Beijing Financial Court has overturned an original ruling in a case involving a 6-year-old boy, ordering an insurance company to pay 400,000 yuan ($59,100) for treatment of his critical illness.

The child, surnamed Li, was diagnosed in 2023 with a potentially life-threatening metabolic disorder. However, when his guardians attempted to use a critical illness insurance policy purchased in February 2018 to cover the treatment costs, the claim was denied.

The family subsequently sued the insurance company. After losing the initial trial, they appealed to the Beijing Financial Court.

During the proceedings, the insurer argued that the illness required six months of continuous chelation therapy. Based on the child's medical records, the treatment had involved only zinc-containing medication, indicating a mild or early-stage condition rather than a severe illness covered by the policy.

To determine the child's condition and treatment, Li Li, the presiding judge at the court, visited Beijing Children's Hospital and learned from the boy's attending physician that there is no one-size-fits-all treatment for the disease.

The judge cited the doctor's explanation that, depending on the patient's condition, either oral zinc supplements or chelation therapy could be used. The doctor added that zinc supplements were chosen because of the side effects associated with chelation therapy, not because zinc is suitable only for mild cases and chelation therapy for severe ones.

Based on that information, the court ruled in favor of the child, ordering the insurance company to pay 400,000 yuan in compensation. The court also waived future premiums under the insurance contract and refunded more than 7,000 yuan in premiums already paid.

The judge said that by making a specific treatment path a prerequisite for compensation, the insurance company had effectively deprived the insured and his doctor of the right to choose the most appropriate and safest treatment based on the medical condition.

"The fundamental purpose of critical illness insurance is to provide financial protection and risk-sharing for the insured in the event of a major illness," she emphasized. "By rigidly linking compensation to a specific treatment plan and ignoring the severity of the disease and the diagnosis, the insurance company deviated from the core protective essence of the insurance product."

"The ruling aims to guide insurance products to respect medical principles, thereby promoting fairness, integrity and the long-term healthy development of the insurance industry," she added.