CASE LAW NO. 22/2018/AL On Non-Disclosure of Pre-existing Medical Conditions in Life Insurance Contracts (Please note that this image is not related to the specific case being discussed).

CASE LAW NO. 22/2018/AL

On Non-Disclosure of Pre-existing Medical Conditions in Life Insurance Contracts

Approved by the Judicial Council of the Supreme People’s Court on October 17^th, 2018, and published under Decision No. 269/QD-CA on November 6^th, 2018, by the Chief Justice of the Supreme People’s Court.

Source of the Case Law:

Appellate Civil Judgment No. 313/2016/DS-PT dated March 16^th, 2016, of the People’s Court of Hồ Chí Minh City in the insurance contract dispute case between the plaintiff, Mr. Đặng Văn L (authorized representative, Mr. Trần Xuân H), and the defendant, Limited Liability Life Insurance Company C (authorized representative, Mr. Hoàng P, with legal counsel, Mr. Đinh Quang T and Mr. Trần Ngọc T).

Location of the Case Law’s Content:

Paragraphs 4, 8, 9, 10, and 11 of the “Court’s Opinion” section.

Summary of the Case Law:

– Case Background:

The life insurance contract, policy, and application form contained ambiguous language regarding the disclosure of the insured’s medical conditions. The information requested was not essential for establishing the insurance contract.

– Legal Resolution:

The court must determine that the ambiguity in the insurance documents did not constitute a breach of the insured’s disclosure obligation. The insured’s failure to disclose certain medical conditions was not a valid reason to invalidate the contract.

Relevant Legal Provisions:

– Clause 2, Article 407 of the 2005 Civil Code (corresponding to Clause 2, Article 405 of the 2015 Civil Code);

– Clause 4, Article 409 of the 2005 Civil Code (corresponding to Clause 3, Article 404 of the 2015 Civil Code);

– Article 21 of the 2000 Insurance Business Law, as amended and supplemented in 2010.

Keywords:

“Insurance Contract”; “Insurance Policy”; “Insurance Application Form”; “Breach of Disclosure Obligation”; “Ambiguous Disclosure Requirement”; “Medical Conditions”.

CASE DETAILS

* In the complaint dated November 10, 2010, and December 8, 2010, plaintiff Mr. Đặng Văn L requested:

The People’s Court of District 1 to compel Life Insurance Company C (hereinafter referred to as Company C) to pay him VND 405,000,000 plus interest accrued up to the effective date of the judgment as the amount Company C must compensate for two insurance contracts purchased by his wife, with the following details:

– Contract S11000009505 purchased on October 14^th, 2008, with a compensation amount of VND 265,000,000.

– Contract S11000040924 purchased on March 25^th, 2009, with a compensation amount of VND 190,000,000.

The company had previously paid him VND 50,000,000.

* In the supplemental and amended complaint dated May 30^th, 2011, Mr. Đặng Văn L requested:

To compel Company C to pay him VND 470,000,000 plus interest accrued up to the effective date of the judgment. The temporary interest calculated up to the current time is VND 43,000,000.

– Contract S11000009505 purchased on October 14^th, 2008, with a compensation amount of VND 287,000,000.

– Contract S11000040924 purchased on March 25^th, 2009, with a compensation amount of VND 190,000,000.

* In the amended complaint dated June 22^nd, 2011, Mr. Đặng Văn L amended his request as follows:

To compel Company C to pay a total amount of VND 203,772,500 for the two insurance contracts S11000009505 and S11000040924 and to continue performing contract S11000009505 purchased on October 14^th, 2008; to return to him the original contracts S11000009505 and S11000040924, specifically:

– The “Thịnh Trí Thành Tài Bảo Gia” contract: as of now, the company must pay the insurance benefit upon death (Article 4.1.2) 50% of the insured amount of VND 35,000,000.

– Annual cash support benefit (Article 4.4) 10% of the insured amount of VND 7,000,000.

– Additionally, continue performing the insurance contract S11000009505 and pay the benefits upon the time specified in the contract.

– Term Insurance with Return of Premium (ROP) contract:

Insurance benefit upon death (Article 4.1): VND 190,000,000 (Company C has paid VND 50,000,000).

