At the end of each month, we regularly share a notable insurance claim case that left a deep impression.
This edition focuses on a client who purchased a critical illness insurance policy with a coverage of 700,000 RMB for their child. Unfortunately, the child was later diagnosed with leukemia, resulting in a payout of 2.1 million RMB. First, let’s review the claim summary: Next, we’ll delve into the detailed claim process. 1. From Denial to Full Payout of 2.1 Million for Leukemia Diagnosis Ms. Z (pseudonym) had strong insurance awareness. As early as 2021, she purchased the “Dahuangfeng No. 5” children’s critical illness insurance for her child, Little L, through our platform. Unexpectedly, in early June this year, Little L was diagnosed with leukemia. The critical illness insurance purchased earlier proved invaluable at this critical moment. Ms. Z immediately contacted our claim experts for assistance. (Communication records between Ms. Z and Shenlanbao’s claim experts) After preliminary assessment, the claim experts confirmed that Little L’s condition met the critical illness criteria. They promptly advised Ms. Z to prepare relevant medical records, test reports, and other documents to submit the claim application. Shortly after submission, Ms. Z received a denial notice from the insurance company: The insurer claimed that Ms. Z had failed to disclose Little L’s fever and abnormal blood test results during the application process. They proposed a settlement of 100,000 RMB less than the full amount. Ms. Z was deeply confused. Since her child’s condition clearly met the policy’s critical illness terms, why should the payout be reduced for such minor issues? She immediately sought intervention from our claim experts. The experts reviewed the submitted documents and policy terms, identifying four key appeal points: First, Little L’s medical history indicated a diagnosis of tonsillitis, an upper respiratory infection, which had been disclosed during the application process, and the policy was issued without exclusions. Second, the fever, blood test, and tonsillitis were part of the same medical visit, and the final diagnosis of tonsillitis had been disclosed. There was no misrepresentation. Third, the insurer provided no evidence linking Little L’s leukemia to the pre-existing fever. Fourth, Little L’s child health manual was also reviewed and confirmed by the insurer during underwriting. These points proved Little L met the health requirements and was entitled to the full payout. Our claim experts assisted Ms. Z in appealing through multiple channels. After a case review, the insurer agreed to the full payout of 2.1 million RMB.For our clients who have purchased insurance through us, please remember that if you encounter any issues during the claims process, you can contact us immediately. A dedicated claims specialist will assist you with your claim.
To reach our claims experts, first follow the WeChat official account “Shenlan Bao Zhuanxin Insurance Broker,” then follow the steps below. 2. What lessons can be learned from this claims case? Many may wonder: Didn’t Child L’s critical illness insurance have a coverage of 700,000 RMB? Why was the payout as high as 2.1 million RMB? This is largely due to the type of product purchased. Below, we’ll analyze Child L’s claims case to highlight key considerations when purchasing critical illness insurance for children. 1. Two key points to consider when buying critical illness insurance for children: First, prioritize purchasing a children-specific version of critical illness insurance. Such policies offer more targeted coverage, typically including protections for childhood-specific diseases, rare illnesses, and genetic conditions. If diagnosed, additional payouts are provided, and the premiums are relatively more affordable. In Child L’s case, the substantial payout was primarily because he had a children-specific critical illness policy. This product offers an additional 50% of the sum insured if a critical illness is diagnosed within the first 30 years of coverage. The base coverage also includes an extra 150% payout for specific childhood diseases, such as leukemia, which was covered under the policy. As a result, he received a total payout of 2.1 million RMB. Second, prioritize higher coverage amounts for children’s critical illness insurance. If the budget allows, aim for a minimum coverage of 300,000 RMB or use additional payout riders to increase the coverage. For those with more flexibility in their budget, adding supplementary protections can enhance coverage comprehensiveness. For example, adding a premium waiver for the policyholder is highly recommended. In the event of the policyholder’s unforeseen circumstances, subsequent premiums for the policy will be waived without affecting the child’s coverage. Note that the policyholder must meet the product’s health requirements to add this rider. Another valuable addition is multiple critical illness payouts. After a critical illness diagnosis, it’s often difficult to secure other insurance products. This rider ensures continued coverage in case of relapse or diagnosis of another critical illness. Child L’s policy included this rider, so his coverage remains effective even after this claim. Additionally, consider pairing critical illness insurance with a million-yuan medical insurance policy for higher reimbursement limits and more affordable premiums. This combination effectively mitigates the financial risks associated with major illnesses. If you’re unsure which products are best suited for your child, click the card at the end of this article to schedule a consultation with a professional advisor for a customized protection plan.Health disclosure is a topic that cannot be overstated.
Many policyholders tend to overlook minor illnesses or discomforts when completing health disclosures, assuming they are insignificant and do not require mention. However, common conditions like frequent colds or fevers in children often necessitate medical tests, such as blood work, during visits to the doctor. Sometimes, these test results may show abnormalities, which are also subject to health disclosure inquiries. (Refer to Darwin 10 Health Disclosure.) Therefore, if the health disclosure form asks about any abnormal test records, it is crucial to provide accurate information to avoid disputes during the claims process. In conclusion, reviewing these claim cases evokes complex emotions, as each payout represents a family’s hardship. Fortunately, these funds ultimately help families overcome their challenges. We sincerely hope everyone remains healthy and safe, never needing to rely on insurance.
