Denied Insurance Claims in Thailand: How to Challenge Your Insurance Company
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How an Insurance Policy Works Under Thai Law
Section 861 of the Civil and Commercial Code defines an insurance contract as one in which the insurance company agrees to indemnify or pay a sum on a specified future event, in return for the premium. Section 877 sets what a non-life insurance company must pay: the actual loss, damage caused by reasonable steps taken to prevent the loss, and reasonable expenses incurred to protect the insured property, with the sum insured presumed to be the correct measure and operating as the ceiling.
Two duties fall on you. Under section 881, once you or the beneficiary knows of the loss you must notify the insurance company without delay, and failure to do so entitles the insurance company to claim damages flowing from that failure, unless you prove you could not notify. Note what that does not say: late notice does not automatically destroy the claim. It gives the insurance company a damages claim for the consequences, which is a very different thing from a forfeiture, and insurance companies frequently overstate this point in refusal letters.
Why an Insurance Company Refuses: Non-Disclosure
The overwhelming majority of refusals rely on section 865. If, at the time of contracting, the insured knew of a fact and withheld it, or knowingly made a false statement, and that fact would have induced the insurance company to charge a higher premium or to decline the risk, the contract is voidable and the insurance company may avoid it.
Read that carefully, because each element is a hurdle for the insurance company. The insured must have known the fact at the time the insurance was taken out. The fact must have been material in the specific sense that it would have changed the premium or the decision to insure. And the non-disclosure must have occurred at the time of contracting.
Case in point — Supreme Court Judgment No. 785/2022: a month before applying, the insured had seen a doctor and been treated for diabetes and high blood lipids, yet answered a clear question about medical consultations in the previous six months by saying only that an annual check-up had been normal. The Court found deliberate concealment of a material fact, held the policy voidable, and because the insurance company had avoided it within one month of learning the ground, the insurance company was not liable. This is what a strong case for the insurance company looks like, and it is worth knowing so you can recognise when yours is not that case.
When the Insurance Company Cannot Avoid the Policy
Three lines of insurance authority cut the other way, and they decide a great many claims.
First, you cannot withhold from an insurance company what you did not know. Case in point — Supreme Court Judgment No. 1277/1981: the insured could not read, did not appreciate the seriousness of his condition because he was still working normally, and the insurance company's own agent never asked about his medical history. The agent merely obtained his age and signature and then filled in the application form himself. The Court held the insured never had the opportunity to know that his earlier high blood pressure was a fact that would have affected the premium or the decision to insure, so he could not be said to have knowingly withheld it, and the insurance company had no right to avoid the policy at all.
That fact pattern is extremely common in Thailand, where an agent completes the Thai-language form for a foreign applicant. If the form was filled in by the agent, say so and prove it.
Second, the insurance company cannot rely on a fact it knew or should have discovered. Case in point — Supreme Court Judgment No. 2447/1973: the Court held that the right to avoid under section 865 arises only from concealment or false statement on a material point at the time of entering the contract, and that where the insurance company should reasonably have known the true position had it exercised the care of a prudent person, section 866 renders the contract valid and the company cannot avoid it. The insurance company's representative had already investigated the applicant's circumstances.
Third, the duty is not unlimited. Case in point — Supreme Court Judgment No. 2397/1993: the Court confirmed that the duty to disclose rests on the insured and that an insurance company's failure to carry out a medical examination beforehand is not treated as negligence on its part, even where no examination was required for a low sum insured. So the argument that the company should simply have examined you does not succeed on its own; it works, as in Judgment No. 2447/1973, when the insurance company actually had or should have had the information.
The One-Month Deadline That Defeats the Insurance Company
This is the most useful provision in the whole of Thai insurance law for a claimant, and it is where insurance companies most often fail.
Under section 865 paragraph two, the right to avoid is extinguished if it is not exercised within one month from the date the insurance company became aware of the ground for avoidance, or within five years from the date of the contract. Miss either period and the insurance policy stands, however serious the non-disclosure.
