Can the insurance refuse to pay for medical treatment during the waiting period of the insurance con

Mondo Social Updated on 2024-02-01

In the retrial case of Guohua Life Insurance v. Niu Insurance, the High Court of the retrial held that the time of diagnosis was later than the waiting period of the contract, and the insurance company should bear the insurance liability.

On October 16, 2018, Niu's husband signed an insurance contract with the applicant to insure the applicant for "Guohua Kangyun Lifetime Critical Illness Insurance Section A", and the insured was Niu.

The insurance contract stipulates: "The waiting period for insurance liability shall be within 180 days from the date of entry into force or final reinstatement of this contract (whichever is later) if the insured suffers from an accidental injury (see 96) Death or suffering from a critical illness as agreed in this contract (see 9.)7) or mild illness (see 9.)8) We do not assume the insurance liability, we refund to you the insurance premium paid in this contract, and this contract is terminated. This period of 180 days is called the waiting period".

On April 9, 2019, a hospital in Wenxi County held a free clinic in Niu's village to conduct a preliminary examination of Niu's body, and on April 11, 2019, a medical laboratory center in Shanxi Province reported that it was a high-grade squamous intraepithelial lesion (HSIL), and a biopsy was recommended.

On May 8, 2019, the "Pathological Diagnosis Report" of a medical laboratory center in Shanxi Province diagnosed that Niu's condition was (cervical) HSL CIN III. On May 13, 2019, Niu was admitted to a hospital and was diagnosed with "cervical intraepithelial neoplasia III".

The High Court held that on May 13, 2019, Niu was admitted to a hospital and was diagnosed with "cervical intraepithelial neoplasia III", and the time for Niu's diagnosis of illness had exceeded the waiting period agreed in the contract. Niu's claim application should be supported.

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