Analysis Of Guo Sues An Insurance Company Person Insurance Contract Dispute Case

In commercial life insurance,in addition to the reasons for exemption,the most used reason for the refusal of insurance companies is that the applicant fails to fulfill the obligation of truthful disclosure,so such disputes can be found everywhere.In the case of Guo v.an insurance company’s life insurance contract dispute,Guo took out a major disease insurance and later applied for compensation for serious illness.According to the investigation of the insurance company,Guo had an operation due to "congenital megacolon" before insurance,and then his colonoscopy during his hospitalization showed "colonic polyps",so he terminated the contract and refused to pay compensation on the grounds that Guo deliberately failed to fulfill the obligation of truthful disclosure.The controversial focus of the case lies in:(1)what is the scope and content that Guo should truthfully inform.(2)Whether Guo has subjective fault of intentional or gross negligence.(3)Whether the matters not informed by Guo belong to "important influence matters".If you know that the rule of enteroscopy is applicable to the diagnosis of a disease,you should first ask whether the rule of enteroscopy is applicable.Therefore,Guo’s congenital megacolon should be informed,but undiagnosed intestinal polyps are not within the scope of notification.Secondly,although Guo was aware of his illness and physical condition,he was not aware of the impact of these conditions on the underwriting of the insurance company,so it was a gross negligence.Finally,"important influence matters" should be measured by the insurer’s underwriting standard.Insurance companies have no special underwriting rules for "Hirschsprung’s disease",while "intestinal polyps" need to make different underwriting decisions according to the results of follow-up examination.Therefore,"intestinal polyps" belong to "important influence matters".Under the existing insurance market transaction and legislative system,the insurer’s information source is limited,and the obligation of truthful disclosure is still a necessary system to ensure the benign operation of the insurance market.However,from the perspective of solving the fundamental problems,it is urgent and of long-term significance to establish the insurer’s underwriting right and its corresponding system.