Crucially, the burden of proving compliance is on the insurance company. Case in point — Supreme Court Judgment No. 4237/2021: the insurance company defended on the basis that two life policies were voidable and had been avoided. The Court held that the company therefore bore the duty of proving when it became aware of the ground for avoidance and that it had avoided within one month of that date under section 865 paragraph two. The insurance company's single witness gave evidence that did not establish this, and the defence failed.
In practice this means your first request to the insurance company should be for its claim file and internal correspondence showing when it obtained your medical records. The date on the refusal letter is often months after the date the insurance company learned the facts, and that gap wins cases.
When the Agent Was Told and the Insurance Company Says Otherwise
A recurring dispute is the applicant who disclosed everything verbally while the agent wrote down something else. Case in point — Supreme Court Judgment No. 4404/2022: the insured developed breast cancer after taking out the policy, and the insurance company refused the hospital expenses, alleging undisclosed uterine tumours, an abnormal chest X-ray, excess weight and a misstated weight. The insured's case was that she had disclosed her health information to the agent, who deliberately omitted it from the application form, and that the agent was the company's own life insurance agent who had collected the premium from her.
The lesson is practical rather than legal. Keep the agent's messages, note who completed the form, and if you are asked to sign a Thai-language application you cannot read, ask for a translation and keep the request. Where the agent acted for the insurance company, what the agent was told is a live issue, not a dead end.
Claiming Directly Against Somebody Else's Insurance
If you were injured by another person, you do not have to wait for that person to claim on their own cover. Section 887 governs liability insurance, where the insurance company agrees to indemnify in the name of the insured for loss caused to a third party for which the insured is responsible. The injured person is entitled to receive compensation directly from the insurance company, up to the limit the insurance company is bound to pay under the insurance policy, and in an action between the injured person and the company the insured must be joined as a party. The insurance company is not discharged by having paid the insured, unless it proves the insured has already paid the injured person.
For road accidents, diving and watersports incidents and injuries on commercial premises in Phuket, this is usually the fastest route to payment, because an insurance company with a policy limit is a far better defendant than an individual or a small operator with none.
The Two-Year Deadline That Applies to You
Section 882 imposes a short limitation period and it catches many claimants. An action to recover an indemnity may not be brought more than two years from the date of the loss. An action to recover or refund premiums may not be brought more than two years from the date the right to claim fell due.
Two years runs from the loss, not from the refusal. A claimant who spends eighteen months in correspondence with the insurance company and then looks for a lawyer has very little time left to sue on the insurance policy. If a refusal is being disputed, diarise the two-year date from the date of the incident at the outset.
Note also the insurance company's own subrogation right under section 880: once the insurance company pays, it steps into your rights against the third party who caused the loss, to the extent of the payment, and where it has paid only part it may not exercise that right so as to prejudice your claim for the balance.
Where These Insurance Cases Are Heard
A dispute between a policyholder and an insurance company is a consumer case. That is a significant advantage: proceedings under the Consumer Case Procedure Act are designed to be accessible, the court takes an active role in an insurance dispute, and the evidential provisions in section 11 allow you to prove what the business operator promised or represented even where it does not appear in the written documents.
Several of the judgments above, including Judgment No. 5520/2021 and Judgment No. 785/2022, came through the consumer divisions on appeal, which is a reminder that these cases are regularly litigated to the highest level and that an insurance company refusal is an opening position rather than a final answer.
Common Mistakes to Avoid
Accepting the refund of premiums, which the insurance company will later characterise as acceptance of the avoidance.
Failing to ask when the insurance company first learned of the ground for avoidance, which is the question it must answer and often cannot.
Letting the two-year period under section 882 run while negotiating.
Not recording that the agent completed the application form, which was decisive in Judgment No. 1277/1981.
