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I came across this question on a life insurance form:

My biological parents or biological siblings have been diagnosed by a member of the medical profession with any of the following: cancer, heart disease, diabetes, kidney disease, Huntington's Disease, Marfan Syndrome, or Lynch Syndrome

My father died with heart disease listed as the cause of death, but he was not diagnosed with heart disease. By the letter of the law, in this situation, would the answer to "does the above apply to me?" be yes or no?

JoeKing
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  • The intent here is to show a family history for heart disease, so I believe the answer should be "yes". – Ron Beyer Mar 14 '19 at 00:46
  • But the question in the contract says diagnosed. If the company wanted to know about any history at all, they could and should have said that, and an argument over this would have to go against them because they're the ones who wrote the document. –  Mar 14 '19 at 06:56

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In interpretting the words of a contract, the courts might consult a dictionary to sort out potential ambiguities, but a dictionary would not provide that kind of information. Instead of appealing to an authoritative source,they are likely to perform a reasonable man analysis, asking what a reasonable man would think a "diagnosis" is. There is no special term that refers to detection of a condition after death, and the literature is full of references to post_mortem diagnoses. A reasonable man would this understand that a diagnosis of a condition after death is still a diagnosis.

user6726
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in this situation, would the answer to "does the above apply to me?" be yes or no?

If none of your father's prior medical checks reflects heart disease (apropos of "he was not diagnosed with heart disease"), then you have merit in answering "no".

According to this study from 2017, "heart disease was incorrectly identified as the cause of death on 54.5%–85% of death certificates" (emphasis added). Therefore, a death certificate alone would hardly be cognizable grounds for insurer's denial of coverage or for a higher premium under pretext of your father's alleged cause of death.

Penalizing insurers essentially for sloppy practices in medical reporting would be unreasonable and does not reflect the exposure a life insurance company is supposed to assess.

Iñaki Viggers
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