Analisis Hukum Penyembunyian Informasi (Concealment) Kesehatan Tertanggung Sebagai Alasan Penolakan Klaim Asuransi Jiwa (Studi Putusan Nomor 134/Pdt.G/2023/PN/Mdn

Abstract

This study analyzes the legal aspects related to the concealment of health information by the insured as a basis for the rejection of life insurance claims, with a case study of Decision Number 134/Pdt.G/2023/PN Mdn. The principle of utmost good faith in insurance contracts obliges the insured to disclose health information honestly, as such information determines the insurer’s decision in accepting the risk. This research aims to examine the legal regulation of concealment in life insurance policies under Indonesian legislation, to analyze the legal consequences of concealment on life insurance claims, and to assess the legal considerations of the panel of judges in Decision Number 134/Pdt.G/2023/PN Mdn. This research employs a normative legal research method using a statutory approach, a conceptual approach, and a case approach. The nature of this study is descriptive, aiming to systematically and comprehensively describe and analyze the legal phenomena under investigation. The data used are secondary data, consisting of primary, secondary, and tertiary legal materials, collected through literature study. Data analysis is conducted qualitatively, with conclusions drawn using a deductive method deriving specific conclusions from general principles in order to answer the research problems. The findings of this study indicate that the concealment of health information in life insurance policies is explicitly regulated in the Indonesian Commercial Code (KUHD), Law Number 40 of 2014 concerning Insurance, and other related regulations, all of which emphasize the importance of the utmost good faith principle in insurance agreements. Concealment by the insured may result in legal consequences such as policy cancellation and claim rejection, provided the insurance company can prove the existence of material information that was withheld, supported by valid medical evidence. In the case of Decision Number 134/Pdt.G/2023/PN Mdn, the panel of judges determined that the claim rejection by PT Asuransi Allianz Life Indonesia was not based on sufficient medical evidence; therefore, such action was deemed a breach of contract, and the insurance company was ordered to pay the insurance benefits to the plaintiff in accordance with the terms of the policy.