The health questionnaire is for insurers an essential tool to know the risk and for the insured a source of conflict if their answers lack the required veracity and it occurs …
The health questionnaire in life or health insurance has become a fundamental tool for insurers.
While to contract car insurance, the insurer looks, among other things, in your history as a driver, in life, or health insurance they are interested in knowing your lifestyle or physical condition. Based on this information, they will delimit the risk and establish the conditions that will govern the contract.
The policyholder has the duty, before the conclusion of the contract, to declare to the insurer, in accordance with the questionnaire that he submits, all the circumstances known to him that may influence the risk assessment.
So all the insurers in the market require that the insured answer a questionnaire as a prerequisite for contracting the insurance.
And it is the insured who has the duty of the declaration, so it must be he and not another, who truthfully answers the questions to which the insurer submits.
What do insurers want to know from the health questionnaire?
A few years ago, the health questionnaire was not so decisive for the insurer to accept the insurance application. Today things have changed and the insurer gives the health questionnaire capital importance, without it, it will not be possible to take out the insurance. In many cases, acceptance is conditional on the approval of the insurer’s medical office.
It should be emphasized that the health questionnaire to which the insurer submits you must meet certain requirements. It must contain questions relating to the health of the insured, be reasonably detailed, and cannot be subject to interpretation. It may not contain questions related to private life, such as the candidate’s sexual orientation.
But the insured is only obliged to answer what is asked, nothing more. Therefore, if the insurer has not asked about it, later it will not be able to claim that the information has been withheld.
Normally the health questionnaire is made up of these three sections:
These are issues related to daily exercise, tobacco use, alcoholic beverages, or drugs.
It lists all the issues related to illnesses you have had, surgical operations, chronic pathologies or accidents, and sick leave. In addition to detailing the above, the insurer is also interested in knowing when it occurred or was diagnosed, so it will ask the date.
This section is intended for you to report if you are in treatment for any ailment, the drugs you take, or, for example if you suffer from any type of allergy.
Depending on the content of your answers, the insurer may request medical information on a certain condition or carry out additional medical tests. In this case, don’t worry about the expenses, the medical check-up is on your own.
Why be honest when answering the health questionnaire?
The health questionnaire is the condition imposed by the insurer to access life or health insurance.
And many times we are not entirely sincere in our responses. If we cheated our mother with the number of drinks or cigarettes, why not do it with the insurance. We also assume the role of a physician for a while, assessing how relevant the question is, and if it has been many years since our tonsils or meniscus were removed, we don’t count it. And unless we are taking pills, cholesterol, glucose, or transaminases, they will always be fine.
But it is that article 10 of the LCS includes another paragraph that says verbatim:
The insurer may terminate the contract by means of a statement addressed to the policyholder within one month, from the knowledge of the reservation or inaccuracy of the policyholder. Unless there is intent or gross negligence on their part, the premiums relating to the current period at the time of making this declaration will correspond to the insurer .
Omitting relevant information, about which the insurer has asked in its health questionnaire, is the reason for terminating the policy. But, if you also prove that it has been omitted on purpose, you will lose the right to a refund of the premium.
If on the occasion of a claim, the insurer became aware of the inaccuracy in the declaration, it could:
- Reject the consequences of the accident,
- Reduce the compensation in proportion to the difference between the premium paid and the one that would have been received if the true entity of the risk was known.
- Include an exclusion in the policy, regarding that ailment.
The inaccuracy in the health declaration is the first argument that the insurer will use to reject the claim. Later, in case of litigation, you may find that you have supplemented it with that the policyholder acted in bad faith (fraud) or gross negligence. Later you will discover how to counteract this situation if you see yourself fully involved.
Do I have to fill out the questionnaire myself or can the bank or the insurance company do it?
It happens many times that in the confidence of the person who makes us the insurance, we fill out the health questionnaire, without the necessary attention. Whoever asks takes it for granted that he knows us well enough not to make a mistake by answering on our behalf and for whom he must answer, it is less compromising than giving explanations. So, without further ado, we stamp the signature on the questionnaire accepting its content.
This situation is frequent when the person filling in the form is the bank manager, the broker, or the insurer’s agent. In both cases, the desire to sell a policy or sign the loan turns such an important event into a mere procedure. And as we have seen, the repercussions of not being honest with the insurance can lead you or your beneficiaries not to charge a dollar.
When this happens and the insurer rejects the claim, the conflict arises. Some of these claims have reached the Supreme Court, which has spoken according to each case. These are some issues on which it has already spoken and in a positive way for the interests of the insured.
On certain occasions, it has been considered irrelevant that the form has not been filled in by the insured, taking into account the amount of personal data provided to the insurer and that he would not have known otherwise.
Absence of intent or gross negligence
One of the reasons argued by the insurer for denying insurance benefits is the existence of bad faith (intent) or gross negligence of the insured, for not answering truthfully or with the intention of deception, to the questions of the health questionnaire.
It has been ruled out by the TS that there is fraud when it is the bank employee or the insurer’s agent who fills out the health questionnaire and the client is limited to signing it. It has been considered that this fact is equivalent to the failure to submit the form by the insurer and therefore its consequences cannot fall on the insured.
The same reasons have been argued to reject the position of the insurer when the questionnaire is not filled out, nor signed by the insured.
If for insurers the health questionnaire is a fundamental tool to assess risk, for the insured it is the key to access to life or health insurance.
But if the key is not correct, you may enter a maze, in which the insurance company has an advantage. To try to be on an equal footing, you must be sincere in your answers when you go to answer the questionnaire that the insurance company puts in front of you. If the company does not want to insure you, it is better that they tell you before and not after paying the insurance for a few years.
Lying on the health questionnaire is one of the most common reasons why insurers reject the insured’s claims. The normal thing, when it happens, is that they deny the medical benefit or reject the payment of the insured capital.
And if they consider that there has been intent or gross negligence in the declaration, they could cancel the contract.
Have you been entirely sincere in responding to the health statement? Has it brought you consequences?
Leave us the answer in the comments, we will be happy to read you!