Healthcare Insurance

Claim case sharing

Importance of a health declaration in medical insurance

Some customers might not understand the importance of declaring their health information when applying for medical insurance. Non-disclosure of health information may lead to rejection of claims. What follows is a case from the Complaints Panel:

Mr. Wong did not declare that he was a Hepatitis B Carrier when applying for medical insurance, so the insurance company accepted his application with a standard premium. 15 months later, he was hospitalised with an oesophageal carcinoma. However, his hospitalisation claim was declined by his insurance company as Mr. Wong did not disclose that he was a Hepatitis B Carrier.

Mr. Wong admitted that he was aware of being a Hepatitis B Carrier when applying for medical insurance. However he disagreed with the decision made by the insurance company as there was no evidence proving the relationship between an oesophageal carcinoma and Hepatitis B. In addition, Mr. Wong claimed that being a Hepatitis B Carrier is common in Hong Kong.

Although there was no direct relationship between his oesophageal carcinoma and Hepatitis B, the non-disclosure was a material fact which would have affected the underwriting decision of his insurer in offering a standard rate. Therefore, his insurance company declined Mr. Wong’s claim according to the terms and conditions of the policy.

Customers are always advised to disclose their health condition in full to their insurance company otherwise it may affect their future claims. If they are not sure what information should be included in their health declaration, they should seek advice from their insurance representatives or insurance company.

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