Assuming late notice of the loss destroys the claim, when section 881 only gives the insurance company a claim for resulting damage.
Suing the individual who injured you instead of claiming directly against their liability insurance under section 887.
Frequently Asked Questions
My insurance company cancelled the policy for non-disclosure. Is that the end?
No. The insurance company must prove you knew the fact, that it was material to the premium or to accepting the risk, and that it avoided the policy within one month of learning the ground. Judgment No. 4237/2021 confirms that burden sits on the company, and it frequently fails to discharge it.
The agent filled in my application form. Does that help me?
Significantly. In Judgment No. 1277/1981 the insured had no opportunity to know the relevant fact because the agent never asked and completed the form himself, and the insurance company had no right to avoid the policy.
Can I claim against the insurance company of the person who injured me?
Yes. Section 887 lets an injured person claim compensation directly from the liability insurance company, up to the policy limit, with the insured joined as a party to the action.
How long do I have to sue my insurance company?
Two years from the date of the loss under section 882, not two years from the refusal letter. For premium claims, two years from when the right fell due.
Should I accept the premium refund the insurance company sent me?
Take advice first. Banking the cheque can be presented as acceptance that the insurance policy was validly avoided, which weakens a claim you may well be able to win.
Speak to a Thai Insurance Litigation Lawyer
A refusal letter from an insurance company is a position, not a verdict, and the law places most of the work of justifying it on the company itself. Our litigation team reviews the policy and the application, obtains the claim file to establish when the insurance company learned of the ground it relies on, tests whether the non-disclosure was material under section 865, and brings the claim in the consumer court within the two-year period under section 882. We also pursue direct claims against liability insurance under section 887 for accident and injury cases. We act for foreign residents and visitors in Phuket and throughout Thailand. Contact us with the refusal letter and the policy for an assessment.
Disclaimer
This article provides general legal information only and does not constitute legal advice. Insurance disputes turn on the policy wording, the application form and the timing of each party's knowledge. Please consult a licensed Thai attorney before acting on any matter with legal consequences
Section 861 of the Civil and Commercial Code defines an insurance contract as one in which the insurance company agrees to indemnify or pay a sum on a specified future event, in return for the premium. Section 877 sets what a non-life insurance company must pay: the actual loss, damage caused by reasonable steps taken to prevent the loss, and reasonable expenses incurred to protect the insured property, with the sum insured presumed to be the correct measure and operating as the ceiling.
Two duties fall on you. Under section 881, once you or the beneficiary knows of the loss you must notify the insurance company without delay, and failure to do so entitles the insurance company to claim damages flowing from that failure, unless you prove you could not notify. Note what that does not say: late notice does not automatically destroy the claim. It gives the insurance company a damages claim for the consequences, which is a very different thing from a forfeiture, and insurance companies frequently overstate this point in refusal letters.
Why an Insurance Company Refuses: Non-Disclosure
The overwhelming majority of refusals rely on section 865. If, at the time of contracting, the insured knew of a fact and withheld it, or knowingly made a false statement, and that fact would have induced the insurance company to charge a higher premium or to decline the risk, the contract is voidable and the insurance company may avoid it.
Read that carefully, because each element is a hurdle for the insurance company. The insured must have known the fact at the time the insurance was taken out. The fact must have been material in the specific sense that it would have changed the premium or the decision to insure. And the non-disclosure must have occurred at the time of contracting.
Case in point — Supreme Court Judgment No. 785/2022: a month before applying, the insured had seen a doctor and been treated for diabetes and high blood lipids, yet answered a clear question about medical consultations in the previous six months by saying only that an annual check-up had been normal. The Court found deliberate concealment of a material fact, held the policy voidable, and because the insurance company had avoided it within one month of learning the ground, the insurance company was not liable. This is what a strong case for the insurance company looks like, and it is worth knowing so you can recognise when yours is not that case.
