A boy in Guizhou suffering from severe epilepsy, whose parents purchased critical illness insurance and applied for a claim, but the insurance company refused to compensate. Recently, the boy’s parents filed a lawsuit against the insurance company. A lawyer reminded the public to carefully read the insurance terms when buying insurance to avoid being misled by the terms. This news has become a hot topic in mainland China.
On July 26th, Ms. Deng from Guizhou revealed to Jiupai News that her son, nicknamed Tiantian, was born in 2019. Before he was one year old, she purchased a critical illness insurance policy for him through China Pacific Life Insurance Co., Ltd. The policy took effect on January 1, 2020, with a basic coverage of 410,000 RMB. The insurance period is lifelong, with an annual premium of 2337 RMB and a payment period of 20 years.
As the child grew older, they noticed his cognitive abilities were lower, and his motor skills were weak. Tiantian often had seizures and fell to the ground with his eyes rolling back. At the age of 1 year and 8 months, he was diagnosed with epilepsy, but due to multiple areas of brain discharge, surgery was deemed too risky. Doctors recommended conservative treatment through medication and rehabilitation.
Ms. Deng revealed that the monthly cost of Tiantian’s medication is hundreds of RMB, and he has to go to the hospital for rehabilitation training five days a week. To treat her child, the family depleted their savings and accrued a loan of 300,000 RMB, making them eligible for government aid in the village.
In February 2024, Ms. Deng applied for a claim with the insurance company. According to the insurance contract, neurosurgery treatment was required to qualify for compensation. The insurance company rejected the claim, citing that the existing information did not meet the conditions for payout, and issued a “Claim Decision Notice” to Ms. Deng.
Subsequently, Ms. Deng hired lawyer Jiang Jian from Guizhou Qianma Law Firm to sue China Pacific Life Insurance Co., Ltd. Zunyi Branch, demanding the company pay the insurance benefit as stipulated in the contract.
Jiang Jian stated that the critical illness insurance contract of the company specified that “severe epilepsy” required “neurosurgery treatment for the treatment of recurring epilepsy.” Hence, the insurance company refused the payout. However, at the time of signing the contract, the insurance agent did not explain this term to Ms. Deng. Moreover, intellectual disabilities caused by illness or injury were also included in the range of major illnesses agreed upon in the contract, entitling Tiantian to double compensation, totaling 820,000 RMB.
Ultimately, the insurance company applied for mediation, and both parties signed a mediation agreement under the court’s supervision. According to the civil mediation document provided by lawyer Jiang Jian to the reporter, China Pacific Life Insurance Co., Ltd. Zunyi Branch agreed to pay Tiantian the insurance benefit of 416,000 RMB before December 20, 2024.
Jiang Jian explained that due to the urgent need for money to treat the child, Ms. Deng and her family accepted the company’s offer to pay 416,000 RMB within 7 days.
Jiang Jian reminded parents that when purchasing insurance for their children, they should pay attention to whether the insurance company explains the relevant exemption clauses and keep evidence.
Many netizens expressed dissatisfaction with the insurance company. User “Looking back, no regrets, moving forward through difficulties” said: “The insurance company knows whether they should compensate or not, why didn’t they do it from the beginning? This is the reason why many people see insurance companies as scammers.”
User “186*****439” also commented: “Let’s put it this way, can ordinary people navigate the pitfalls in insurance contracts as well as the professional teams who specialize in deciphering contracts?”