The temporary interest up to this point is VND 21,772,500 due to late payment by the company.

* In the supplemental complaint dated April 18^th, 2015, Mr. Đặng Văn L requested:

To compel Company C to pay him VND 405,000,000 plus interest accrued up to the effective date of the judgment.

To compel Company C to return the original insurance contracts S11000009505 and S11000040924 that the company had collected from his family.

*In the response letter No. 008/2011/CV dated January 28^th, 2011, the defendant, Company C, stated:

Customer Trương Thị H had a history of stomach pain and high cholesterol before entering into the two insurance contracts but did not declare it in the questionnaire in the insurance application form. If Company C had known that customer Trương Thị H had stomach pain and high cholesterol, it would have refused to enter into the insurance contracts. Therefore, Company C’s refusal to pay insurance benefits and its decision to cancel the two insurance contracts of Ms. H is grounded (according to Article 11.2 of the Terms and Conditions of the contract) and in accordance with the law (according to Article 19 of the Insurance Business Law).

Company C requested the People’s Court of District 1 to dismiss Mr. L’s lawsuit.

* In response letter No. 024/2011/CV dated May 16^th, 2011, the defendant, Company C, stated:

1. Regarding the request for Company C to pay VND 405,000,000 and interest accrued from the two insurance contracts S11000009505 and S11000040924, Company C maintained its position. The company had fulfilled all its obligations under the above two insurance contracts. Furthermore, Mr. Đặng Văn L’s request is baseless according to the terms and conditions of the insurance contract and has no legal basis. Therefore, Company C requested the Court to dismiss Mr. L’s request.
2. Regarding the request for Company C to return the two original insurance contracts S11000009505 and S11000040924, Company C agreed to return the two original insurance contracts to Mr. L.

* In the written statements dated April 14^th, 2011 and May 9^th, 2011, Mrs. Lương Thị T, a interested party, presented:

Mrs. T is the biological mother of Mrs. Trương Thị H, who passed away on January 9^th, 2010. She requests that Company C pay her and her family the insurance benefit. She agrees to let her son-in-law, Mr. Đặng Văn L, receive the benefit she is entitled to so that Mr. L has full authority and convenience in the dispute with Company C.

* In the written statement dated April 14^th, 2011, Ms. Đặng Kiều L, a interested party, presented:

Mrs. L is the biological daughter of Mrs. Trương Thị H, who passed away on January 9^th, 2010. The insurance benefit that the company must pay to Mrs. H and Ms. L according to the law includes her share, so she requests that Company C pay her the exact amount of the inheritance from the insurance benefit the company owes upon her mother’s unfortunate passing. She agrees to gift her father, Mr. Đặng Văn L, the insurance benefit and the right to inherit the amount from her mother, allowing Mr. L full authority to dispute with Company C to claim the insurance benefit of her mother, Mrs. H.

* In the declaration dated May 9^th, 2011, Mr. Đặng Văn L, the legal representative of Đặng Linh N, stated:

He requests that the court expedite the trial to bring justice and honor back to his family as well as to many Vietnamese citizens who have purchased life insurance from Company C and other life insurance companies.

– The representative of the People’s Procuracy of District 1 stated the following regarding compliance with the law in civil proceedings by the judicial officers and participants:

The judge adhered to the legal provisions of the Civil Procedure Code.

The dispute was correctly identified, the case was still within the statute of limitations, and evidence was fully collected.

The issuance and delivery of procedural documents to the Procuracy and the participants were in accordance with Article 147 of the Civil Procedure Code.

The legal status of the parties was correctly identified, and the decision to bring the case to trial and the deadline for sending the file to the Procuracy for review were met according to the law.

The preparation period for the trial was delayed, violating Article 179 of the Civil Procedure Code.

At the trial, the court conducted proceedings on time, at the right place, and with the participants as recorded in the decision to bring the case to trial, complying with legal principles. During the trial, the presiding judge ensured that the parties had the opportunity to present their views.

The participants complied with legal requirements throughout the case proceedings and at today’s trial; the plaintiff, the defendant, and the interested parties adhered to the provisions of civil procedure law.

