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Case Review: Insurance
Summary of some of the decisions made by the Mediators on some of the complaints received by FMB.
This summary is for information only and should not be used for other purpose.
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FMB/LI 0087 Non-disclosure of Pre-Existing Illness
TThe insurers declined the claim submitted by the beneficiary of the deceased assured on the ground that the deceased had failed to disclose in the proposal form dated 12.07.2001 about his illness ( tuberculosis ).
The insurers' decision was based on the report from the attending doctor who stated that the deceased probably had tuberculosis for about one year prior to his admission to the hospital. It was the doctor's opinion that the deceased probably had tuberculosis for one year. There is no evidence that the deceased had knowledge that he was suffering from tuberculosis at the material time of completing the proposal form on 12.07.2001.
The insurers then furnished the Mediator with a medical report which stated that the assured was referred to the hospital on 13.11.2002 with history of cough for one year. The insurers maintained that the assured ought to have disclosed his medical condition ( cough for one year ) in the proposal form.
Based on the medical report the assured started to suffer from cough in November 2001 ( one year from 13.11.2002 ), which is after he had completed the proposal form on 12.7.2001.
The Mediator found there was no evidence of non-disclosure of material fact in the proposal form dated 12.7.2001 and accordingly held the insurers liable to settle the claim.
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