Precedent No. 22/2018/AL

Precedent No. 22/2018/AL on determining non-violation of the obligation to provide information on medical conditions in life insurance contracts was adopted by the Council of Judges of the Supreme People's Court on October 17, 2018 and promulgated under Decision No. 269/QD-CA dated November 6, 2018 of the Chief Justice of the Supreme People's Court.

Source of case law:

Civil Appeal Judgment No. 313/2016/DS-PT dated March 16, 2016 of the People's Court of Ho Chi Minh City on the insurance contract dispute case between the plaintiff, Mr. Dang Van L (authorized representative of Mr. Dang Van L is Mr. Tran Xuan H) and the defendant, C Life Insurance Company Limited (authorized representative is Mr. Hoang P, protector of legal rights and interests is Mr. Dinh Quang T, Mr. Tran Ngoc T).

Location of case law:

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

Overview of the case law:

- Case law

The life insurance contract, insurance rules, and insurance application form contain unclear requirements regarding the declaration of the insured's medical condition. The information required to be declared is not the basis for the parties to decide on the establishment of the life insurance contract.

- Legal solutions

In this case, it must be determined that the insured did not violate the obligation to provide information when signing the insurance contract or insurance application.

Legal provisions relating to precedents:

- 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 Law on Insurance Business 2000 amended and supplemented in 2010.

Keywords of case law:

“Insurance contract”; “Insurance rules”; “Insurance application”; “Breach of duty to provide information”; “Unclear request for information”; “Medical condition”.

CASE CONTENT

* In the petition dated November 10, 2010, on December 8, 2010, Mr. Dang Van L, the plaintiff, requested: 

District 1 People's Court ordered C Life Insurance Company Limited (hereinafter referred to as Company C) to pay him 405,000,000 VND and the interest accrued up to the time the judgment takes effect, which is the amount that Company C must compensate for two insurance contracts purchased by his wife with the following symbols:

- Contract S11000009505 purchased on October 14, 2008, compensation amount is 265,000,000 VND.

- Contract S11000040924 purchased on March 25, 2009, compensation amount is 190,000,000 VND.

The company paid him 50,000,000 VND in advance.

* In the supplementary petition, changing the lawsuit request dated May 30, 2011, Mr. Dang Van L requested:

 Company C is required to pay him the amount of 470,000,000 VND and the interest accrued up to the time the judgment takes legal effect. The provisional interest up to now is 43,000,000 VND.

- Contract S11000009505 purchased on October 14, 2008, compensation amount is 287,000,000 VND.

- Contract S11000040924 purchased on March 25, 2009, compensation amount is 190,000,000 VND.

* In the petition to change the lawsuit request dated June 22, 2011, Mr. Dang Van L changed the lawsuit request as follows :

Force Company C to pay a total amount of VND 203,772,500 for 02 insurance contracts No. S11000009505, S11000040924 and continue to perform contract S11000009505 purchased on October 14, 2008; return two original contracts No. S11000009505; S11000040924 specifically:

Thinh Tri Thanh Tai Bao Gia contract up to this point the company must pay the death benefit (Article 4.1.2) 50% of the insurance amount of 35,000,000 VND.

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

At the same time, continue to implement insurance contract number S11000009505 to pay benefits when the time stated in the contract comes.

- Term life contract with refund.

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

The provisional interest up to this point is the amount of interest due to the company's late payment: VND 21,772,500.

* In the supplementary petition for lawsuit dated April 18, 2015, Mr. Dang Van L requested:

Company C is required to pay him the amount of VND 405,000,000 and the interest accruing until the time the judgment comes into legal effect.

Force Company C to pay 02 original insurance contracts No. S11000009505 and S11000040924 that the company seized from Mr.'s family.

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

Before entering into the two insurance contracts, customer Truong Thi H had a history of stomach pain and high blood fat, but did not declare it in the questionnaire in the insurance application. If Company C had known that customer Truong Thi H had stomach pain and high blood fat, it would have refused to enter into the insurance contract. Therefore, Company C's refusal to pay insurance benefits and the decision to cancel Ms. H's two insurance contracts were well-founded (according to Article 11.2 of the Rules and Terms of the Contract) and in accordance with the provisions of the law (according to Article 19 of the Law on Insurance Business).

