A Case Study of Pre-existing Medical Condition in Dread Disease Insurance

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  • 特定疾病保障保険における責任開始期前発病の事例について

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Dread disease insurance has a high risk of mixing of the adverse selection. Particularly, the adverse selection is easy to occur in the case of breast cancer from the nature of the disease. The pre-existing condition exclusion provision is provided for medical expenses insurance and personal accident insurance handled by the company, and the 90-day waiting period provision for breast cancer was laid down in June 1996. According to the treaty the company shall apply the pre-existing condition exclusion provision and the 90-day waiting period provision for breast cancer not to the date of diagnostic definition but to the time when the insured contracted a disease. We reported two cases that we countered the adverse selection according to the provisions. Both cases reported here were that if we had applied the 90-day waiting period provision for breast cancer to the date of diagnostic definition, we could not have decided nonpayment of claims of dread disease insurance, and the court definitely showed the judgment for one of the two cases that the 90-day waiting period provision for breast cancer can be applied to the time when the insured contracted a disease. It is considered that the application of the time when the insured contracted a disease in the 90-day waiting period provision for breast cancer would be appropriate and effective to avoid the entry of the adverse selection of breast cancer to dread disease insurance.

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