In the First-instance Judgment, it was decided:

* Applying:

– Clause 3, Article 25, Point a, Clause 1, Article 33, Point a, Clause 1, Article 35, Article 245 of the Civil Procedure Code 2004 as amended and supplemented in 2011;

– Articles 21, 29 of the Insurance Business Law effective from April 1^st, 2004;

– Articles 305, 407 of the Civil Code effective from January 1^st, 2006;

– Ordinance on Court Fees and Charges effective from July 1^st, 2009;

– Inter-Ministerial Circular No. 01/TTLT dated June 19^th, 1997 of the Ministry of Justice – Ministry of Finance – Supreme People’s Court – Supreme People’s Procuracy;

– Decision No. 2868/QĐ-NHNN dated November 29^th, 2010 of the State Bank of Vietnam.

* Judgment:

1. Accept the plaintiff’s request.

– Company C is required to pay Mr. Đặng Văn L insurance benefit of VND 300,875,342 (Three hundred million eight hundred seventy-five thousand three hundred forty-two dong).

– Company C must hand over to Mr. Đặng Văn L the two insurance contracts: “Thịnh Trí Thành Tài Bảo Gia” dated October 14^th, 2008 and the “Term Insurance with Return of Premium (ROP)” contract dated March 25^th, 2009.

– The insurance contract No. S11000009505 dated October 14^th, 2008 (“Thịnh Trí Thành Tài Bảo Gia”) will continue to be in effect, and the maturity benefits will be paid out when Đặng Linh N turns 22 years old and is alive on the maturity date.

The judgment shall be executed immediately upon the legal effect of the judgment under the supervision of the competent civil judgment enforcement agency.

From the day Mr. Đặng Văn L requests the enforcement of the judgment, if Company C does not pay the full amount as stated, it must also pay Mr. L an interest amount based on the basic interest rate announced by the State Bank corresponding to the time of delayed execution.

2. Regarding court fees: Company C must bear the first-instance civil court fee of VND 15,043,767.

The plaintiff is exempt from the first-instance civil court fee and is entitled to a refund of the advance court fee paid, totaling VND 11,925,000, including: VND 10,100,000 per receipt No. 05237 dated January 5^th, 2011, VND 200,000 per receipt No. 05621 dated April 26^th, 2011, and VND 1,625,000 per receipt No. 05737 dated January 5^th, 2011 of the District 1 Civil Judgment Enforcement Department, Hồ Chí Minh City.

3. Regarding the right to appeal:

– Mr. Trần Xuân H – Representative authorized by Mr. L, Mrs. T, and Mrs. Kiều L, was present on the trial day but absent during the verdict announcement; thus, Mr. L, Mrs. T, and Mrs. Kiều L have the right to appeal the judgment within 15 days from the date the judgment is duly served.

– Company C has the right to appeal the judgment within 15 days from the date the judgment is pronounced.

In case the judgment or decision is executed according to the provisions of Article 2 of the Law on Civil Judgment Enforcement, the person entitled to civil judgment enforcement, the person obliged to execute the judgment, has the right to agree on the execution of the judgment, the right to request judgment enforcement, voluntarily execute the judgment, or be compelled to execute the judgment according to the provisions of Articles 6, 7, and 9 of the Law on Civil Judgment Enforcement; the statute of limitations for judgment enforcement is carried out according to the provisions of Article 30 of the Law on Civil Judgment Enforcement.

On September 9^th, 2015, the defendant – Limited Liability Life Insurance Company C (hereinafter referred to as Company C) filed an appeal, appealing the entire content of the first-instance judgment.

At the appellate trial:

The plaintiff did not withdraw the lawsuit request, the appellant did not withdraw the appeal request. The parties could not reach an agreement on resolving the case.