Company C requested District 1 People's Court to dismiss Mr. L's lawsuit.

* In response document No. 024/2011/CV dated May 16, 2011; Defendant Company C stated:

1. Regarding the request for Company C to pay the amount of VND 405,000,000 and the interest accrued from the two insurance contracts No. S11000009505 and S11000040924, Company C maintains its position. The Company has paid all of its obligations as stipulated in the two insurance contracts mentioned above. At the same time, Mr. Dang Van L's request is groundless according to the provisions of the Rules and Terms of the insurance contract and has no legal basis. Therefore, Company C requests the Court to dismiss Mr. L's request.
2. Regarding the request for Company C to return two (02) original insurance contracts No. S11000009505 and S11000040924, Company C agrees to return two (02) original insurance contracts to Mr. L.

* In the self-declaration dated April 14, 2011; May 9, 2011, Ms. Luong Thi T, a person with related rights and obligations, stated:

She is the biological mother of Ms. Truong Thi H who passed away on January 9, 2010; she requested Company C to pay her and her family the insurance compensation. Agree to give her son-in-law, Mr. Dang Van L, the insurance compensation that she is entitled to so that Mr. L has full authority and convenience in the dispute with Company C.

* In the declaration dated April 14, 2011, Ms. Dang Kieu L, a person with related rights and obligations, stated:

Ms. L is the biological daughter of Ms. Truong Thi H who passed away on January 9, 2010. The amount of money the insurance company paid to Ms. H and she, according to the law, also had a part, so she requested that Company C pay her the exact amount of money that she was entitled to inherit from the insurance money that the company had to pay when her mother unfortunately passed away. She agreed to give her father, Mr. Dang Van L, the insurance compensation money as well as the right to receive the amount that she should have inherited from her mother and Mr. L had the full right to dispute with Company C to claim the insurance money from her mother, Ms. H.

* In the statement dated May 9, 2011, Mr. Dang Van L, the legal representative of Dang Linh N, stated:

Request the Court to bring the case to trial soon to restore justice and honor to his family as well as many Vietnamese people who have purchased life insurance from Company C as well as other life insurance companies.

The representative of District 1 People's Procuracy stated the compliance with the law in civil proceedings by the litigants and participants as follows: 

The judge complied with the legal provisions of the Civil Procedure Code.

Correctly determine the dispute relationship, the lawsuit is still within the statute of limitations, and collect sufficient evidence.

The issuance and service of procedural documents to the Procuracy and participants in the proceedings as prescribed in Article 147 of the Civil Procedure Code.

Correctly determine the legal status of the parties, decide to bring the case to trial and send the case file to the Procuracy for research within the prescribed time limit.

The delay in preparing for trial violates Article 179 of the Civil Procedure Code.

At the trial, the panel of judges conducted the trial at the correct time, location and composition as stated in the decision to bring the case to trial, and the trial principles complied with the law. During the trial, the presiding judge ensured that the litigants were allowed to express their views.

Compliance with the law by the participants in the proceedings: Since accepting the case as well as at today's trial, the plaintiff and the defendant, and those with related rights and obligations, have complied with the provisions of the civil procedure law.

The first instance judgment stated:

* Apply:

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

- Article 21, Article 29 of the Law on Insurance Business takes effect from April 1, 2001;

- Article 305, Article 407 of the Civil Code takes effect from January 1, 2006;

- The Ordinance on Court Fees and Charges takes effect from July 1, 2009;

- Joint Circular No. 01/TTLT dated June 19, 1997 of the Ministry of Justice - Ministry of Finance

- Supreme People's Court - Supreme People's Procuracy;

- Decision No. 2868/QD-NHNN dated November 29, 2010 of the State Bank of Vietnam.

