Is this a case of misrepresentation or concealment ? Discuss the governing principle which requires full declaration of material facts.

CS Professional · Insurance - Law & Practice · PYQS · December 2019
Is this a case of misrepresentation or concealment ? Discuss the governing principle which requires full declaration of material facts.

Answer & Explanation:

Misrepresentation or Concealment: Misrepresentation: A misrepresentation is a statement, whether written or oral, that is false. Generally speaking, in order for an insurance company declare a contract as void due to misrepresented information, the information in question must be material to the decision in order to extend coverage. Concealment: Concealment, on the other hand, is the failure to disclose information that one clearly knows about. To void a contract on the grounds of concealment, the insurer typically must prove that the applicant willfully and intentionally concealed information that was of a material nature. Fraud: While Fraud is the intentional attempt to persuade, deceive, or trick someone in an effort to gain something of value. Although misrepresentations or concealments may be used to perpetrate fraud, by no means are all misrepresentations and concealments acts of fraud. For instance, if an insurance applicant intentionally lies in order to obtain coverage or make a false claim, it could very well be grounds for the charge of fraud. However, if an applicant misrepresents some piece of information with no intent for gain (such as, for example, failing to disclose a medical treatment that the applicant is personally embarrassed to discuss), then no fraud has occurred. In the given case, there is no misrepresentation or concealment. There was oversight on the part of the Insurance Company. Hence the claim is payable. Governing Principle: Utmost Good Faith (Uberrimae Fidei) The governing principle which requires full declaration of material facts is the principle of Utmost Good Faith. Although all contracts ideally should be executed in good faith, insurance contracts are held to an even higher standard, requiring the utmost of this quality between the parties. Due to the nature of an insurance agreement, each party needs and is legally entitled - to rely upon the representations and declarations of the other. Each party must have a reasonable expectation that the other party is not attempting to defraud, mislead, or conceal information and is indeed conducting themselves in good faith. In a contract of utmost good faith, each party has a duty to reveal all material information (that is, information that would likely influence a party's decision to either enter into or decline the contract), and if any such data is not disclosed, the other party will usually have the right to void the agreement. The Principle of 'Uberrimae Fidei' (a Latin phrase), or in simple English words, the Principle of Utmost Good Faith, is a very basic and first primary principle of insurance. According to this principle, the insurance contract must be signed by both parties (i.e. insurer and insured) in an absolute good faith or belief or trust. The person getting insured must willingly disclose and surrender to the insurer his complete true information regarding the subject matter of insurance. The insurer's liability gets void (i.e. legally revoked or cancelled) if any facts, about the subject matter of insurance are either omitted, hidden, falsified or presented in a wrong manner by the insured. The principle of 'Uberrimae Fidei' applies to all types of insurance contracts.

Topics: Principles of Insurance

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