Can a life insurer refuse to pay because of an undisclosed illness?

Question

José Manuel Alburquerque · Accepted Answer

Only if the insurer asked clearly about that illness and the insured, who knew about it, concealed it through wilful misconduct or gross negligence, not through a mere inaccuracy. If there was neither wilful misconduct nor gross negligence, the insurer pays, although it may reduce the amount in proportion. Moreover, once a year has passed since the policy was signed, it can only rely on this if there was wilful misconduct. It is the insurer that has to prove all of this. What the insurer has to prove That it used a questionnaire with clear questions that required that illness to be mentioned. If there was no questionnaire, or the questions were general, the insured did not have to guess what to disclose. That the insured knew about the illness when taking out the policy and that the insurer did not. That what was concealed was relevant to the risk covered by the policy. That the concealment involved wilful misconduct or gross negligence. Common situations If the questionnaire was filled in by the bank employee or the agent without asking you the questions and you only signed it, the insurer bears the consequences. The “Tribunal Supremo”, Spain's Supreme Court, has said so several times. But it is not enough that someone else filled it in, because what counts is that you were not asked. If the questionnaire contains information that only you could have given, such as your weight or whether you smoke, that will be hard to argue. If treatment or hospital admissions that did take place were denied, the courts do tend to find wilful misconduct. If the illness appeared after the policy was taken out, it did not have to be notified. In personal insurance, changes in health do not have to be notified. If the policy was signed on or after 30 June 2023 and five years had passed since the end of cancer treatment, without relapse, it did not have to be disclosed. If payment is refused Ask for a copy of the signed questionnaire and of all the paperwork from when the policy was taken out. Check exactly what was asked, when it was signed and who filled it in. That will show whether the refusal holds up. You have five years to claim. If you win, the insurer will normally also have to pay late-payment interest.