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2025 MarsdenLR 3007

HIGH COURT MALAYA KUALA LUMPUR
UNIVERSITI KEBANGSAAN MALAYSIA – Appellant
Versus
ZURICH TAKAFUL MALAYSIA BERHAD – Respondent
[Suit No: WA-22NCC-534-12-2021]



Petitioner Advocates:Sharmini Navaratnam,Nabilah Farhanah ,Respondent Advocate: Tan Boo Wee,Emily Chong

Full disclosure of material facts in insurance proposals is mandatory; failure to disclose prior incidents allows insurers to repudiate contracts without needing to prove materiality.

Headnote:(A) Insurance Law - Medical Malpractice Indemnity Takaful Policy - Basis Clause - Plaintiff failed to disclose material facts regarding previous incident of medical negligence in the Proposal Form, leading to the insurer's repudiation of liability. (Paras 14-31)

(B) Duty of Disclosure - Insurer's obligation to avoid contract upon misstatements in proposal - Mistake in omitting past incidents can lead to contract avoidance regardless of whether the omitted information would have affected the risk. (Paras 14-26)

Facts of the case:
Plaintiff, a medical centre, sought indemnity from Defendant insurer after being found liable for negligence, but failed to disclose an internal investigation concerning an incident involving a patient before obtaining coverage. (Paras 1-11)

Findings of Court:
The Plaintiff's failure to disclose critical information constituted a breach of the insurance contract, and the Defendant was entitled to repudiate liability based on established principles of insurance law and the specific clauses of the policy. (Paras 32-60)

Issues: The court addressed whether there was a breach of the Basis Clause by non-disclosure of material facts and whether this breach entitled the insurer to repudiate the contract. (Paras 12)

Ratio Decidendi: The court held that full disclosure is an essential element of insurance contracts, where failure to provide accurate information permits the insurer to void the contract without proving material impact on risk assessment. (Paras 14-29)

Result: Claim dismissed with costs.

Judgement Key Points

Key Points: - The judgment holds that the Basis Clause creates warranties and non-disclosure or misstatement allows repudiation without proving material impact. (!) (!) (!) - The plaintiff was found to have breached the Duty of Disclosure by failing to disclose a potentially claim-generating incident (Henry Siang Len) known before inception. (!) (!) (!) (!) - Clause 2.1.5 excludes coverage for claims or circumstances known to the participant at inception or not disclosed, permitting repudiation. (!) (!) - The court found no waiver through insurer’s actions; repudiation was timely after discovering the undisclosed incident. (!) (!) - The plaintiff’s internal failure to share information and timing of discovery support the finding of breach and entitlement to repudiation. (!) (!) (!) - The case concludes with the claim being dismissed with costs due to breach of basis and duty of disclosure. (!) (!)

How to determine breach of the Basis Clause in a proposal form?

What is the effect of non-disclosure on the insurer's right to repudiate the contract?

What are the circumstances that trigger a duty of disclosure in a medical malpractice takaful policy?


Table of Content
1. claim for insurance indemnity (Para 1 , 3 , 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11)
2. claim dismissed with costs (Para 2)
3. issues for determination outlined (Para 12 , 14)
4. breach of duty of disclosure (Para 13 , 38 , 52)
5. implications of pre-existing knowledge (Para 42 , 45 , 50)
Ahmad Fairuz Zainol Abidin J:

Introduction

[1] This claim was brought by the Plaintiff who has under its stable of entities a hospital, Universiti Kebangsaan Malaysia Medical Centre ("UKMMC"), against the Defendant, an insurer, under a Takaful insurance policy. The Plaintiff had been found liable for medical negligence in an action brought by one of UKMMC's former patients. Having failing to reverse the decision on appeal, the Plaintiff then sought indemnity from the Defendant as their insurer under the Medical Malpractice Indemnity Takaful ("MMIT") policy. It is an insurance to indemnify the Plaintiff against any claim, inter alia, for actual or alleged breach of professional duty in provision of any medical service by reason of any act, error or omission committed or allegedly committed by the Plaintiff provided that the alleged act or omission occurs after the retroactive date stated in the Schedule. The Defendant refused to indemnify on the grounds that the Plaintiff breached the Basis Clause of the policy which entitled them to repudiate liability on the terms and condition of the Takaful policy.

[2] At the conclusion of the trial, I dismissed the claim on the basis that the Plaintiff failed to disclose a circumstance that might lead to a claim when the Plaintiff proposed to the Defendant for coverage.

Brief Background

[3] On 10 March 2015, the Plaintiff completed a Proposal Form for the MMIT coverage and handed to a representative of PNSB Insurance Brokers Sdn Bhd. ("PNSB"), an insurance broker, who in turn submitted the proposal to the Defendant for evaluation. The Plaintiff made no mention of any facts about the incident involving Henry Siang Len ("Henry Siang Len incident") in the Proposal Form despite having knowledge of that incident involved medical negligence and malpractice and the fact that there was an internal investigation meeting for the incident on 2 March 2011.

[4] Based on that Proposal Form, the Defendant then issued MMIT dated 22 December 2015 with Certificate No 011550009770-01 for the period from 8 December 2015 to 7 December 2016.

[5] On 21 December 2016, the Plaintiff was served with a Writ of Summons bearing No WA-22NCVC-795-12/2016 filed by Henry Siang Len who was represented by Messrs. P.S. Ranjan (hereinafter referred to as the "Suit 795").

[6] Upon receiving the said Writ of Summon and Statement of Claim, the Plaintiff then served PNSB a letter dated 21 December 2016 enclosed with a Notification of Claim Form dated 21 December 2016. In the Notification of Claim, it was stated that the date of work done out of which the claim arises was 21 December 2016.

[7] PNSB then informed the Defendant about the civil claim brought based on the Henry Siang Len incident. The Defendant appointed Messrs. Azim, Tunku Farik & Wong to represent the Plaintiff in the Suit 795 until 6 April 2018.

[8] On 12 March 2018, Messrs. Azim, Tunku Farik & Wong sent an e-mail asking the Plaintiff a series of question regarding to the Henry Siang Len incident. Via an e-mail dated 13 March 2018, the Plaintiff admitted that there was an internal investigation meeting for Henry Siang Len incident held on 2 March 2011 and the Plaintiff became aware that the Henry Siang Len incident is a circumstance that might give rise to a claim on 7 December 2015 ie when the Plaintiff received a letter from Messrs. P.S. Ranjan requesting for the medical records of Henry Siang Len.

[9] Upon finding out the true state of affairs about the Henry Siang Len incident, the Defendant then sent an e-mail dated 4 April 2018 to PNSB stating that the Suit 795 is not covered under the policy. PNSB forwarded the same e-mail to the Plaintiff on the same day. In effect, the Defenda

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