The High Court ruled that New Ireland Assurance plc must pay Caroline Coleman €95,230.76 under a critical illness policy after finding she had not knowingly withheld relevant medical information when she applied for cover.
In a judgment delivered on 12 June 2009, Mr Justice Clarke found that Coleman was entitled to the payment after being diagnosed with multiple sclerosis. New Ireland accepted that she prima facie qualified under the policy’s terms but argued it could avoid the policy because her application did not disclose medical tests and a specialist consultation from 1990 and 1991.
Coleman had applied for life and critical illness cover in the late 1990s while arranging a mortgage. A New Ireland representative read the application questions aloud and recorded her answers. Coleman disclosed back trouble, which led to an exclusion relating to critical illness cover for that condition. Her application otherwise recorded only visits for colds and flu, and said she had not seen another doctor or specialist or undergone other relevant tests.
The court heard that, aged 19, Coleman had experienced eyesight problems around Christmas 1990. Her GP arranged hospital tests, including a scan and lumbar puncture, and she saw a consultant. The doctors considered multiple sclerosis likely, but did not tell her that. She was told she had optic neuritis, described to her as inflammation of the eye. She had no recurrence or other relevant symptoms before applying for insurance years later.
Justice Clarke applied the principle that disclosure and application answers were assessed by what the proposer knew and whether she answered truthfully to the best of her ability. He accepted Coleman’s evidence that she had put the brief episode out of her mind because it had not recurred and did not seem significant. He found this was not wilful ignorance, deliberate forgetfulness or culpable forgetfulness.
The judge was not satisfied that Coleman had materially failed to disclose a fact she knew, answered any question untruthfully, or breached a policy warranty or condition. He directed that the €95,230.76 claim be paid and proposed awarding Courts Act interest from 1 July 2004. The judgment said the application for payment had been made towards the end of 2003 and should have been processed by 30 June 2004 at the latest.