Hiding Diabetes and Filing an Insurance Fraud Claim? The Court Drew the Line at Deception [Filing False Claims]

Complications developed after joining the insurance policy A man in his 50s, identified as A, had struggled with diabetes for more than two years.
He had also undergone long-term hospitalization.He had also undergone long-term hospitalization.
A assumed that his personal information had probably been sold somewhere and did not think much of it.
The agent recommended cancer insurance, but A did not really need it.
The agent then changed direction and suggested a broader policy.Given his diabetes and his age, it seemed wise to prepare for the illnesses the agent mentioned.In the end, A signed up for the policy.
And a few months later, A was successively diagnosed with cerebral infarction, unstable angina, hyperlipidemia, and proliferative diabetic retinopathy in both eyes.All of them were complications of diabetes.Fortunately, most of the conditions were covered under the policy he had purchased.Feeling reassured, he filed a claim, but the response he received was “insurance fraud.” The insurer said that A had failed to disclose his diabetes before signing the contract and had not informed the company even though he could have anticipated the complications, and therefore had violated the Special Act on Prevention of Insurance Fraud.
In the end, investigators also stepped in and brought A to trial.
He had also undergone long-term hospitalization.He had also undergone long-term hospitalization.
” The prosecution argued that “A’s diabetes was severe, and he must have recognized that there was a high likelihood of developing its typical complications, such as cerebral infarction and unstable angina.” But the court found that “based on the evidence submitted alone, it is difficult to conclude that A recognized the high likelihood of an insurance event occurring, namely the onset of complications, to such an extent that it would undermine the essence of insurance, which is the uncertainty of an insured event.” The court also added that although A did not disclose his diabetes treatment to the insurer, that conduct could not be said to have reached the level of deception required under the Special Act on Prevention of Insurance Fraud.
It noted that the risk of complications is widely known, so it would be common sense to assume that A also made efforts to prevent them, and there was no evidence showing otherwise.
The court further accepted as evidence against fraudulent intent the fact that A did not first call the insurer to inquire about joining a policy, but instead entered into the contract after receiving a sales call.
[Filing False Claims] investigates cases that have been exposed as insurance fraud.
He had also undergone long-term hospitalization.He had also undergone long-term hospitalization.
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