A person applying for life insurance has an obligation to disclose symptoms associated with heart disease, but may not have to disclose symptoms that are not related to heart disease

A person applied for life insurance.  He advised the insurer that he had never been told that he had problems with his heart or blood vessels or shortness of breath.  He was granted insurance and subsequently died of a heart condition.  The clinical records indicated that he suffered from shortness of breath but that his doctor did not believe that the condition was related to a heart condition.  The insurer refused to pay the proceeds of the policy on the basis of a misrepresentation.  The insurer was ordered to pay the proceeds on the basis that the insured did not knowingly misrepresent his condition, as it was his belief that his shortness of breath was not related to his heart condition.

Kong v. Manulife Financial Services Inc., [2008] B.C.J. No. 65, British Columbia Supreme Court, G.B. Butler J., January 17, 2008

The Plaintiff was the beneficiary of proceeds under a life insurance policy obtained by her late husband, who was insured under that policy. She brought an action against the Insurer to recover death benefits upon her husband’s passing. The Insurer sought a dismissal of the Plaintiff’s claim on summary trial application on the basis that the Insured had knowingly or recklessly made false representations to the Insurer at the time he applied for insurance coverage and that the policy was therefore void.

The alleged false representations were made by the Insured in respect of the medical history he provided to a nurse acting for the Insurer around the time of his application for life insurance. In particular, the Insured had answered “No” to questions concerning whether, to his knowledge, he had ever been told that he had any problem with his heart or blood vessels, including whether he had heart disease, heart murmur, shortness of breath, high blood pressure, angina or chest discomfort or other related conditions. The Insurer claimed that the Insured’s medical records were inconsistent with his answers and that they indicated a history of shortness of breath, chest discomfort, asthma, allergies and irregular electrocardiograms or other heart investigations.

The Court considered the medical evidence presented at the summary trial to determine whether the Insured had misrepresented his medical history in answering in the negative to the impugned questions and whether he had made the misrepresentation with knowledge of its falsehood or recklessly, without belief in its truth, with the intention that it should be acted upon by the insurer.

The Court held, largely based on the clinical notes made by the Insured’s physicians, that he did not have any knowledge that he had a heart problem and that his answers to the questions were thus truthful. There was no need for the Insured to have advised his Insurer of symptoms which he had been led by his doctors to believe were unrelated to a heart problem. Similarly, the Insured was not required to answer “Yes” to questions concerning allergies or problems with his nose, throat or lungs given his understanding of the problem he suffered from as being related to reflux, again based on what his doctors had told him.

The Court concluded that the Insured had not misrepresented his medical history and that he had an honest belief in the truth of his responses based on the information and advice he had received from his physicians. Accordingly, the Insurer’s application for dismissal of the Plaintiff’s claim was dismissed.

This case was originally summarized by Shanti Davies and edited by David W. Pilley.

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