If the applicant intentionally fails to fulfill the obligation of telling the truth, the insurer shall not be liable for compensation or payment of insurance premium for the insured accident that occurred before the termination of the contract, nor shall it refund the insurance premium.
When concluding a contract, the insurer knows that the applicant has not truthfully informed the situation and an insured accident has occurred, so it shall be liable for compensation or payment of insurance benefits.
According to your example, the insured concealed some insurance conditions, and the company didn't know about it, so the insured concealed it on purpose, so the insurance company has the right to refuse to pay compensation or pay insurance money;
In the incontestable clause, the insurer shall not refuse to pay compensation more than two years after the contract is established. This means that if the insured or the insured has an insurance accident two years after the establishment of the contract, the insurer cannot refuse to pay compensation, and if the insured or the insured has an insurance accident at 1, the insurer will not be liable for compensation and will not refund the premium according to the clear explanation of the basic clauses of individual insurance and the truthful disclosure clause.
Extended data:
The incontestable clause, also known as the incontestable clause, is basically as follows: if the insured fails to fulfill the obligation of telling the truth stipulated in the preceding paragraph intentionally or due to gross negligence, which is enough to affect the insurer's decision on whether to agree to underwrite or increase the insurance premium rate, and fails to exercise it for more than 30 days from the date when the insurer knows that there are reasons for rescission, the clause will be extinguished.
If more than two years have passed since the establishment of the contract, the insurer shall not terminate the contract; In the event of an insured accident, the insurer shall be liable for compensation or payment of insurance benefits.
The incontestable clause is generally limited to disputes over the validity of the policy, aiming at prohibiting disputes over the validity of the policy due to fraud, concealment or material misstatement of the applicant.
There are exceptions to this rule. In the case of impersonation, loss of insurance interest, intentional homicide by the insured, etc. Even if the dispute period ends, the insurer can raise a defense.
Generally speaking, the insurer's defense based on the following reasons is not bound by the incontestable clause:
If an accident occurs during the incontestable period, the right of rescission shall not be extinguished due to the expiration of the incontestable period, and the insurer may still notify that the obligation is defective and terminate the contract.
Anglo-American legislation generally stipulates that "after one year from the date of establishment, this contract shall be regarded as undisputed, provided that the insured is still alive" to prevent the insured or beneficiary from evading it.
Failure to pay the insurance premium is not bound by the incontestable clause.
The applicant must have insurable interest in the subject matter of insurance to prevent the use of life gambling and moral hazard factors. Therefore, the argument of insurable interest is not within the adjustment scope of this rule.
Although this rule is applicable to general fraud, especially serious fraud may still invalidate the contract, such as pretending to be the insured for medical examination.
In insurance practice, incontestable clauses mainly exist in long-term life insurance, health insurance and accident insurance contracts.
References:
Encyclopedia-indisputable clauses