* Processing:

1. Accept the plaintiff's request.

- Compel C Life Insurance Company Limited to be responsible for paying Mr. Dang Van L the insurance amount of 300,875,342 VND (Three hundred million eight hundred seventy-five thousand three hundred forty-two VND).

- Life Insurance Company C must return to Mr. Dang Van L two insurance contracts of Thinh Tri Thanh Tai Bao Gia dated October 14, 2008, and a term insurance contract with refund dated March 25, 2009.

- Insurance contract No. S11000009505 dated October 14, 2008 (Thinh Tri Thanh Tai Bao Gia) continues to be implemented and the maturity benefit will be settled when Dang Linh N is 22 years old and still alive on the maturity date.

Executed immediately when the judgment comes into legal effect under the supervision of the competent civil enforcement agency.

From the date Mr. Dang Van L filed a request for enforcement of the judgment, if C Life Insurance Company Limited does not pay the full amount as above, C Life Insurance Company Limited must also pay Mr. L a monthly interest amount according to the basic interest rate announced by the State Bank corresponding to the time the judgment has not been enforced.

2. Regarding court fees: C Life Insurance Company Limited must pay first instance civil court fees of VND 15,043,767.

The Plaintiff is not required to pay the first instance civil court fees, so the total advance payment of court fees paid is 11,925,000 VND, including: 10,100,000 VND according to receipt No. 05237 dated January 5, 2011, 200,000 VND according to receipt No. 05621 dated April 26, 2011 and 1,625,000 VND according to receipt No. 05737 dated January 5, 2011 of the Civil Judgment Enforcement Office of District 1, Ho Chi Minh City.

3. Regarding the right to appeal:

- Mr. Tran Xuan H - Authorized representative of Mr. L, Ms. T, Ms. Kieu L, was present on the trial day, absent when the verdict was announced, therefore Mr. L, Ms. T, Ms. Kieu L have the right to appeal the verdict within 15 days from the date of valid service of the verdict.

- C Life Insurance Company Limited has the right to appeal the judgment within 15 days from the date of judgment.

In case the judgment or decision is enforced according to the provisions of Article 2 of the Law on Civil Judgment Enforcement, the person entitled to civil judgment enforcement and the person subject to civil judgment enforcement have the right to agree on judgment enforcement, the right to request judgment enforcement, voluntarily enforce the judgment or be forced to enforce 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 implemented according to the provisions of Article 30 of the Law on Civil Judgment Enforcement.

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

At the appeal hearing:

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

The appellant, company C, represented by Mr. Hoang P under authorization and the lawyer protecting legal rights and interests, presented:

When signing the insurance contract with Company C, Ms. H made dishonest declarations. Specifically, in the insurance application, Ms. H made dishonest declarations in the following two points:

1. According to the consultation record No. 42/BV-99 of Hospital B dated September 3, 2009, Ms. H had a history of stomach pain for 2 years. Company C stated that this content was declared by Ms. H and recorded by the doctor in the above consultation record. Therefore, it can be determined that Ms. H had stomach pain since September 3, 2007, before the time Ms. H signed the insurance contract. Company C stated that the phrase stomach disorder includes all diseases related to the stomach, including stomach pain. In question No. 54 of the Insurance Application Form dated March 25, 2009: "Gastrointestinal ulcers, gastrointestinal bleeding, pancreatitis, colitis, frequent indigestion, difficulty swallowing, or disorders of the stomach, intestines, liver or gallbladder?" Ms. H checked the no box (meaning that Ms. H declared that she did not have a stomach disorder) which is a dishonest declaration.
2. At the appeal hearing, Company C provided a photocopy of a blood biochemistry test dated September 22, 2008, collected by Company C in the periodic medical examination records for employees of Kindergarten C, where Ms. H previously worked. Company C argued that on September 22, 2008, Ms. H had a blood test but did not declare it in section 61 of the insurance claim form, which meant that Ms. H intentionally made a dishonest declaration.

