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Non-disclosure of psychiatric treatment in supplementary insurance questionnaire

ATA/770/1998Cour de justice / Verwaltungskammer01.12.1998Dismissed

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Omnilex-Zusammenfassung

The court held that an insured who completes a questionnaire for supplementary insurance must disclose ongoing psychiatric treatment. Failing to do so can justify retroactive misrepresentation consequences under the Insurance Contract Act. The insured could not invoke the fact that the same insurer, acting as basic insurer, had previously paid invoices relating to that treatment. The prior payment did not create a justificatory circumstance or override the duty to answer the supplementary-insurance questionnaire truthfully.

Omnilex-Regeste

Art. 6 LCA; duty of truthful disclosure in the formation of supplementary insurance contracts and retroactive consequences of non-disclosure. An applicant for supplementary insurance must answer health questions completely and truthfully, including the existence of ongoing psychiatric treatment. The insured cannot rely, as a justificatory circumstance, on the fact that the insurer previously settled treatment invoices in its capacity as basic insurer, since such conduct does not negate the duty to disclose nor create a legitimate expectation that the information need not be mentioned. The decisive point is the relevance of the omitted fact to the risk inquiry in the supplementary-insurance questionnaire.

Gesamter Gesetzestext

Descripteurs

ASSURANCE SOCIALE; AM; VIOLATION DE L'OBLIGATION D'ANNONCER; LOI SUR LE CONTRAT D'ASSURANCE; AFFECTION PSYCHIQUE; PSYCHOLOGIE; ASSURANCE COMPLEMENTAIRE; RESERVE D'ASSURANCE; ETAT ANTERIEUR; PRINCIPE DE LA BONNE FOI; REDUCTION DE LA PRESTATION D'ASSURANCE; CONTRAT; MODIFICATION(EN GENERAL); ASSU

Normes

LCA.6

Résumé

Lorsqu'un assuré remplit un questionnaire visant à la conclusion d'une assurance complémentaire, il ne peut taire le fait qu'il suit un traitement psychiatrique sans risquer de se voir ensuite imposer une réticence rétroactive. Le fait que l'assureur, en sa qualité d'assureur de base, a réglé auparavant des factures ayant trait à ce traitement ne peut être invoqué à titre de fait justificatif.

Schlagwörter

social insuranceinsurance contractduty to disclosepsychiatric treatmentsupplementary insurancegood faithmisrepresentationrisk questionnairebasic insurancepre-existing condition

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Von Omnilex extrahierte Kernrechtsfragen

Kernrechtsfrage

Whether failure to disclose psychiatric treatment in a supplementary insurance questionnaire justified retroactive misrepresentation consequences under the Insurance Contract Act.

Extrahierter Entscheid

Yes. An applicant for supplementary insurance must disclose ongoing psychiatric treatment; concealing it can lead to retroactive misrepresentation consequences.

Extrahierte Begründung

The questionnaire was aimed at concluding supplementary insurance, so the insured had a duty to answer truthfully on the psychiatric treatment. Prior payment of related invoices by the insurer as basic insurer did not excuse the non-disclosure or constitute a justificatory fact.

Kernrechtsfrage

Whether the insurer's prior payment of treatment invoices under basic insurance excused the non-disclosure based on good faith.

Extrahierter Entscheid

No. Prior payment of invoices under basic insurance cannot be relied on as a justificatory circumstance.

Extrahierte Begründung

The insurer's earlier handling of invoices in its role as basic insurer did not amount to an assurance that disclosure was unnecessary for the supplementary insurance questionnaire.

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