An applicant must list all medical information requested by an insurer on an application form. If not, insurance may not be valid, even if complete medical records were provided to the insurer during the application.

The defendant insurer denied the plaintiff’s application for long-term disability benefits on the grounds that the plaintiff had misrepresented his medical condition on the initial application questionnaire. The court accepted the defendant’s evidence that it would not have written the policy had the plaintiff’s medical history been disclosed and dismissed the case.

Fernandes v. RBC Life Insurance Co. [2008] O.J. No. 2726 Ontario Superior Court of Justice S. Chapnik, J. July 8, 2008

The plaintiff’s application for disability insurance was accepted by the defendant insurer, and subsequently he became “totally disabled” so as to qualify for benefits under the policy.  The defendant insurer denied the plaintiff’s application for long-term disability benefits on the grounds that the plaintiff had misrepresented his medical condition on the initial application questionnaire.  The defendant relied on the plaintiff’s medical records that indicated the plaintiff had minor back pain and hip pain problems prior to filling out the questionnaire.  The defendant argued that the plaintiff had failed to disclose these problems despite being specifically asked in the questionnaire about back and hip problems.  The plaintiff argued that his back and hip problems were not serious enough to warrant disclosure on the questionnaire.

The court found that the plaintiff had misrepresented his state of health on the questionnaire, and that “it is the applicant’s knowledge of his own health that is relevant, not what the applicant believes may be important to the insurer.”  The court found the questions on the questionnaire to be “clearly worded and unambiguous.”  Further, the court accepted the defendant’s evidence that it would not have written the policy had the plaintiff’s medical history been disclosed, agreeing that the plaintiff’s complaints may not have been medically significant, but were significant from an underwriting perspective.  The court concluded that the plaintiff’s misrepresentations were material to the risk assumed by the defendant under its policy and that the defendant would have declined to write the policy had the plaintiff’s medical history been properly disclosed.

This case was originally summarized by jhavelaar@harpergrey.com and originally edited by dpilley@harpergrey.com

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