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ATA/410/1996 ΓÇó Failure to disclose pregnancy constitutes reticence
ATA/410/1996Cour de justice / Chambre administrative31 juil. 1996Confirmed
A health-insurance applicant failed to disclose a pregnancy after more than 110 days of amenorrhea. The court held that she could not in good faith ignore the pregnancy, or at least a pathological state, and that her silence therefore amounted to reticence. The insurer’s position was upheld.
LAMA art. 5; reticence in health-insurance application; an applicant who, after more than 110 days of amenorrhea, does not disclose a pregnancy cannot invoke good faith ignorance of the pregnancy or of a pathological condition. Such omission concerns a material fact and constitutes reticence when it is not reported at the time of application.
Descripteurs
ASSURANCE SOCIALE; AM; VIOLATION DE L'OBLIGATION D'ANNONCER; RESERVE D'ASSURANCE; GROSSESSE; ASSU
Normes
LAMA.5
Résumé
On ne peut admettre qu'après une aménorrhée de plus de 110 jours, une candidate à l'assurance-maladie puisse de bonne foi ignorer sa grossesse ou, à tout le moins, un état pathologique. Le fait de ne pas renseigner à ce sujet constitue une réticence.