A dispute has arisen over a million-yuan medical insurance claim with China Life Insurance Company Limited (SSE: 601628, HKEX: 02628), centering on whether the policyholder failed to renew on time due to insufficient notification from the insurer.
The policyholder, Mr. Tian, aged 61 from Changzhou, Jiangsu, purchased multiple insurance policies, including a "Guoshou Ru E Kangyue Million Medical Insurance (Plan A)" in May 2018 through an agent. The policy had an automatic annual renewal feature via bank account deduction. Following regulatory changes in 2021 that prohibited automatic renewal for short-term health insurance, China Life launched a new version of the product requiring manual renewal application.
In May 2022, China Life sent three SMS reminders to Mr. Tian about renewing his policy. Mr. Tian did not respond, leading to a lapse in coverage. In November 2024, Mr. Tian was hospitalized and diagnosed with sigmoid colon malignancy. When he filed a claim, China Life's Changzhou branch denied it, citing the lack of an active policy.
Mr. Tian sued, claiming China Life failed in its pre-contractual duty of care (culpa in contrahendo). He sought compensation for medical expenses totaling 58,291.02 yuan and a fixed hospital allowance of 5,200 yuan. His arguments included that China Life did not adequately notify him of the product change and the shift from automatic to manual renewal, especially given his age and history of automatic payments. He also argued that the SMS reminders were insufficient and could have been missed or filtered.
China Life defended its position, stating it had fulfilled its notification obligations. The company presented evidence, including SMS delivery records and a WeChat link sent by the agent before the policy's expiration, proving Mr. Tian was aware of the need to manually renew. China Life argued that Mr. Tian, having purchased multiple policies electronically, was familiar with the process. The insurer also contended that Mr. Tian had ample time after the lapse to raise concerns but did not do so until after his diagnosis nearly two years later.
A key point of contention was whether an agent had visited Mr. Tian to discuss renewal. China Life presented a handwritten log and witness testimony suggesting a visit occurred where Mr. Tian allegedly declined renewal. Mr. Tian disputed this, claiming the visit and related recording occurred only after his claim was denied and were part of a misleading attempt to gather evidence.
The first-instance court ruled in favor of China Life. It found that based on 2021 SMS records and bank transactions, Mr. Tian was highly likely aware of the manual renewal requirement and had successfully renewed once before. The court determined that China Life's multiple SMS reminders and the agent's WeChat link constituted sufficient notification. As Mr. Tian's illness occurred after the policy lapsed and he failed to renew or raise any objection for nearly three years, his claim for compensation lacked factual and legal basis. The court dismissed his lawsuit.
The appellate court upheld the decision. It found that the transition between the old and new insurance products in 2021 was seamless and did not harm Mr. Tian's rights. The evidence of reminder SMS and the renewal link demonstrated that China Life had fulfilled its duty to inform and notify regarding renewal or product conversion. Therefore, the appellate court agreed that China Life was not liable for pre-contractual fault and correctly dismissed the claims.