The appellant, Company C, represented by Mr. Hoàng P under authorization and the legal counsel, presented:

When signing the insurance contract with Company C, Ms. H provided untruthful information. Specifically, in the insurance application form, Ms. H falsely declared in two points as follows:

1. According to the consultation report No. 42/BV-99 of Hospital B dated September 3^rd, 2009, it showed that Ms. H had a history of stomach pain for 2 years. Company C claims that this information was declared by Ms. H and recorded by the doctor in the aforementioned consultation report. Therefore, it can be determined that Ms. H had stomach pain since September 3^rd, 2007, which was before she signed the insurance contract. Company C asserts that the term “gastric disorder” includes all diseases related to the stomach, including stomach pain. In question No. 54 of the insurance application form dated March 25^th, 2009: “Peptic ulcer, gastrointestinal bleeding, pancreatitis, colitis, frequent indigestion, difficulty swallowing, or gastric, intestinal, liver or gallbladder disorder?” Ms. H marked “No” (meaning she declared not having any gastric disorder), which was an untruthful declaration.
2. At the appellate court, Company C provided a photocopy certified blood biochemistry test form dated September 22^nd, 2008, collected by Company C in the regular medical examination file for the employees of Kindergarten C, where Ms. H previously worked. Company C claims that on September 22^nd, 2008, Ms. H had a blood test but did not declare it in item 61 of the insurance application form, showing she intentionally provided untruthful information.

Based on these two points, it is determined that Ms. H provided untruthful information and violated the disclosure obligation. Therefore, based on Article 11.2 of the insurance contract terms and conditions, Company C canceled the above two insurance contracts, and the contracts were ineffective.

Furthermore, on September 15^th, 2010, Mr. L received an amount of 50,000,000 VND and signed a payment receipt and acknowledgment of completion of insurance responsibilities. In this receipt, Mr. L agreed to terminate the two insurance contracts No. S11000009505 and No. S11000040924, acknowledging that Company C had fully paid the insurance amount and had no further responsibility regarding the settlement of insurance benefits for these two contracts.

Therefore, Company C has no obligation to pay insurance benefit to Mr. L and requests the appellate court to consider amending the first-instance judgment by not accepting the plaintiff’s claim.

The plaintiff, Mr. Đặng Văn L, represented by Mr. Trần Xuân H, presented:

Common understanding considers “stomach pain” and “gastric disorder” as two different concepts, with no document or evidence proving that stomach pain is a gastric disorder. Annually, Ms. H had regular health check-ups organized by her workplace. However, this is completely normal, as most agencies and organizations arrange this for their employees. When participating in regular health check-ups, the examinee does not know and is not required to know the specific measures and methods used by the medical organization.

Furthermore, the routine health checkup records do not reveal any conditions relevant to Company C’s refusal to issue the insurance policy. Therefore, Company C’s claim that Ms. H provided untruthful information to deny insurance payment is unfounded. It is requested that the appellate court uphold the first-instance judgment.

The interested parties, Ms. Lương Thị T, Ms. Đặng Kiều L, and minor Đặng Linh N (represented by Mr. Đặng Văn L), represented by Mr. Trần Xuân H under authorization, presented:

The interested parties share the same opinion as the plaintiff, requesting the Trial Panel to uphold the first-instance judgment.

The representative of the Hồ Chí Minh City People’s Procuracy participating in the trial expressed opinions:

In terms of form: The appellant’s appeal was made within the statutory time limit, so it is valid and should be accepted by the court. The Trial Panel and the participants in the trial adhered to the legal regulations during the appellate phase.

In terms of content: According to the content of the appeal presented by Company C and the its legal counsel, there is insufficient basis to determine that Ms. H provided untruthful information, violating the disclosure obligation. Therefore, there is not enough condition to cancel the 02 insurance contracts as claimed by Company C. Hence, there is insufficient ground to accept Company C’s appeal, and it is recommended that the Trial Panel uphold the first-instance judgment.

COURT’S OPINION:

[1] After examining the documents in the case file that were verified at the trial and based on the results of the trial, the Trial Panel finds:

[2] Regarding the procedure: Company C’s appeal was made within the statutory time limit, and Company C completed the appeal procedures in accordance with the law, so it is valid.

[3] Regarding the merits: Considering the defendant’s appeal requesting the dismissal of the plaintiff’s claim, the Trial Panel finds:

[4] In question No. 54 of the insurance application form dated March 25^th, 2009, the question: “Peptic ulcer, gastrointestinal bleeding, pancreatitis, colitis, frequent indigestion, difficulty swallowing, or gastric, intestinal, liver, or gallbladder disorder?” Ms. H marked “No.” In the consultation report No. 42/BV-99 of Hospital B dated September 3^rd, 2009, Ms. H declared a history of stomach pain for 2 years.

