The Financial Supervisory Service (FSS) has determined that individuals are not required to disclose follow-up tests recommended prior to enrolling in simplified insurance or hospitalization for clinical trials.
On July 27, the FSS's Financial Dispute Mediation Committee announced its decision to resolve two disputes related to the obligation to disclose information before signing simplified insurance contracts, ordering insurers to pay claims.
In the first case, a policyholder diagnosed with myelodysplastic syndrome after enrolling in insurance in April 2023 filed a claim for cancer diagnosis benefits. The insurer denied the claim, stating that the policyholder failed to disclose a recommendation for a 'blood test two months later' received from a hospital within three months prior to enrollment.
The committee ruled that the blood test was merely a follow-up observation to monitor changes in platelet levels and did not qualify as an 'additional test' as defined in the application form. It clarified that additional tests should be conducted when abnormalities are found in existing tests, necessitating more accurate diagnoses.
In the second case, another policyholder was denied benefits for not disclosing a four-day hospitalization for a clinical trial aimed at assessing the effectiveness of a new drug prior to enrolling in insurance.
The committee interpreted hospitalization due to illness as requiring standard inpatient treatment or management due to disease symptoms. Since the policyholder was able to manage their condition through outpatient treatment and there were no individual treatment actions taken during the clinical trial, the committee concluded that this did not need to be disclosed.
* This article has been translated by AI.
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