The woman with lung cancer was extremely angry when the insurance company refused to pay compensation and gave a series of arguments.
Insurance company refused to pay compensation
In March 2022, the content about "A woman with insurance but when she got cancer, she was denied 600,000 yuan in compensation" became a popular topic on Chinese social networks.
Accordingly, in March 2019, Ms. My (Nanjing, China) bought critical illness insurance from an insurance company in Wuhan for a total of 600,000 yuan (about 2.2 billion VND). She said that insurance is just one of the methods to protect oneself, and no one wants to get sick and then receive compensation.
However, she did not expect that just 4 months after purchasing the insurance, Ms. My discovered that she had a nodule in her lung during a routine health check-up. At that time, the doctor confirmed that this was a benign nodule so there was no need to worry too much. After monitoring for a while, until 2020, after a follow-up examination, she received a diagnosis of lung cancer from the doctor.
Faced with a serious illness, Mrs. My felt hopeless. However, her husband constantly encouraged her and affirmed that she had critical illness insurance to support her so she did not need to worry too much about financial issues.
From there, Ms. My underwent many important surgeries. By the end of 2021, after her condition improved, she proceeded with the procedures to send to the insurance company to receive compensation.
However, after a week, the insurance company sent a notice of its decision to settle the compensation claim to Ms. My. Accordingly, the content of the notice clearly stated that this female customer would not receive any compensation from the insurance company because she violated the contract.
The insurance company representative said that there is a disclaimer clause in the contract. This clause stipulates that if the insured discovers the disease within 180 days (about 6 months) from the date of signing the insurance contract, the insurance company will refuse to pay the claim.
After checking the information, this unit discovered that the female customer had discovered a cloudy spot in her lung in the 4th month after purchasing the insurance. This discovery is believed to be related to Ms. My's lung cancer. Therefore, the insurance company will comply with the content of the contract and refuse to pay compensation.
As soon as she received this information, Ms. My felt extremely surprised. Because during the transaction, the consultant had never informed the customer about this exemption clause.
She believes that during the consultation process, staff should clearly inform about this issue, instead of making customers have to search for exemption clauses among a series of information. The woman said that if she had known about the above regulation, she definitely would not have spent money to buy this insurance package.
No matter how Ms. My explained, the insurance company staff always insisted that they were only following the contract and would not settle the claim.
This angered the woman, who was being treated for lung cancer. In order to seek justice, Ms. My chose to go to court with the insurance company.
Court ruling
At the trial, the two sides debated two points of adjustment, including: First, is the disclaimer clause valid in this case when the consultant did not introduce it to the customer? Second, is the opaque nodule on the lung within the scope of pre-existing disease as prescribed by this clause?
After reviewing, the judge said that according to Article 17 of the Chinese Insurance Law, insurance contracts always contain disclaimers. The insurance company must have the obligation to disclose and explain these terms truthfully before the buyer signs the contract. Only when the above conditions are met, will the terms be applied.
In this case, the insurance company representative was dishonest about the content of the disclaimer. Therefore, the insurance company still has to compensate the customer.
Furthermore, after consulting with a doctor from the Oncology Department of Shanghai Pulmonary Hospital, the judge who handled the case said that 80-90% of our lung nodules are benign. At the time of discovery, the doctor who examined Ms. My also said that the nodules on her lungs did not develop into cancer. Therefore, this female customer did not violate the disclaimer clause set forth by the insurance company.
Therefore, in any situation, the insurance company must still compensate the customer according to the signed contract.
Through this incident, the local government in coordination with relevant agencies has issued a notice on insurance sales. Accordingly, people need to carefully read the information when purchasing insurance products, the terms in the contract. Especially the contents related to insurance liability and exemption conditions need to be noted.
Dinh Anh (According to Toutiao)
Source: https://giadinh.suckhoedoisong.vn/nguoi-phu-nu-bo-22-ty-dong-mua-bao-hiem-4-thang-sau-phat-hien-ung-thu-phoi-nhung-bi-tu-choi-boi-thuong-toa-phan-quyet-gay-bat-ngo-172250108073759215.htm
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