When the Insurance Company Cannot Avoid the Policy
Three lines of insurance authority cut the other way, and they decide a great many claims.
First, you cannot withhold from an insurance company what you did not know. Case in point — Supreme Court Judgment No. 1277/1981: the insured could not read, did not appreciate the seriousness of his condition because he was still working normally, and the insurance company's own agent never asked about his medical history. The agent merely obtained his age and signature and then filled in the application form himself. The Court held the insured never had the opportunity to know that his earlier high blood pressure was a fact that would have affected the premium or the decision to insure, so he could not be said to have knowingly withheld it, and the insurance company had no right to avoid the policy at all.
That fact pattern is extremely common in Thailand, where an agent completes the Thai-language form for a foreign applicant. If the form was filled in by the agent, say so and prove it.
Second, the insurance company cannot rely on a fact it knew or should have discovered. Case in point — Supreme Court Judgment No. 2447/1973: the Court held that the right to avoid under section 865 arises only from concealment or false statement on a material point at the time of entering the contract, and that where the insurance company should reasonably have known the true position had it exercised the care of a prudent person, section 866 renders the contract valid and the company cannot avoid it. The insurance company's representative had already investigated the applicant's circumstances.
Third, the duty is not unlimited. Case in point — Supreme Court Judgment No. 2397/1993: the Court confirmed that the duty to disclose rests on the insured and that an insurance company's failure to carry out a medical examination beforehand is not treated as negligence on its part, even where no examination was required for a low sum insured. So the argument that the company should simply have examined you does not succeed on its own; it works, as in Judgment No. 2447/1973, when the insurance company actually had or should have had the information.
The One-Month Deadline That Defeats the Insurance Company
This is the most useful provision in the whole of Thai insurance law for a claimant, and it is where insurance companies most often fail.
Under section 865 paragraph two, the right to avoid is extinguished if it is not exercised within one month from the date the insurance company became aware of the ground for avoidance, or within five years from the date of the contract. Miss either period and the insurance policy stands, however serious the non-disclosure.
Crucially, the burden of proving compliance is on the insurance company. Case in point — Supreme Court Judgment No. 4237/2021: the insurance company defended on the basis that two life policies were voidable and had been avoided. The Court held that the company therefore bore the duty of proving when it became aware of the ground for avoidance and that it had avoided within one month of that date under section 865 paragraph two. The insurance company's single witness gave evidence that did not establish this, and the defence failed.
In practice this means your first request to the insurance company should be for its claim file and internal correspondence showing when it obtained your medical records. The date on the refusal letter is often months after the date the insurance company learned the facts, and that gap wins cases.
When the Agent Was Told and the Insurance Company Says Otherwise
A recurring dispute is the applicant who disclosed everything verbally while the agent wrote down something else. Case in point — Supreme Court Judgment No. 4404/2022: the insured developed breast cancer after taking out the policy, and the insurance company refused the hospital expenses, alleging undisclosed uterine tumours, an abnormal chest X-ray, excess weight and a misstated weight. The insured's case was that she had disclosed her health information to the agent, who deliberately omitted it from the application form, and that the agent was the company's own life insurance agent who had collected the premium from her.
The lesson is practical rather than legal. Keep the agent's messages, note who completed the form, and if you are asked to sign a Thai-language application you cannot read, ask for a translation and keep the request. Where the agent acted for the insurance company, what the agent was told is a live issue, not a dead end.
Claiming Directly Against Somebody Else's Insurance
If you were injured by another person, you do not have to wait for that person to claim on their own cover. Section 887 governs liability insurance, where the insurance company agrees to indemnify in the name of the insured for loss caused to a third party for which the insured is responsible. The injured person is entitled to receive compensation directly from the insurance company, up to the limit the insurance company is bound to pay under the insurance policy, and in an action between the injured person and the company the insured must be joined as a party. The insurance company is not discharged by having paid the insured, unless it proves the insured has already paid the injured person.
