"Family History of Tumors" Considered a "Genetic Disease"? Court Clarifies Through Case Law

Is cancer a genetically inheritable disease?
What are the differences between an insurance agent and an insurance broker?
How is the scope of the policyholder’s duty of truthful disclosure determined?

On the eve of the “3.15” International Consumer Rights Day, Beijing Financial Court held a public hearing at the Financial Street Circuit Court on an appeal case involving a health insurance contract dispute, and delivered a verdict in court. This case highlights the “small detail” of the policyholder’s duty of truthful disclosure in insurance law, reflecting the “big issue” of protecting financial consumer rights.

The case originated from a claim dispute caused by the failure to disclose a “family cancer history.” In August 2022, Ms. Huang purchased critical illness insurance from a certain insurance company with a coverage of 500,000 yuan, agreeing that if diagnosed with a serious illness, future premiums would be waived. In January 2025, Ms. Huang was diagnosed with lung adenocarcinoma, but when she applied for a claim, her request was denied.

Subsequently, Ms. Huang sued the insurance company to the Beijing Chaoyang District People’s Court.

The dispute at trial centered on whether the policyholder’s failure to disclose family medical history constituted “deliberate concealment.” In the first instance, the insurance company argued that Ms. Huang knew that her mother and grandmother had breast cancer, ovarian cancer, and lung cancer, which posed a significant hereditary cancer risk, but did not disclose this information when applying for insurance, indicating intentional concealment, and thus refused to pay.

However, the first-instance court held that Ms. Huang did not violate her duty of truthful disclosure, ruling that she should be paid 500,000 yuan in insurance benefits, refunded 6,454 yuan in premiums, and be exempted from future premiums, with the insurance contract remaining valid. The insurance company was dissatisfied and appealed to the Beijing Financial Court.

The second-instance hearing further clarified the scope of “truthful disclosure.” During the investigation, the panel examined four key issues: whether the insurance company’s questions about “family cancer history” constituted effective inquiry; whether the sales personnel involved were insurance agents or insurance brokers; whether Ms. Huang’s failure to disclose violated her duty of truthful disclosure; and whether the insurance company’s denial of claim and contract termination were lawful and justified.

After review, the Beijing Financial Court held that the scope of the duty of truthful disclosure should be limited to the “explicit questions” asked by the insurance company. According to the Insurance Law and relevant judicial interpretations, the policyholder’s obligation is only to disclose matters in response to the insurer’s inquiries.

In this case, the electronic application asked about “hereditary diseases,” and based on contract interpretation and medical knowledge, “family cancer history” cannot be directly equated with “hereditary disease.” Therefore, it cannot be deemed that the insurance company conducted an explicit and effective inquiry about “family cancer history.”

Additionally, the legal status of the sales personnel and the legal consequences of their inquiries became another key point. The court found that the sales personnel who contacted Ms. Huang were insurance brokers, not agents of the insurance company. Although insurance brokers are broadly considered insurance sales personnel, their inquiries do not directly equate to those made by the insurance company.

More importantly, Ms. Huang had already disclosed her relatives’ cancer history to the sales personnel at the time of application, and the sales personnel did not further inquire or refuse coverage based on this information. Therefore, the court concluded that Ms. Huang had fulfilled her disclosure obligations, and her disclosures should be attributed to the insurance company.

Based on these legal findings, the Beijing Financial Court issued a final judgment in court.

The court held that Ms. Huang was diagnosed with a critical illness during the policy period, and she did not violate her duty of truthful disclosure. The insurance company had no right to terminate the contract. Since the “two-year non-pleading” clause applied in this case, the insurance contract remains valid. Therefore, the first-instance judgment requiring the insurance company to pay 500,000 yuan and refund premiums was supported by sufficient facts and law.

The Beijing Financial Court announced in court: the appeal was dismissed, and the original judgment was upheld. This is a final and binding judgment.

Source: Beijing Daily Client