"Even if the agent says it's okay"... Breast calcification and dense breasts could lead to denial of cancer insurance claims

Conditions discovered during regular checkups, such as breast calcification, cysts, and dense breasts, can lead to the denial of cancer diagnosis payouts if they result in a violation of the duty to disclose when signing up for insurance. This requires caution because even if an insurance agent guides a client that certain diseases do not constitute a violation of the duty to disclose, actual insurance reviews are conducted through comprehensive judgments based on legal precedents.

"I trusted the agent"... The target for fulfilling the duty to disclose is the 'insurance company', not the agent

In the process of signing up for insurance, many people fail to report their medical history because they trust the guidance of an agent, but the legal responsibility belongs to the policyholder themselves. According to the 'Kim Do-hyeong's Insurance Claims TV' video, insurance agents do not legally have the 'right to receive disclosure'. In other words, informing an agent of a disease does not mean the duty to disclose has been fulfilled.

The entity that must fulfill the duty to disclose is the insurance company, not the agent. Typically, the handwritten 'duty to disclose before contract' documents or recorded contents serve as the criteria for determining whether the duty to disclose was fulfilled. The video pointed out, "Claims that an agent said it was okay to do this, or that the client fulfilled the duty as explained, are difficult to serve as valid defenses in an actual review." This is because insurance companies judge whether the duty to disclose was violated based on documents or recorded data directly prepared by the policyholder, not the agent.

For breast diseases, it is dangerous to judge 'not a violation' by looking only at specific symptoms

Dense breasts, calcification, and cysts discovered by women through regular checkups, or uterine fibroids and adenomyosis, are diseases that must be monitored with the possibility of developing into cancer in mind. Some insurance sales channels provide materials claiming that certain diseases do not fall under a violation of the duty to disclose, but this is dangerous as it may only extract favorable parts from the full context.

Actual court precedents judge whether the duty to disclose was violated very strictly and comprehensively. According to the precedent cited in the video, if a policyholder was informed that additional ultrasound testing was required based on mammography results, the policyholder is considered to have had sufficient reason to suspect the possibility of a breast lesion. In this case, if the fact of the additional test was not disclosed, it constitutes a violation of the duty to disclose due to significant negligence, which can lead to the denial of insurance payouts.

Therefore, fragmentary interpretations such as "dense breasts are fine" or "benign tumors are not subject to disclosure" are very dangerous. This is because whether the duty to disclose was violated is decided by considering the circumstances of the examination, whether instructions for re-examination were given, and the possibility of lesions.

To prevent denial of insurance claims, one must 'directly check past medical records'

If an on-site investigation is conducted by an insurance company after an insurance claim is filed, the act of carelessly signing documents can lead to a denial of the claim. During the investigation process, insurance companies ask detailed questions through a 'circumstances of enrollment statement' regarding the circumstances of the contract conclusion, whether there was a handwritten signature, and whether instructions on the terms and conditions were received, thereby taking a form of holding the policyholder responsible.

Experts emphasize 'directly checking past medical records' as a practical defense method to prevent the denial of insurance claims. Rather than relying on the words of an agent, one must accurately identify what tests were taken in the past and what opinions were received through hospital records. By doing so, one can judge in advance whether there is a possibility of violating the duty to disclose and respond to the insurance company to avoid disadvantages such as contract termination or denial of insurance claims.