According to the consultation report, Ms. H had stomach pain since September 3^rd, 2007, before signing the insurance contract. Company C asserts that the term “gastric disorder” includes all diseases related to the stomach, including stomach pain. However, at the appellate court, the defendant did not present any evidence to prove, nor did they provide any scientific explanation to determine that stomach pain is a gastric disorder.

[5] According to Clause 2, Article 407 of the 2005 Civil Code: “In cases where a standard-form civil contract contains unclear provisions, the party that provided the standard-form contract shall bear the disadvantageous interpretation of those provisions”;

[6] According to Clause 4, Article 409 of the 2005 Civil Code: “When a contract contains ambiguous provisions or terms, they shall be interpreted according to the customary practice at the place where the contract was concluded”;

[7] According to Article 21 of the Insurance Business Law: “In cases where the insurance contract contains unclear provisions, those provisions shall be interpreted in favor of the policyholder.”

[8] Based on the aforementioned legal provisions, in cases where there are differing interpretations, unclear and ambiguous terms must be interpreted in favor of Ms. H. Thus, there is insufficient basis to determine that stomach pain is included in gastric disorder as claimed by Company C.

[9] It is found that the insurance application form did not include a question about stomach pain. Therefore, Company C’s claim that Ms. H had stomach pain and did not declare it as intentionally providing untruthful information and violating the disclosure obligation is unfounded.

[10] In question 61 of the insurance application form dated March 25^th, 2009: “In the past 5 years, have you undergone diagnostic tests such as X-ray, ultrasound, electrocardiogram, blood test, biopsy? Or have you experienced any illness, sickness, or medical treatment not mentioned above at a hospital?” Ms. H checked the box for “No.”

During the appellate trial, Company C provided a blood biochemistry test form dated September 22^nd, 2008, under the name Trương Thị H. Company C confirmed that this document was collected by Company C in the periodic health examination records for employees of Kindergarten C, where Ms. H previously worked. Company C argued that on September 22^nd =, 2008, Ms. H had a blood test but did not report it in question 61 of the insurance application form, meaning she deliberately provided false information.

The Trial Panel found that periodic health checks are regularly conducted by organizations. When participating in these checks, the examinee does not know and is not required to know what measures or methods the medical organization has used. Furthermore, the periodic health examination did not reveal any signs of disease that would lead Company C to refuse to sign the contract with Ms. H. Therefore, there is no basis to determine that Ms. H felt unwell and thus underwent a blood test before buying insurance from Company C.

[11] Thus, there is insufficient evidence to determine that Ms. H was dishonest when signing the insurance contract and that her checking “No” in sections 54 and 61 of the insurance application form directly affected Company C’s decision to consider signing the insurance contract with her.

[12] Additionally, according to the terms of the term insurance with ROP policy and the “Thịnh Trí Thành Tài Bảo Gia” policy of Company C:

[13] “Clause 11.2. If any information provided by the policyholder or the insured is intentionally concealed or falsely declared, seriously affecting the insurance underwriting decision, the company may cancel the contract, and the contract is invalid from the beginning.” The phrase “adversely affecting” in Clause 11.2 was not clearly explained by Company C during today’s trial, nor did the defendant provide a consistent explanation regarding the underwriting decision for term insurance applicants with a history of stomach pain and high cholesterol.

In response document No. 008 dated January 28^th, 2011, Company C stated: “If we had known that customer Trương Thị H had stomach pain and high cholesterol, Company C would have refused to sign the insurance contract.” During the first-instance and appellate trials, Company C’s representative and legal counsel argued that if they had known Ms. H had stomach pain and high cholesterol, they would have considered whether to sign the contract or not. This indicates that Company C did not have a specific criterion to handle such cases.

Therefore, the term “adversely affecting” should be understood to mean a condition that leads to a refusal of insurance purchase rather than possibly selling or not selling insurance as Company C claimed.

This clause creates ambiguity, and according to Clause 2, Article 407 of the Civil Code: “In cases where a standard contract has unclear terms, the party proposing the standard contract must bear the disadvantage when interpreting those terms,” and Article 21 of the Insurance Business Law stipulates: “In cases where the insurance contract has unclear terms, those terms are to be interpreted in favor of the insurance purchaser.” Thus, this clause must be understood and interpreted in favor of Mrs. H.

