Arvind while taking the Life Insurance Policy had informed in his proposal form to XYZ Insurance Company that he is a smoker. He also submitted special reports of his diabetes and blood pressure, which were asked by the
CS Professional · Insurance - Law & Practice · PYQS · December 2021
Arvind while taking the Life Insurance Policy had informed in his proposal form to XYZ Insurance Company that he is a smoker. He also submitted special reports of his diabetes and blood pressure, which were asked by the company. The proposal was accepted with extra premium and was informed on 10th January, 2019. He was hospitalised on 17th January, 2019 due to chest congestion and breathlessness. He was under treatment from 17th January. However, he died on 1st October, 2019 due to heart failure. The claim was repudiated on the grounds of suppression of material facts based on certificate of treatment, prescription, letters of doctors and hospital. It was observed that all the diagnosis/treatment commenced after 17th January. All the documents proved that the deceased was not aware of his ailment at the time of taking the proposal. Bharti was working as a supervisor in postal department. While taking the life insurance policy on 5th January, 2008 she had produced a voter ID card as the age proof and the agent filled up the proposal form. Date of birth mentioned in that voter ID was 01-01-1950 though her actual date of birth was 01-08-1943. However she passed away on 20th December, 2008. The insurer has repudiated the claim based on the allegation of wrong age proof. With reference to the first two cases (a and b), explain the following: Warranties Representation Misrepresentation Concealments.
Answer & Explanation:
(a) Warranties: A warranty is a statement that is considered guaranteed to be true and, once declared, becomes an actual part of the contract. Warranties in insurance contracts can be divided into two types: affirmative or promissory. An affirmative warranty is a statement regarding a fact at the time the contract was made. A promissory warranty is a statement about future facts or about facts that will continue to be true throughout the term of the policy. An untruthful affirmative warranty makes an insurance contract void at its inception. If a promissory warranty becomes true, the insurer may cancel coverage at such time as the warranty becomes untrue. (b) Representation: A representation is a statement that is believed to be true to the best of the other party's knowledge. If the insurer relies on a representation in entering into the insurance contract and if it proves to be false at the time it was made, the insurer may have legal grounds to void the contract. (c) Misrepresentation: Getting into a contract with a person or a company on false grounds by making statements that are not in accordance with the facts is known as misrepresentation. In an insurance policy, misrepresentation on the behalf of the insured gives the insurance company a right to terminate the policy. (d) Concealment: Concealment is the failure to disclose information that one clearly knows about. In the case of (a) the deceased was not aware of his ailment at the time of taking the proposal, so the question of misrepresentation or concealment does arise against the warranty of the contract. However, in the case of (b) the life assured was aware of her correct age but she produced a voter ID showing a wrong date of birth so this is a clear case of concealment and misrepresentation.
Topics: Insurance Principles
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