From the above two points, it is determined that Ms. H has declared false information and violated the obligation to provide information. Therefore, based on Article 11.2 of the Insurance Contract Terms and Conditions, Company C cancels the above two insurance contracts and the two contracts are invalid.

In addition, on September 15, 2010, Mr. L received the amount of VND 50,000,000 and signed the Payment and Confirmation Form for completion of insurance liability. In this Form, Mr. L agreed to terminate the two Insurance Contracts No. S11000009505 and Contract No. S11000040924, and acknowledged that Company C had paid the full insurance amount and was no longer responsible for settling insurance benefits for these two contracts.

Therefore, Company C has no obligation to pay insurance to Mr. L, so it is requested that the Court of Appeal consider amending the first instance judgment in the direction of not accepting the plaintiff's request to initiate a lawsuit.

Plaintiff Mr. Dang Van L presented by Mr. Tran Xuan H:

According to common understanding, "stomach ache" and "stomach disorder" are two different concepts, there is no document or evidence to prove that stomach ache is a stomach disorder. Every year, Ms. H has a periodic health check organized by the agency where she works. However, this is completely normal and is organized by most agencies and organizations for their employees. When participating in a periodic health check, the person being examined does not know and is not required to know what measures and methods the medical examination and treatment organization has taken. In addition, this periodic health check form does not show any illness that Ms. H has related to her refusal to sign the insurance contract of Company C. Therefore, Company C's claim that Ms. H provided dishonest information to refuse to pay insurance is unfounded. The Court of Appeal is requested to uphold the first instance judgment.

The people with related rights and obligations, Ms. Luong Thi T, Ms. Dang Kieu L, and child Dang Linh N (Mr. Dang Van L is the legal representative for the minor child) represented by Mr. Tran Xuan H under authorization, present:

Those with related rights and obligations agree with the plaintiff and request the Trial Panel to uphold the original judgment.

The representative of the People's Procuracy of Ho Chi Minh City participating in the trial expressed his opinion:

Regarding the form: The appeal of the litigant was made within the statutory time limit and is therefore valid. The Court is requested to accept it. The panel of judges and the participants in the trial complied with the provisions of the law during the process of resolving the case at the appeal stage.

Regarding the content: According to the appeal content presented by Company C and the lawyer protecting the rights and interests of Company C, there is not enough basis to determine that Ms. H made dishonest statements and violated the obligation to provide information. Therefore, there are not enough conditions to cancel the 02 insurance contracts according to the presentation of Company C. Therefore, there is not enough basis to accept the appeal of Company C, requesting the Trial Panel to uphold the first instance judgment.

JUDGMENT OF THE COURT

[1] After studying the documents in the case file examined at the trial and based on the results of the debate at the trial, the Trial Panel determined:

[2] Regarding the proceedings: Company C's appeal was made within the statutory time limit, Company C completed the appeal procedures in accordance with the provisions of law, so there is a basis for acceptance.

[3] Regarding the content: Considering the defendant's appeal requesting to dismiss the plaintiff's lawsuit, the Trial Panel finds that:

[4] In question number 54 of the Insurance Application Form dated March 25, 2009, the question: “gastrointestinal ulcers, gastrointestinal bleeding, pancreatitis, colitis, frequent indigestion, difficulty swallowing, or disorders of the stomach, intestines, liver or gallbladder” Ms. H checked the no box. In the consultation record number 42/BV-99 of Hospital B dated September 3, 2009, Ms. H stated that she had a history of stomach pain for 2 years.

According to the consultation minutes, Ms. H had stomach pain since September 3, 2007, before the time Ms. H signed the insurance contract. Company C argued that the phrase stomach disorder includes all diseases related to the stomach, including stomach pain. However, at the appeal hearing, the defendant did not provide any evidence to prove it, nor did he provide any scientific explanation to determine that stomach pain is a stomach disorder.

