“健康告知” 暗藏的理赔风险

Core Viewpoint - The article discusses recent court cases in China regarding disputes over insurance claims related to health disclosures, highlighting the importance of accurate health information during the insurance application process and the responsibilities of both insurers and insured parties [1][2][3][4]. Group 1: Case Summaries - In a case involving Xu and his spouse Ma, the insurance company denied a claim based on Ma's failure to disclose a history of hypertension and abnormal arterial indicators, leading to a court ruling that the insurer's contract termination was invalid, and they were ordered to pay 49,149.67 yuan [2]. - Another case involved Huang, who was denied a claim for liver cancer after failing to disclose a history of intestinal polyps during the initial application, despite the insurer not inquiring about health status during the renewal process. The court ruled in favor of Huang, ordering the insurer to pay over 80,000 yuan [3][4]. Group 2: Legal and Regulatory Insights - The courts emphasized that the duty of disclosure for the insured is limited to the inquiries made by the insurer, and if the insurer does not ask specific health questions, they cannot claim non-disclosure as a reason for denying a claim [4]. - The principle of utmost good faith in insurance contracts requires insurers to clearly communicate their inquiries and maintain proper evidence of health disclosures [5]. Group 3: Recommendations for Consumers - Consumers are advised to accurately complete health questionnaires, retain medical records, choose insurance products with favorable renewal conditions, and provide truthful information during the claims process to avoid disputes [5][6].