The principle of utmost good faith, uberrimae fidei, forms the foundation of insurance contracts worldwide, including in UAE. Under this principle, both the insurer and the insured are obligated to disclose all material facts that may influence the terms, acceptance, or pricing of an insurance policy. In the context of health insurance, one of the most important aspects of this duty is the disclosure of pre-existing medical conditions. Failure to do so can have significant legal and financial consequences.
What is Pre-Existing Medical Condition
A pre-existing medical condition refers to any illness, injury, or health condition that existed prior to the commencement of the insurance policy. This includes chronic diseases such as diabetes, hypertension, cardiovascular disorders, or even previously diagnosed but untreated conditions.
In UAE insurance practice, insurers typically include specific questions in the proposal form requiring applicants to disclose their medical history. The accuracy and completeness of these disclosures are essential in determining risk assessment and underwriting decisions.
Insurance law in UAE
Insurance relationships in UAE are governed primarily by:
- Federal Decree-Law No. 48 of 2023 on Insurance Regulation (replacing earlier laws), and
- Relevant provisions of the UAE Civil Code (Federal Law No. 5 of 1985).
Under UAE law, an insured is legally obligated to disclose all material facts before entering into the contract. A “material fact” is any information that would influence a prudent insurer in deciding whether to accept the risk or determine the premium.
Non-disclosure or misrepresentation, whether intentional or unintentional, can lead to serious consequences under these legal provisions.
Consequences of Non-Disclosure
Failure to disclose pre-existing medical conditions may result in:
- Policy Avoidance (Nullification)
The insurer has the right to void the insurance policy ab initio (from the beginning) if it is proven that the insured deliberately concealed material information. - Claim Rejection
If a claim arises related to a non-disclosed condition, the insurer may reject the claim on the grounds of misrepresentation or concealment. - Proportionate Remedies
In some cases, if the non-disclosure is deemed non-fraudulent, insurers may apply proportionate remedies, such as reducing the claim pay-out based on the premium that would have been charged had full disclosure been made. - Legal Disputes
Disputes arising from claim denials may lead to litigation before UAE courts or complaints before regulatory bodies, increasing costs and uncertainty for the insured.
Distinction Between Intentional and Unintentional Non-Disclosure
UAE courts often examine the intent behind non-disclosure:
- Fraudulent Non-Disclosure: Deliberate concealment of a known medical condition. This typically results in policy cancellation and forfeiture of benefits.
- Innocent Non-Disclosure: Failure to disclose due to lack of knowledge or misunderstanding. Courts may take a more balanced approach, depending on the circumstances and evidence.
The burden of proof generally lies with the insurer to demonstrate that the non-disclosure was material and influenced the underwriting decision.
Judicial Trends in UAE
UAE courts have shown a balanced approach in insurance disputes. While they uphold the insurer’s right to deny claims in cases of clear misrepresentation, they also scrutinize:
- Whether the insurer asked clear and specific questions
- Whether the insured understood the disclosure requirements
- Whether the condition was directly related to the claim
Ambiguities in policy wording are often interpreted in favour of the insured, reflecting consumer protection principles.
To avoid disputes and ensure coverage, policyholders should fully disclose all known medical conditions, even if minor or controlled, provide accurate and complete information in proposal forms, retain copies of all submitted documents and seek clarification from insurers on what constitutes a pre-existing condition
Conclusion
Non-disclosure of pre-existing medical conditions remains a serious issue in UAE insurance law, balancing contractual fairness with consumer protection. While insurers rely on accurate disclosures to assess risk, policyholders must recognize the legal importance of transparency. The evolving regulatory landscape and judicial interpretations in UAE continue to promote fairness, but the duty of disclosure remains central to the enforceability of insurance contracts.
Ultimately, honesty at the inception of the policy is not merely a contractual obligation, it is the cornerstone of a valid and enforceable insurance relationship.
Our team at Ayesha Aldhaheri Advocates and Legal Consultants, consists of the best insurance lawyers in Dubai offering service in dispute resolution for any insurance related issues be it a health insurance, motor insurance, property insurance or life insurance. Our client’s demands are of utmost priority to us, we understand, analyse and conclude so we can provide the very best legal services.