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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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IMB/1925/L Fact Within Insurers' Knowledge
The assured was diagnosed as suffering from Carcinoma of Thyroid and submitted a claim for living assurance rider benefit. The claim was declined on the ground of non-disclosure of material fact in the Health Warranty Form dated 27.3.2001.
The insurers' decision was based on the medical report dated 4.6.2003 that the assured had anterior neck swelling for the past 5 years. The assured maintained that she had disclosed in the proposal form dated 14.3.1999 that she was treated for throat pain. At the time of reinstatement on 27.3.2001 she had no medical problem except for the throat pain which had been declared in the proposal form. She was hospitalized from 17.5.2002 to 20.5.2002 and on 28.4.2003 for throat pain / neck swelling and her hospitalization claims were approved by the insurers.
It appears that the assured's health condition ( throat pain / neck swelling ) were already within the insurers' knowledge. Upon being queried, the insurers revised their decision and settled the claim.
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