Health · Healthcare & Policy · 2 hrs ago
Court backs cancer patient in insurance disclosure dispute
A court sided with a customer diagnosed with liver cancer after an insurer cancelled his policy and refused a claim.
He had bought a simplified health insurance policy in 2022 that promised 30 million won for a cancer diagnosis.
The insurer said he failed to disclose a note from a health screening a month before he enrolled, which suggested further checks for possible liver problems.
The customer said he had not been told to get more tests and had not seen the results letter.
The court found it hard to establish that he knowingly or seriously carelessly withheld the information, noting there was no proof the letter reached him and no record of a doctor recommending further tests.
The ruling means a note on a screening result alone does not prove that a customer breached their duty to disclose information.
The decision could have been different if he had clearly been told about further tests and concealed that advice; the court’s ruling addressed this case.
A court ruled for a cancer patient in a dispute with an insurer over whether he had failed to disclose a health-check finding.
The insurer had cancelled his policy and refused a 30 million won cancer benefit after he was diagnosed with liver cancer.
The court found it difficult to conclude that the patient had intentionally or with gross negligence failed to disclose the finding.
The health-check notice was sent by ordinary mail, and it was unclear whether or when he received it.
The ruling said a notice on a health-check report alone was not enough to establish a breach of the duty to disclose.
- Who
- A cancer patient identified as A and his insurer, identified as B.
- What
- The court ruled for A in a dispute over the insurer’s refusal to pay a cancer benefit and cancellation of his policy.
- When
- A joined the policy in June 2022 and was diagnosed with liver cancer about two years later. The ruling date is not stated.
- Where
- South Korea. The specific court is not stated.
- Why
- The insurer said A failed to disclose a health-check finding that further testing was needed. A said he had not been told to undergo further tests and had not seen the report.
Insurer B
Patient A
Disclosure
Insurer B
The insurer said A had received a recommendation for further testing but did not disclose it when applying for insurance.
Patient A
A said he received no specific advice to undergo further tests and had not seen the health-check report.
Policy and benefit
Insurer B
The insurer cancelled the policy and refused to pay the 30 million won benefit, citing a breach of the duty to disclose.
Patient A
A challenged the cancellation and refusal in court.
A received a health check about one month before applying for insurance; its report said further checks of liver function and possible causes were needed.
A joined B’s simplified health insurance and answered no to a question about whether a doctor had recommended further tests in the previous three months.
A was diagnosed with liver cancer and claimed a 30 million won benefit; the insurer cancelled the policy and refused payment.
A sued, and the court ruled in his favor, finding it difficult to establish intentional or grossly negligent nondisclosure.
- Policy start
- June 2022
- Insurance benefit
- 30 million won for a cancer diagnosis
- Diagnosis
- Liver cancer, about two years after A joined the policy
- Health-check report
- Recommended further checks of liver function and possible causes
- Court’s assessment
- The report was sent by ordinary mail; whether or when A received it was unclear
What people are saying
If your insurance benefit is denied because you did not disclose health-check results, it is necessary to carefully check whether you received the examination report, the medical records at the time and what the doctor explained.