A Chinese insurance company has paid a cancer patient’s critical illness claim after initially rejecting it on the grounds that his condition was linked to a hereditary disease, a decision that prompted a lawsuit and widespread scrutiny online.
The policyholder, identified by the surname Xiao, was diagnosed in August with a malignant tumor of the descending colon and familial polyposis. He subsequently filed a claim with the Sichuan branch of Taikang Life Insurance for 86,320 yuan under a critical illness policy his family had maintained for more than a decade.
According to The Paper’s Sept. 23 report, Xiao’s mother purchased the “Taikang Healthy Life Critical Illness Lifetime Protection Plan” for him on July 18, 2011, when he was 18. The policy required annual premiums of 2,000 yuan for 20 years and provided lifetime coverage, including 86,320 yuan in coverage for major illnesses such as malignant tumors. His parents continued paying the premiums in full each year.
On Aug. 4, Xiao was treated at Sichuan Provincial People’s Hospital and diagnosed with a malignant tumor of the descending colon and familial polyposis. After his discharge on Aug. 18, he submitted a claim for the full 86,320-yuan benefit.
Insurer cites hereditary-disease exclusion
Taikang Life rejected the claim on Sept. 3, stating in its claim decision that Xiao’s condition was associated with familial polyposis and therefore fell under the policy’s exclusion for hereditary diseases.
Xiao disputed the decision and repeatedly contacted the company seeking payment. After those efforts failed, he filed a lawsuit against Taikang Life in Chengdu’s Jinjiang District People’s Court on Sept. 15, asking the court to order the insurer to pay the 86,320-yuan benefit plus interest and legal costs, according to The Paper.
His attorney, Guo Gang, questioned the basis for the rejection. Guo said the insurer appeared to have relied on the fact that Xiao’s father had also been diagnosed with cancer about 15 years earlier but had not required Xiao to undergo genetic testing.
Guo also said the policy explicitly covered malignant tumors and did not clearly list Xiao’s descending-colon cancer as an excluded condition.
“If Taikang Life can, based on its own standards, arbitrarily determine that a disease falls under the hereditary-disease exclusion,” Guo said, the validity of the policy’s cancer coverage itself could be called into question.
A Sichuan cancer specialist interviewed by The Paper said some cases of colon cancer are hereditary and others are not, arguing that heredity should not be determined from family history alone and should instead be confirmed through genetic testing.
When contacted on Sept. 22, an employee at Taikang Life’s Sichuan branch said the company could not explain whether colon cancer was automatically classified as a hereditary disease and said the determination “should be made by doctors.” The employee also pointed to the pending lawsuit and said the company would defer to the court.
A Taikang Life customer-service representative told The Paper the following day that the company itself could not determine whether colon cancer was hereditary or non-hereditary and that individual claims were reviewed by claims personnel. The representative could not confirm whether Xiao had been asked to undergo genetic testing.
Taikang reverses course and pays claim
The dispute changed course shortly after it became public.
On Sept. 24, one day after The Paper published its initial report, Xiao received the full 86,320-yuan insurance payment from Taikang Life, according to a follow-up report by The Paper. The amount was identical to the sum he had sought in his lawsuit.
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