Financial Institution in Hong Kong - Insurance IndustryUnder ...课件.ppt

Non-disclosure (cont’d) Non-disclosure arises when: - an applicant for an insurance policy fails to disclose on the application material fact within his actual or presumed knowledge Information given by an applicant in the application has great impact on the insurers underwriting assessment * 18年 whether or not non-disclosed ? 1. A material fact, which would influence a prudent underwriter in assessment 2. A fact within the knowledge of the applicant 3. A fact which the applicant could reasonably be expected to disclose * 18年 Non-disclosure (cont’d) Non-disclosure could result in policy repudiation and claim rejection One golden rule to follow - if in doubt as to whether a fact is material, it is better to disclose it ! * 18年 Case 2 The deceased was killed in a traffic accident. At the time of the accident, he was a passenger on a motorcycle. It is stipulated in the policy exclusions that no benefit will be payable for any accidental death directly or indirectly caused by or resulting from engaging in hazardous activities including but not limited to… motorcycling…. As the circumstance leading to the deceaseds death was outside the scope of the policy coverage, the insurer refused to settle the accidental death benefit. * 18年 Case 2 (cont’d) The deceaseds mother presented a traffic accident report to substantiate that her sons death was caused by the negligence of a public light bus driver who talked on a mobile phone while driving. She emphasized that her son was only a passenger at the time of the accident and had never been engaged in hazardous activities. * 18年 個案二 : 死者因交通意外喪生，發生意外時，死者是電單車的乘客。 保單豁免條款訂明：「不會賠償因為參與危險活動，包括(但不限於)......騎電單車......，直接或間接導致或造成的意外死亡」。由於導致死者喪生的情況並非在保單的保障範圍之內，故此保險公司拒絕發放意外死亡賠償。 死者的母親出示交通意外報告，以資證明其子之死是因為小巴司機疏忽所致，當時小巴司機一面行車，一面使用手提電話。她強調其子發生意外時只是電單車乘客，並沒有參與危險活動。 * 18年 ... ... ... ... ... ... ... ... ... ... Financial Institution in Hong Kong – Insurance IndustryUnder Certain Regul