[5] Clause 2, Article 407 of the 2005 Civil Code: “In case a standard civil contract has unclear provisions, the party providing the standard contract shall be at a disadvantage when interpreting such provisions”;

[6] In Clause 4, Article 409 of the 2005 Civil Code: “When a contract has difficult-to-understand terms or language, it must be interpreted according to the customs at the place where the contract is signed”;

[7] In Article 21 of the Law on Insurance Business: “In case an insurance contract has unclear terms, such terms shall be interpreted in favor of the insurance buyer”.

[8] Based on the above legal provisions, in case the parties have different and unclear interpretations, this Clause must be interpreted in favor of Ms. H. Thus, there is not enough basis to determine that stomach pain is included in stomach disorders as presented by Company C.

[9] Considering that the insurance application does not contain any questions about stomach pain, Company C's claim that Ms. H had stomach pain but did not declare it was a deliberate false declaration and a violation of the obligation to provide information is unfounded.

[10] In question 61 of the Insurance Application dated March 25, 2009: “Within the past 5 years, have you had any diagnostic tests such as X-rays, ultrasounds, electrocardiograms, blood tests, biopsies? Or have you had any illnesses, medical examinations, or hospital treatment that were not mentioned above?” Ms. H checked the no box. At the appeal hearing, Company C provided a Blood Biochemistry Test Form dated September 22, 2008 under the patient’s name, Truong Thi H.

Company C determined that this was a document collected by Company C in the periodic health check-up records for employees of Kindergarten C where Ms. H previously worked. Company C stated that on September 22, 2008, Ms. H had a blood test but did not declare it in question 61, and that Ms. H intentionally made a dishonest declaration in the insurance application. Considering that periodic health check-ups are carried out regularly and periodically by agencies and organizations.

When participating in a periodic health check, the person being examined does not know and is not required to know what measures or methods the medical examination and treatment organization has taken. Furthermore, during the periodic health check, Ms. H did not detect any signs of any disease, leading to Company C refusing to sign a contract with Ms. H. Therefore, there is not enough basis to determine that Ms. H felt abnormal in her body before going for a blood test and then buying insurance from Company C.

[11] Thus, there is not enough basis to determine that Ms. H committed fraud when signing the insurance contract. There is no basis to determine that Ms. H's ticking of the no box in items 54 and 61 of the Insurance Application directly affects whether Company C will consider signing an insurance contract with Ms. H or not.

[12] Furthermore, according to the rules and terms of the term insurance product with refund and the Thinh Tri Thanh Tai Bao Gia product of Company C, the content is as follows:

[13] “Article 11.2. If any information provided by the insurance buyer or the insured is intentionally concealed or falsely declared, seriously affecting the decision to assess and accept the insurance, the company may cancel the contract and the contract shall be invalid from the beginning”.

Regarding the phrase “serious impact” in Article 11.2 above, at today’s court hearing, Company C did not clearly explain what serious impact means. At the same time, the defendant’s presentation on the sale of insurance was also inconsistent when deciding whether to accept or not to accept insurance for the case of a term insurance buyer with a history of stomach pain and high blood fat.

In response document No. 008 dated January 28, 2011, Company C stated: “If we knew that customer Truong Thi H had stomach pain and high blood fat, Company C would refuse to sign the insurance contract”. At the first instance and appeal hearings, the representative of Company C and the lawyer protecting the legal rights and interests of Company C stated that if we knew that Ms. H had stomach pain and high blood fat, Company C would consider whether to sign the contract or not.

This shows that Company C did not have a specific criterion to resolve the above case. Therefore, the phrase "serious impact" must be understood in the sense that the disease leads to the refusal to buy insurance, and cannot be accepted in the sense that insurance can be sold or not sold as stated by Company C. This provision also creates ambiguity, so based on Clause 2, Article 407 of the Civil Code, it is stipulated that: "In case the standard contract has unclear provisions, the party issuing the standard contract shall be disadvantaged when interpreting that provision" and Article 21 of the Law on Insurance Business stipulates: "In case the insurance contract has unclear provisions, that provision shall be interpreted in a way that is beneficial to the insurance buyer", so this provision must be understood and interpreted in a way that is beneficial to Ms. H.

