Harmonious Health Accused of Repeated "Malicious" Claim Denials for Cancer Patients

Harmonious Health Insurance has once again made headlines due to claim rejections. An insurance lawyer has even revealed to the media that the company exhibits a pattern of "malicious" claim denials, using various vague or far-fetched reasons to delay or refuse payouts.

In recent days, the insurer has been in the news for refusing to honor claims. A lawyer specializing in insurance law disclosed that multiple legitimate claims have been wrongfully denied by Harmonious Health. The company allegedly creates obstacles during the claims process, employing ambiguous or unreasonable justifications to delay or reject payments. Affected customers are forced to resort to lawsuits to protect their rights, sometimes enduring second trials, making the path to justice long and arduous.

While claim denial is a right afforded to insurance companies, with disputes ultimately resolvable through legal channels, "malicious" denial practices are considered particularly egregious. This raises questions about how the company justifies the trust placed in it by consumers.

According to a report, Yu Shuangshuang (a pseudonym) purchased a "Harmonious Health Zhi Xiang Term Critical Illness Insurance" policy from Harmonious Health Insurance Co., Ltd. in 2018. The policy had a sum insured of 100,000 yuan, with coverage lasting until age 70.

For policyholders, insurance contracts represent promises of security, intended to serve as a financial safety net during health crises.

Unfortunately, Yu was diagnosed with thyroid malignant tumor this year and underwent surgery promptly. After her operation, she promptly gathered all necessary documents, including the hospital's diagnostic reports and pathological materials, and formally submitted a claim to Harmonious Health.

Expecting a smooth compensation process, Yu was instead dealt a heavy blow. Rather than receiving the expected payout, she was notified by Harmonious Health that her claim was denied, with the reason cited as "failure to meet compensation conditions."

In addition to this critical illness policy with Harmonious Health, Yu also held another insurance policy underwritten by PING AN. Following her diagnosis, she submitted a claim to PING AN around the same time, which has since been processed and paid successfully.

The stark contrast between the two outcomes—both involving insurance and a diagnosis of malignant tumor—has caused significant frustration for consumers. One policy was paid without issue, while the other was rejected.

Yu argues that while the 2021 revised "Usage Standards for Disease Definitions in Critical Illness Insurance" introduced a tiered compensation system for thyroid cancer based on severity, her policy is an "old critical illness insurance" product. It is governed by the 2007 standards issued by the China Insurance Association and the Chinese Medical Doctor Association, under which thyroid cancer is explicitly defined as a malignant tumor qualifying for immediate payout upon diagnosis.

Li Wenzhong, Deputy Director of the Rural Insurance Research Institute at the Capital University of Economics and Business, commented on the case. He stated that under the 2007 standards applicable when Yu purchased her policy, thyroid cancer clearly falls within the definition of "malignant tumor" and is not listed among any policy exclusions. Therefore, it is almost certain that the insurer should bear the responsibility for paying the claim.

Yu's situation is not isolated. An insurance lawyer revealed that Harmonious Health is currently facing multiple instances of what appears to be malicious denial of standard claims. By creating procedural hurdles and using dubious reasons to delay or refuse payment, the insurer forces customers into litigation. Cases that should rightfully be paid can drag on for over six months, involving lengthy and difficult legal battles for policyholders.

Finding Harmonious Health's denial reason unacceptable, Yu is now preparing documentation and plans to file a lawsuit against the company.

Harmonious Health is one of only seven dedicated health insurance companies in China, having commenced operations in 2006. However, the company has not published annual reports since 2017, with its solvency reports last updated for the first quarter of that year. According to its 2024 Social Responsibility Report, the company achieved original premium income of 641.16 billion yuan, with total assets reaching 4.5205 trillion yuan by the end of 2024.