENERAL); ASSURANCE COMPLEMENTAIRE; PRINCIPE DE LA BONNE FOI; SEJOUR A L'HOPITAL; FRAIS(EN GENERAL); INFORMATION(EN GENERAL); ASSU

Normes

O III/LAMA 2 al.2

Résumé

Lors d'une modification de contrat d'assurance maladie, le fait de n'indiquer, dans le questionnaire détaillé qui l'accompagne, n'avoir fait au cours des 5 dernières années qu'un contrôle pour un lumbago, alors que l'on souffre en réalité d'une affection vertébrale traitée par un chiropraticien, constitue une réticence. Le parent qui remplit le questionnaire pour son enfant doit répondre de cette inexactitude, au même titre que celui-ci.

Keywords

health insurancenon-disclosurequestionnairepre-existing conditiongood faithparental representationmedical informationreticence

Extracted by Omnilex

Key legal questions extracted by Omnilex

Key legal question

Whether the incomplete answer in the health-insurance questionnaire amounted to a concealment of a material pre-existing condition.

Extracted holding

Yes. Failing to disclose that the insured had a spinal disorder treated by a chiropractor, while declaring only a lumbago control, constituted a reticence.

Extracted reasoning

The discrepancy between the declared minor complaint and the actual vertebral condition concerned information relevant to the insurer's assessment and therefore breached the duty of disclosure.

Key legal question

Whether a parent who completes the questionnaire for a child is responsible for the inaccurate answer.

Extracted holding

Yes. The parent is accountable for the inaccuracy in the same way as the child.

Extracted reasoning

The duty to provide truthful information in the application process applies to the person filling out the form on behalf of the insured child.

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