projetos

Non-disclosure in health insurance questionnaire by parent

ATA/445/1997Tribunal de Justiça / Câmara Administrativa5 de ago. de 1997

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Extraído pela Omnilex

Resumo Omnilex

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.

Sumário Omnilex

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.

Texto completo

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.

Palavras-chave

health insurancenon-disclosurequestionnairepre-existing conditiongood faithparental representationmedical informationreticence

Extraído pela Omnilex

Questões jurídicas principais extraídas pela Omnilex

Questão jurídica principal

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

Decisão extraída

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

Fundamentação extraída

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.

Questão jurídica principal

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

Decisão extraída

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

Fundamentação extraída

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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