On January 6,2020, the Hangzhou Intermediate People's Court issued a case of \"cancer risk rejection \". Ms. Wang, who has breast cancer after insuranceing women's health insurance, received a notice of refusal and took the insurance company to court. The court held that the insurance company used the form clause to exclude Ms. Wang's main rights and ruled that it compensated Ms. Wang 100,000 yuan, hospitalization allowance 2000 yuan and corresponding interest.
According to the relevant judgment documents of Hangzhou Xihu District people's Court, in March 2018, Ms. Wang insured her charm female card insurance for herself through an agent in the insurance company, the insurance liability was \"accidental death 200,000, breast cancer 100,000, other gynecological cancer 80,000, female reproductive system malignant tumor hospitalization allowance 100 yuan \/ day, insurance premium 385 yuan, insurance period 1 year \", Ms. Wang paid the insurance premium 385 yuan to the agent through WeChat, the agent confirmed the success of the insurance to Ms. Wang.
In September 2018, Ms. Wang was diagnosed with (right breast) mid-grade intraductal cancer of the mammary gland, and the hospital recommended removing the entire right breast. In october, ms. wang underwent surgery in hospital for a total of 20 days.
After the operation, Ms. Wang applied to the insurance company to settle the claim, however, the insurance company issued a notice of refusal on November 2,2018, thinking that Ms. Wang's suffering from cancer in situ, did not meet the conditions of payment, and refused to pay the insurance premium.
In February 2019, Ms. Wang filed a lawsuit against the insurance company in the West Lake Court. She said she was in her early 40s when she had her breasts removed and that the defendant's refusal to honour her contractual obligations added to her situation.
At the same time, one of the most prominent insurance guarantees is \"breast cancer.\" For the general insured, the difference between\" breast cancer \"and\" carcinoma in situ \"is not clear, and what insurance companies call\" carcinoma in situ \"is not widely accepted in medicine.
The defendant's insurance company replied that cancer in situ is not a real cancer, and Ms. Wang's insurance page clearly defined the scope of insurance liability \"2. breast cancer insurance... the above mentioned breast cancer does not include orthotopic cancer \". Ms. Wang's disease is cancer in situ and is not covered by the insurance liability, so she should not pay the insurance premium.
The court heard that insurance companies did not explain to ms. wang at the time of the insurance policy on what constituted carcinoma in situ, what was the difference between carcinoma in situ and the cancer they had insured, and whether the insured person's disease was a right of interpretation for carcinoma in situ. And the purpose of the insured is to relieve the pressure of the huge medical expenses after the cancer, and the exemption clause is the form clause, which excludes the main rights of Ms. Wang, so the exemption clause is invalid.
After the first instance of the West Lake Court and the second instance of the Hangzhou Intermediate people's Court, the insurance company was finally judged to pay Ms. Wang's insurance premium of 100,000 yuan and the corresponding hospitalization allowance, and to compensate for the loss of interest.