The Kaohsiung Branch of the Taiwan High Court rendered the 102-Bao-Xian-Shang-Yi-6 Decision of October 22, 2014 (hereinafter, the "Decision"), holding that Article 127 of the Insurance Law stipulates if the insured has already been ill when an insurance contract is executed, the insurer shall not be liable to the insured for indemnification for such illness. Having been ill means that an illness has shown externally visable signs which objectively prevent the insured from asserting being unaware of the illness. In the absence of evideniary materials indicating that the insured has been aware of his/her illness due to obvious symptoms at the time the insurance contract is executed, the insurer shall not refuse to pay claim.
According to the facts underlying the Decision, the Appellant and the Appellee executed the insurance contract at issue on May 29, 2008. According to the Appellee's medical records, however, it is sufficient to conclude that he had had psychiatric symptoms such as illusion, negative complex with a strong sense of insignificance, and suicidal ideas, which still exist even today. The Appellee subsequently was hospitalized for symptoms such as chest pain, acute respiratory infections and schizophrenia and insurance was claimed. However, the insurance claim was rejected by the Appellant pursuant to Article 127 of the Insurance Law. As a result, the Appellee filed a complaint.
Article 127 of the Insurance Law provides: "When an insurance contract is executed, if the insured has already been ill or pregnant, the insurer shall not be liable for insurance indemnification for such illness or childbirth." It was pointed out in the Decision that the expression "the insured has been ill" means that there have been externally visible signs of the illness, objectively ruling out the possibility of the insured's awareness of the illness. In the absence of evidentiary materials indicating that the insured has been aware of his/her illness due to obvious symptoms at the time the insurance is executed, the insurer shall not refuse to pay claim.
It was finally determined in the Decision that since there was no obvious symptom when the insurance contract was executed that allowed the Appellee to know that he had been ill, it was concluded that the Appellee's insurance claim is well-grounded.