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Court Rules Insurers Need Clear Cancer History Questions
16 Mar
Summary
- Insurer denied claim despite asking about genetic diseases, not family history.
- Court ruled the insurer's inquiry was not clear or valid.
- Nearly 70% of personal insurance disputes involve disclosure issues.
In a significant ruling, the Beijing Financial Court has affirmed a decision in favor of a policyholder, Ms. Huang, whose critical illness claim was initially denied. The insurer had rejected her claim for 500,000 yuan, alleging she did not disclose her mother's and grandmother's cancer histories during the application.
However, the court found the insurer's questionnaire was inadequate. It specifically inquired about "genetic diseases" but made no explicit reference to family cancer history, nor did its definition of genetic disease include such history. The court determined that a reasonable consumer would not equate family cancer history with genetic diseases.
The ruling also noted that Huang had informed the insurance agent about her mother's condition, but the agent did not pursue further details. This case underscores that nearly 70 percent of personal insurance disputes relate to disclosure obligations, reinforcing the need for insurers to pose clear, valid, and unambiguous questions.
