Theory of unforeseen circumstances Conditions and Insurance Companies’ Contractual Liability to Insured against Sickness.
There is a question that many people, insured against illness, too asked about the contractual liability of insurance companies; Especially in the light of the new Corona pandemic outbreak; about the extent to which the rules of the theory of unforeseen circumstances apply to such contracts.
The Civil Code No. 22 of 2004 defines insurance as a contract under which the insurer is obliged to pay to the insured, or to the beneficiary for whose benefit the insurance required an amount of money, salary income, or other financial compensation, with the occurrence of the risks set forth in the contract when paid the respect of a premium or other payment made by the insured to the insurer.
By extrapolating the text, it is clear that the insured if he paid the premiums or payments under the insurance contract is made to the insurer, and the occurrence of the risks set in the contract, the insurer must pay the insurance amount agreed in the contract, Given the question, insurance is based on the occurrence of the sickness; So since the Coronavirus disease (COVID-19) is the same as the rest of the diseases, therefore, if the insured insurance contract is based on the occurrence of the disease as generally, there is no way that the insurers will shirk the obligation if the disease has occurred, This is because all the components of the insurance contract have occurred, payment of the premium, the insured injury. Unless the insurance contract provides that the insurance insurer must be paid to the insured only when certain diseases have been realized, not including diseases affecting the respiratory system such as corona, sars, and other diseases affecting the lungs, insurance for the mere occurrence of the disease whatever its form or type is required for the insurer to be insured; but it has often been the practice of contracts that the sickness insurance policy does not exclude certain diseases; The insurance contract often covers all diseases without exception.
Accordingly, the insurance contract between the parties must be taken into consideration and the agreed texts must be considered and the agreed provisions followed, and the parties must comply with the terms of the insurance contract.
Then for apply the Theory of unforeseen circumstances or force majeure theory to the sickness insurance contract, must be stated that the main column to apply her notion is due to the occurrence of general exceptional incidents that were not considered by the parties to the contract at the time of their agreement and the signing of a contract, The court shall be exercising its authority when occurred unforeseen circumstances incidents and put back the obligation which has become burdensome to reasonably, if the contract cannot be performed and it is not only burdensome, must re-status parties to the situation in which they were before they were on it contracted, with the award of compensation, if necessary.
But on the contrary, the insurance contract is based on accidents and damages that will occur in the future and can be predicted they occur on a firm basis, the extent of the damages that are insured, and the way they are, all this taken into consideration when signing the insurance contract, Accordingly, the two ideas differed from each other and went against each other. so, as the result the theory of unforeseen circumstances should not be applied to the sickness insurance contract, for the rules considerations we have shown & explained.
Consequently, insurance companies have suffered heavy losses due to their coverage of Corona’s patients in most countries of the world; so, most of these companies have completely stopped accepting applicants for a sickness insurance policy.
Thus, any type of disease is not an emergency in the sickness insurance contract it is expected to occur, the element of expectation and probability is essential, for the conclusion of such insurance contracts.
Author: MR. MOHANAD BABIKER\ Senior Legal Consultant