[14] In fact, Ms. Nguyen Thi Diem P, a witness in this case, stated that she purchased a preferential periodic insurance product from Company C based on insurance contract number S11000297923. At the time of signing the insurance contract, she informed Company C that she was using stomach pain medication, had occasional stomach pain for about 3 years, and had a periodic check-up for Triglyceride 2.2 mmol/l. According to the verification results of the District 1 People's Court at the District 1 People's Hospital on July 28, 2015, Triglyceride 2.2 mmol/l was higher than normal.

[15] Considering the case of Ms. Nguyen Thi Diem P when buying term insurance from Company C, Ms. P stated that she had stomach pain and her blood fat was higher than normal, but Company C still sold insurance to Ms. P at the standard premium. This shows that stomach pain and high blood fat were not considered to have serious effects, so Company C sold insurance at the normal premium like other cases.

This shows that the fact that the insured did not declare his stomach pain and high blood fat did not seriously affect Company C's decision to evaluate whether or not to accept the signing of the insurance contract, so the customer did not violate Article 11.2 of the Rules and Terms of the product issued by Company C as the Court of First Instance found to be well-founded.

[16] Company C claims that it has paid all of its obligations as stipulated in the two insurance contracts. Regarding this dispute, Company C and Mr. L have resolved it, as shown in the Payment and Confirmation of Completion of Insurance Responsibility dated September 15, 2010.

In section 3 of this form, Mr. L confirmed that Company C had paid in full and was no longer responsible for settling insurance benefits for these two contracts; In section 4, Mr. L committed that from now on he would not perform any actions affecting Company C, and Company C would not have to perform any responsibilities and obligations for contracts No. S11000009505 and S11000040924. Considering that Mr. L's signing of the Payment Form and confirmation of completion of insurance responsibilities on September 15, 2010, does not deprive Mr. L of his right to sue if he believes that this agreement affects his legitimate rights and interests.

[17] From the above observations, there is a basis to determine that the Court of First Instance's acceptance of the Plaintiff's request for a lawsuit is well-founded and in accordance with the law. Therefore, there is no basis to accept the appeal request of Company C, and the judgment of first instance is upheld.

[18] For other decisions of the first instance judgment, the parties did not appeal, the People's Procuracy did not protest, so they have legal effect.

[19] Regarding civil appeal court fees: Because the first instance judgment was upheld, company C must pay civil appeal court fees of VND 200,000.

For the above reasons,

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

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

DECISION

Verdict:

1. Do not accept the appeal request of the defendant, C Life Insurance Company Limited.

2. Uphold the original first instance judgment No. 1211/2015/TLST-DS dated August 26, 2015 of the People's Court of District 1, Ho Chi Minh City.

Accept the plaintiff's request

- Compel C Life Insurance Company Limited to be responsible for paying Mr. Dang Van L the insurance amount of 300,875,342 VND (Three hundred million eight hundred seventy-five thousand three hundred forty-two VND).

- Life Insurance Company C must return to Mr. Dang Van L two insurance contracts of Thinh Tri Thanh Tai Bao Gia dated October 14, 2008, and a term insurance contract with refund dated March 25, 2009.

- Insurance contract No. S1100000505 dated October 14, 2008 (Thinh Tri Thanh Tai Bao Gia) continues to be implemented and the maturity benefit is settled when child Dang Linh N is 22 years old and still alive on the maturity date.

2.2 Enforced immediately when the judgment comes into legal effect and is supervised by a competent civil enforcement agency.

2.3 From the date Mr. Dang Van L filed a request for enforcement of the judgment, if C Life Insurance Company Limited does not pay the full amount as above, C Life Insurance Company Limited must also pay Mr. L a monthly interest amount according to the interest rate announced by the State Bank for the period of time the judgment has not been enforced.

3. First-instance civil court fees:  C Life Insurance Company Limited must pay first-instance civil court fees of VND 15,043,767. Mr. Dang Van L does not have to pay first-instance civil court fees, so he will be refunded the total advance payment of court fees of VND 11,925,000, including: VND 10,100,000 according to receipt No. 05237 dated January 5, 2011, VND 200,000 according to receipt No. 05621 dated April 26, 2011 and VND 1,625,000 according to receipt No. 05737 dated January 5, 2011 of the Civil Judgment Enforcement Office of District 1, Ho Chi Minh City.

