Non-Disclosure Deliberate or Accidental?

When it comes to insurance claims the answer is not always quite so clear cut.

If a material fact has not been disclosed it may well alter the way that a particular risk is assessed.

Example 1: A Locum Insurance policyholder submits a claim, medical information is requested and this persons GP stated that he had not seen this patient for a particular condition for which the claim is being made – fairly straight forward so far.  However, this person had been treated by another doctor for the same condition and had failed to disclose this on the Locum Insurance application form.  If this information had been declared it would have affected the assessment of this persons Locum Insurance application.  My assessment – non-disclosure.

Example 2: A practice manager signs a declaration for Locum Insurance on behalf of the GP Partners who are insured.  This declaration requests information about all of the insured persons.  To the practice managers knowledge nothing has changed since the application forms were signed.  Unfortunately one of the insured GPs had not told any of the partners or practice manager that he had received treatment for a particular illness.  This would have altered the terms that this GP had received under our Locum Insurance policy.  My assessment – this is an awkward one as the practice manager had acted in good faith and declared what he thought was correct. Was enough done to verify information?

What can be learnt from the above?  Non-Disclosure whether deliberate or accident can cause real financial problems for an individual, as well as a practice.  If in doubt, giving more information is better than less!