For road accidents, diving and watersports incidents and injuries on commercial premises in Phuket, this is usually the fastest route to payment, because an insurance company with a policy limit is a far better defendant than an individual or a small operator with none.
The Two-Year Deadline That Applies to You
Section 882 imposes a short limitation period and it catches many claimants. An action to recover an indemnity may not be brought more than two years from the date of the loss. An action to recover or refund premiums may not be brought more than two years from the date the right to claim fell due.
Two years runs from the loss, not from the refusal. A claimant who spends eighteen months in correspondence with the insurance company and then looks for a lawyer has very little time left to sue on the insurance policy. If a refusal is being disputed, diarise the two-year date from the date of the incident at the outset.
Note also the insurance company's own subrogation right under section 880: once the insurance company pays, it steps into your rights against the third party who caused the loss, to the extent of the payment, and where it has paid only part it may not exercise that right so as to prejudice your claim for the balance.
Where These Insurance Cases Are Heard
A dispute between a policyholder and an insurance company is a consumer case. That is a significant advantage: proceedings under the Consumer Case Procedure Act are designed to be accessible, the court takes an active role in an insurance dispute, and the evidential provisions in section 11 allow you to prove what the business operator promised or represented even where it does not appear in the written documents.
Several of the judgments above, including Judgment No. 5520/2021 and Judgment No. 785/2022, came through the consumer divisions on appeal, which is a reminder that these cases are regularly litigated to the highest level and that an insurance company refusal is an opening position rather than a final answer.
Common Mistakes to Avoid
Accepting the refund of premiums, which the insurance company will later characterise as acceptance of the avoidance.
Failing to ask when the insurance company first learned of the ground for avoidance, which is the question it must answer and often cannot.
Letting the two-year period under section 882 run while negotiating.
Not recording that the agent completed the application form, which was decisive in Judgment No. 1277/1981.
Assuming late notice of the loss destroys the claim, when section 881 only gives the insurance company a claim for resulting damage.
Suing the individual who injured you instead of claiming directly against their liability insurance under section 887.
Frequently Asked Questions
My insurance company cancelled the policy for non-disclosure. Is that the end?
No. The insurance company must prove you knew the fact, that it was material to the premium or to accepting the risk, and that it avoided the policy within one month of learning the ground. Judgment No. 4237/2021 confirms that burden sits on the company, and it frequently fails to discharge it.
The agent filled in my application form. Does that help me?
Significantly. In Judgment No. 1277/1981 the insured had no opportunity to know the relevant fact because the agent never asked and completed the form himself, and the insurance company had no right to avoid the policy.
Can I claim against the insurance company of the person who injured me?
Yes. Section 887 lets an injured person claim compensation directly from the liability insurance company, up to the policy limit, with the insured joined as a party to the action.
How long do I have to sue my insurance company?
Two years from the date of the loss under section 882, not two years from the refusal letter. For premium claims, two years from when the right fell due.
Should I accept the premium refund the insurance company sent me?
Take advice first. Banking the cheque can be presented as acceptance that the insurance policy was validly avoided, which weakens a claim you may well be able to win.
Speak to a Thai Insurance Litigation Lawyer
A refusal letter from an insurance company is a position, not a verdict, and the law places most of the work of justifying it on the company itself. Our litigation team reviews the policy and the application, obtains the claim file to establish when the insurance company learned of the ground it relies on, tests whether the non-disclosure was material under section 865, and brings the claim in the consumer court within the two-year period under section 882. We also pursue direct claims against liability insurance under section 887 for accident and injury cases. We act for foreign residents and visitors in Phuket and throughout Thailand. Contact us with the refusal letter and the policy for an assessment.
Disclaimer
This article provides general legal information only and does not constitute legal advice. Insurance disputes turn on the policy wording, the application form and the timing of each party's knowledge. Please consult a licensed Thai attorney before acting on any matter with legal consequences
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