[14] In reality, Ms. Nguyễn Thị Diễm P, a witness in this case, stated that she purchased a periodic preferential insurance product from Company C based on insurance contract number S11000297923. At the time of entering into the insurance contract, she informed Company C that she was using medication for stomach pain, occasionally experiencing stomach pain for about three years, and underwent periodic Triglycerid tests of 2.2 mmol/l. According to the verification results from the People’s Court of District 1 at District 1 General Hospital on July 28^th, 2015, a Triglycerid level of 2.2 mmol/l is higher than normal.

[15] Considering the case of Ms. Nguyễn Thị Diễm P when she purchased term insurance from Company C, Ms. P declared that she had stomach pain and high cholesterol higher than normal, but Company C still sold her the insurance with standard premiums. This demonstrates that stomach pain and high cholesterol are not considered adversely affecting, as Company C sold insurance at standard premiums like other cases.

This implies that an insurance purchaser not declaring stomach pain and high cholesterol does not severely affect Company C’s decision to evaluate and accept the insurance contract, thus the customer does not violate Article 11.2 of the rules and terms of the product issued by Company C, as correctly determined by the first instance court.

[16] Company C stated that it had fulfilled all its obligations as stipulated in the two insurance contracts. Regarding this dispute, Company C and Mr. L have resolved the matter, as indicated in the payment and insurance responsibility completion confirmation receipt dated September 9^th, 2010.

In item 3 of this receipt, Mr. L confirmed that Company C had made full payment and had no further responsibilities regarding the insurance benefits for these two contracts; in item 4, Mr. L committed not to perform any actions affecting Company C in the future, and Company C would not have to fulfill any responsibilities or obligations regarding contracts S11000009505 and S11000040924.

Therefore, Mr. L’s signing of the payment and insurance responsibility completion confirmation receipt dated September 9^th, 2010 does not waive Mr. L’s right to file a lawsuit if he believes this agreement affects his legal rights and interests.

[17] Based on the above observations, there is a basis to determine that the first instance court’s acceptance of the plaintiff’s claim is grounded and lawful. Therefore, there is no basis to accept Company C’s appeal request, and the first instance judgment should be upheld.

[18] Regarding other decisions of the first instance judgment, the parties did not appeal, and the People’s Procuracy did not protest, thus these decisions take legal effect.

[19] Regarding appellate civil court fees: Since the first instance judgment is upheld, Company C must bear the appellate civil court fees of VND 200,000.

In light of the foregoing,

Pursuant to Clause 1, Article 132, Clause 1, Article 275 of the Civil Procedure Code;

Pursuant to Clause 1, Article 30 of the Ordinance on Court Fees and Charges 2009.

IT IS DECIDED:

The appeal of the defendant, Limited Liability Insurance Company C, is not accepted.

The first-instance judgment No. 1211/2015/TLST-DS dated August 26^th, 2015, of the People’s Court of District 1, Hồ Chí Minh City, is upheld.

Accepting the plaintiff’s request.

Limited Liability Insurance Company C is responsible for paying Mr. Đặng Văn L the insurance amount of VND 300,875,342 (Three hundred million eight hundred seventy-five thousand three hundred forty-two dong).

Limited Liability Insurance Company C must return to Mr. Đặng Văn L the two insurance contracts: Thịnh Trí Thành Tài Bảo Gia dated October 14^th, 2008, and the Term Insurance with Refund dated March 25^th, 2009.

The insurance contract No. S1100000505 dated October 14^th, 2008 (Thịnh Trí Thành Tài Bảo Gia) continues to be valid and will be settled upon maturity if Đặng Linh N is 22 years old and still alive on the maturity date.

Execution is to be carried out immediately upon the judgment taking legal effect and under the supervision of the competent civil judgment enforcement agency.

From the date Mr. Đặng Văn L submits a request for enforcement, if Limited Liability Insurance Company C does not fully pay the aforementioned amount, the company must additionally pay Mr. L a monthly interest amount according to the interest rate announced by the State Bank for the time period of non-enforcement.

