In March 2021, Mr. M purchased a lifetime critical illness insurance policy from an insurance company, with an annual premium of 14,091.26 yuan, a payment period of 19 years, a basic coverage of 30,000 yuan, and a lifetime insurance period. He also purchased one-year insurance types such as accidental injury expense compensation medical insurance and hospitalization expense compensation medical insurance, and has been continuously insured from 2022 to 2025.
In April 2025, Mr. M called the insurance company to report that he had hepatitis B. He claimed that the insurance company did not inform him of the liability exemption for hepatitis B when he took out the policy. Now that he has learned that no claims will be made for diseases caused by hepatitis B in the future, he requested a full policy refund.
After investigation, it was found that all the application materials submitted by Mr. M when he took out the policy were confirmed and signed by himself. The policy salesperson also stated that he had truthfully informed the customer of the insurance liability, payment period, insurance period, withdrawal during the cooling-off period, and the losses caused by mid-policy withdrawal. During the follow-up visit to the new policy, Mr. M clearly stated that he was aware of the insurance liability and liability exemption and other terms, indicating that the insurance company fulfilled the obligation of clear explanation. In June 2021, the client entrusted a supplementary notification of the hepatitis B situation. After the company’s review, it made additional charges and liability exemptions for the major illness and medical expense insurance purchased by the client respectively. Mr. M also signed in person to express his approval of the company’s underwriting decision. For these reasons, the insurance company lawfully refused his request for a full policy refund
Case Analysis
Insurance Law of the People’s Republic of ChinaArticle 13 [Formation and Effectiveness of Insurance Contracts]: When the policyholder makes an insurance claim and the insurer agrees to underwrite, the insurance contract is formed. The insurer shall issue the insurance policy or other insurance certificate to the policyholder in a timely manner. The insurance policy or other insurance certificate shall set forth the contents of the contract agreed upon by both parties. An insurance contract lawfully established shall come into effect upon its establishment.
Article 16 [Obligation of Truthful Disclosure]: When an insurance contract is clearly concluded and the insurer inquires about the subject matter of insurance or the relevant circumstances of the insured, the policyholder shall truthfully disclose. If the policyholder intentionally or due to gross negligence fails to perform the obligation of truthful disclosure, and such failure is sufficient to affect the insurer’s decision on whether to underwrite or increase the insurance premium, the insurer has the right to terminate the contract. The right to terminate the contract shall be extinguished if it is not exercised within 30 days from the date when the insurer becomes aware of the grounds for termination.
After Mr. M provided supplementary information, he made an underwriting agreement of “premium increase and exemption from liability” with the insurance company. Both parties reached an agreement and the contract remained valid. The insurance company waived the 30-day right to terminate the contract. Mr. M’s request for a full policy refund on this ground is invalid.
Risk Warning
Be Honest When Purchasing Insurance:
When taking out insurance, be sure to fill in the health questionnaire item by item truthfully. Don’t take any chances! If the obligation of truthful disclosure is not fully fulfilled due to negligence (such as unintentionally forgetting past medical history), supplementary explanations should be provided to the insurance company immediately. The insurance company will re-make the underwriting conclusion based on the supplementary content (or terminate the contract, or adjust the premium, or clarify the scope of liability exemption).
Sign for Confirmation and Act with Caution:
Insurance consumers need to carefully read the underwriting conclusion, including key information such as the coverage and exemption clauses. Make sure you understand the clear content before signing. Only by being cautious can you protect your own rights and interests.
Long-term Commitment and Keeping Promises:
After the insurance contract takes effect, a long-term contractual relationship is initiated. Insurance consumers should adhere to the principle of good faith and continuously fulfill their obligations, not arbitrarily “go back on their word,” and maintain the stability and effectiveness of their own insurance protection.
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