Failure to disclose generalised symptoms will not void a critical illness insurance policy
An insured under a critical illness policy ("Duke") was successful in obtaining judgment against the insurer ("Clarica") for a critical illness benefit of $500,000 where the Court found that generalised symptoms suffered by Duke prior to entering into the policy were not, at that time, associated with Parkinson’s disease such that an exclusion in the policy applied.
Here is the citation: Duke v. Clarica Life Insurance Co. [2007] A.J. No. 404. Alberta Court of Queen’s Bench. Lutz J. April 10, 2007.
This case was originally digested by Jonathan Meadows and edited by David Pilley.
Here is a link to the decision.
Duke was an engineering technician who entered into a critical illness insurance policy with Clarica. At the time he entered into the policy, Duke had no particular health concern and was farming, flying regularly and running 6 km a day, three times a week. He passed his pilot’s physicals on a regular basis. Duke further passed a physical by a physician retained by Clarica. Subsequently, the plaintiff was diagnosed with Parkinson’s disease.
During the investigation into his condition, Duke told one of his physicians that, in hindsight, "I’d been carrying my arm on an angle and dragging my heel" over the last five years. Once diagnosed with Parkinson’s disease, Duke made a claim for critical illness benefits under the policy. Clarica denied coverage based upon an exclusion in the policy excluding coverage where "the insured person had a covered critical illness or any symptoms associated with a covered critical illness before the date the policy came into effect".
The Court held that the requisite timing of the association of the symptoms with the covered critical illness was unclear from this exclusion clause. The Court noted that it could not determine from a plain reading of the exclusion clause that having symptoms of Parkinson’s disease before the policy was issued would exclude coverage whether or not anyone made an association between the symptoms and Parkinson’s disease as of that date. In this case, the Court interpreted the ambiguity in the exclusion clause against Clarica and in favour of Duke such that, under the exclusion clause, the association of the symptoms with Parkinson’s disease had to occur before the policy was issued to exclude coverage. The Court found that neither Duke nor any of the physicians who had treated or assessed him had "associated" his symptoms with Parkinson’s disease prior to the issuance of the policy.
Therefore, the Court held that the exclusion clause did not apply and Clarica had improperly denied the critical illness benefits under the policy.