First-instance civil court fees: Limited Liability Insurance Company C must bear the first-instance civil court fee of VND 15,043,767. Mr. Đặng Văn L is exempted from the first-instance civil court fee and is refunded the total amount of VND 11,925,000 paid as advance court fees, including VND 10,100,000 according to receipt No. 05237 dated January 5^th, 2011, VND 200,000 according to receipt No. 05621 dated April 26^th, 2011, and VND 1,625,000 according to receipt No. 05737 dated January 5^th, 2011, of the District 1 Civil Judgment Enforcement Department, Hồ Chí Minh City.

Appellate civil court fees: Limited Liability Insurance Company C must bear the appellate civil court fee of VND 200,000 (Two hundred thousand dong), which is deducted from the advance appellate court fee amount paid according to receipt No. AE/2014/0005146 dated September 10^th, 2015, of the Hồ Chí Minh City Civil Judgment Enforcement Department. Limited Liability Insurance Company C has fully paid the advance appellate court fee.

In case the judgment or decision is executed according to the provisions of Article 2 of the Law on Civil Judgment Enforcement, the person entitled to civil judgment enforcement, the person obliged to execute the judgment, has the right to agree on the execution of the judgment, the right to request judgment enforcement, voluntarily execute the judgment, or be compelled to execute the judgment according to the provisions of Articles 6, 7, and 9 of the Law on Civil Judgment Enforcement; the statute of limitations for judgment enforcement is carried out according to the provisions of Article 30 of the Law on Civil Judgment Enforcement.

The appellate judgment takes legal effect from the date of pronouncement.

CONTENT OF THE CASE LAW:

“[4] In question No. 54 of the insurance application form dated March 25^th, 2009, the question: “Peptic ulcer, gastrointestinal bleeding, pancreatitis, colitis, frequent indigestion, difficulty swallowing, or gastric, intestinal, liver, or gallbladder disorder?” Ms. H marked “No.” In the consultation report No. 42/BV-99 of Hospital B dated September 3^rd, 2009, Ms. H declared a history of stomach pain for 2 years.

According to the consultation report, Ms. H had stomach pain since September 3^rd, 2007, before signing the insurance contract. Company C asserts that the term “gastric disorder” includes all diseases related to the stomach, including stomach pain. However, at the appellate court, the defendant did not present any evidence to prove, nor did they provide any scientific explanation to determine that stomach pain is a gastric disorder.

[8] Based on the aforementioned legal provisions, in cases where there are differing interpretations, unclear and ambiguous terms must be interpreted in favor of Ms. H. Thus, there is insufficient basis to determine that stomach pain is included in gastric disorder as claimed by Company C.

[9] It is found that the insurance application form did not include a question about stomach pain. Therefore, Company C’s claim that Ms. H had stomach pain and did not declare it as intentionally providing untruthful information and violating the disclosure obligation is unfounded.

[10] In question 61 of the insurance application form dated March 25^th, 2009: “In the past 5 years, have you undergone diagnostic tests such as X-ray, ultrasound, electrocardiogram, blood test, biopsy? Or have you experienced any illness, sickness, or medical treatment not mentioned above at a hospital?” Ms. H checked the box for “No.”

During the appellate trial, Company C provided a blood biochemistry test form dated September 22^nd, 2008, under the name Trương Thị H. Company C confirmed that this document was collected by Company C in the periodic health examination records for employees of Kindergarten C, where Ms. H previously worked. Company C argued that on September 22^nd =, 2008, Ms. H had a blood test but did not report it in question 61 of the insurance application form, meaning she deliberately provided false information.

The Trial Panel found that periodic health checks are regularly conducted by organizations. When participating in these checks, the examinee does not know and is not required to know what measures or methods the medical organization has used. Furthermore, the periodic health examination did not reveal any signs of disease that would lead Company C to refuse to sign the contract with Ms. H. Therefore, there is no basis to determine that Ms. H felt unwell and thus underwent a blood test before buying insurance from Company C.

[11] Thus, there is insufficient evidence to determine that Ms. H was dishonest when signing the insurance contract and that her checking “No” in sections 54 and 61 of the insurance application form directly affected Company C’s decision to consider signing the insurance contract with her.”

If you need more consulting, please Contact Us at TNHH NT International Law Firm (ntpartnerlawfirm.com)

You can also download the .docx version here.