4. Civil appeal court fees: C Life Insurance Company Limited must pay a civil appeal court fee of VND 200,000 (Two hundred thousand Dong) deducted from the amount of advance court fees that C Life Insurance Company Limited has paid according to Receipt No. AE/2014/0005146 dated September 10, 2015 of the Ho Chi Minh City Civil Judgment Enforcement Department. C Life Insurance Company Limited has paid the full advance court fee for appeal.

In case the judgment or decision is enforced according to the provisions of Article 2 of the Law on Civil Judgment Enforcement, the person entitled to civil judgment enforcement and the person subject to civil judgment enforcement have the right to agree on judgment enforcement, the right to request judgment enforcement, voluntarily enforce the judgment or be forced to enforce the judgment according to the provisions of Articles 6, 7 and 9 of the Law on Civil Judgment Enforcement; the statute of limitations for initiating a lawsuit to enforce the judgment is implemented according to the provisions of Article 30 of the Law on Civil Judgment Enforcement.

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

CONTENT OF PRECEDENT

“[4] In question number 54 of the Insurance Application dated March 25, 2009, the question: “gastrointestinal ulcers, gastrointestinal bleeding, pancreatitis, colitis, frequent indigestion, difficulty swallowing, or disorders in the stomach, intestines, liver or gallbladder” Ms. H checked the no box. In the consultation record number 42/BV-99 of Hospital B dated September 3, 2009, Ms. H stated that she had a history of stomach pain for 2 years. According to the consultation record, Ms. H had stomach pain since September 3, 2007, before the time Ms. H signed the Insurance Contract. Company C argued that the phrase “stomach disorder” includes all diseases related to the stomach, including stomach pain. However, at the appeal hearing, the defendant did not provide any evidence to prove it, nor did he provide any scientific explanation to determine that stomach pain is a stomach disorder.

 [8] Based on the above legal provisions, in case the parties have different and unclear interpretations, this Clause must be interpreted in favor of Ms. H. Thus, there is not enough basis to determine that stomach pain is included in stomach disorders as presented by Company C.

[9] Considering that the insurance application does not contain any questions about stomach pain, Company C's claim that Ms. H had stomach pain but did not declare it was a deliberate false declaration and a violation of the obligation to provide information is unfounded.

[10] In question 61 of the Insurance Application dated March 25, 2009: “Within the past 5 years, have you had any diagnostic tests such as X-rays, ultrasounds, electrocardiograms, blood tests, biopsies? Or have you had any illnesses, medical examinations, or hospital treatment that were not mentioned above?” Ms. H checked the no box. At the appeal hearing, Company C provided a Blood Biochemistry Test Form dated September 22, 2008 under the patient’s name, Truong Thi H.

Company C determined that this was a document collected by Company C in the periodic health check-up records for employees of Kindergarten C where Ms. H previously worked. Company C stated that on September 22, 2008, Ms. H had a blood test but did not declare it in question 61, and that Ms. H intentionally made a dishonest declaration in the insurance claim.

Considering that periodic health checks are carried out regularly and periodically by agencies and organizations. When participating in periodic health checks, the person being examined does not know and is not required to know what measures and methods the medical examination and treatment organization has taken. Furthermore, when Ms. H underwent a periodic health check, no signs of any disease were detected, leading to Company C refusing to sign a contract with Ms. H. 

Therefore, there is not enough basis to determine that Ms. H felt something was wrong with her body before going for a blood test and then buying insurance from Company C.

[11] Thus, there is not enough basis to determine that Ms. H committed fraud when signing the insurance contract. There is no basis to determine that Ms. H's ticking of the no box in items 54 and 61 of the Insurance Application directly affects whether Company C will consider signing an insurance contract with Ms. H or not."

 

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