Pre-existing Conditions in Health Insurance, Retrospective Insurance and Good Faith — Comments on Relevant Court Rulings

Pre-existing Conditions in Health Insurance, Retrospective Insurance and Good Faith — Comments on Relevant Court Rulings

 

Title
Pre-existing Conditions in Health Insurance, Retrospective Insurance and Good Faith — Comments on Relevant Court Rulings
Author
Chi-Chou Yeh
Keywords
Health Insurance, Pre-Existing Condition, Good Faith, Congenital Disorder, Retrospective Insurance, Principle of Equivalence, Pre-Existing Exclusion Period
Abstract
According to Article 127 of Insurance Act, the provider of health insurance is
not liable for any illness that existed before the contract is formed (pre-existing
conditions). Hence, in a majority of cases, the insurers would deny the insured
benefit payments based on Article 127 or similar terms in the insurance contracts.
However, a number of courts have ruled that, if the insured is unaware of such preexisting
conditions because the illness has no symptoms that can be observed based
on appearances, then the insurer is still liable. The basis of this judgment seemingly
rests on the retrospective insurance provision in Article 51(a) of Insurance Act.
Nevertheless, illness itself is an insured risk under health insurance, so without the
insurers’ prior and explicit consent to extend coverage period retrospectively, it
seems to be unfounded to hold the insurer liable for pre-existing conditions based
on the retrospective insurance doctrine. To restrict the application of Article 127
with the retrospective insurance doctrine contradicts the intention of the legislature
and the principle of equivalence.
Abstract Article

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