Failure to disclose pregnancy constitutes reticence

ATA/410/1996Cour de justice / Chambre administrative31 juil. 1996Confirmed

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Résumé Omnilex

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.

Regeste Omnilex

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.

Texte intégral

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.

Mots-clés

social insurancehealth insurancereticenceduty to disclosepregnancyamenorrhea

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Questions juridiques clés extraites par Omnilex

Question juridique clé

Whether the applicant's failure to disclose the pregnancy when applying for health insurance constituted reticence.

Solution extraite

Yes. After more than 110 days of amenorrhea, the applicant could not in good faith ignore the pregnancy, or at least a pathological condition, and the omission amounted to reticence.

Motifs extraits

The court considered that the duration of amenorrhea was such that the applicant should have been aware of her pregnancy or at minimum of a health disorder; nondisclosure of this relevant circumstance breached the duty to inform.

Failure to disclose pregnancy constitutes reticenceGénéré par IA