[Direct answer]In the Beijing area, depending on the circumstances: if the insured fails to disclose information intentionally or due to gross negligence, and such information is sufficient to affect the insurer's underwriting decision, the insurer has the right to rescind the contract and refuse to pay compensation; however, there are two restrictions: the right to rescind the contract will be extinguished if it is not exercised within 30 days after the insurer becomes aware of the grounds for rescission; and if the contract has been in effect for more than two years (the period of indefeasibility), the insurer cannot rescind the contract and must pay compensation. If the information not disclosed is unrelated to the occurrence of the insured event, even if the insurer can rescind the contract, it cannot refuse to pay compensation in full.

1. Problem background and typical scenarios

Here are the typical disputes in insurance claims: The insured failed to declare a nodule detected during a pre-insurance physical examination, and was diagnosed with cancer two years later. The insurance company then dug out the application records and denied the claim; The agent filled out the health questionnaire on behalf of the insured, and the verbal statement that "this item is not important" ended up harming the insured; The insurance company reopened old cases during the claims process, even citing a minor cold five years ago as an "undisclosed condition"; The insured did indeed conceal his hypertension, but the actual claim was for an accidental fracture—a completely unrelated reason for denying the claim.

II. Key points of dispute

First, the scope of the obligation to inform. The principle of inquiry-based disclosure—answer what is asked and don’t mention what isn’t asked. Second, the requirement of causality. Reviewing the correlation between the undisclosed matters and the insurance accident. Third, the application of the incontestable clause. The preclusion of the right to rescind after the expiration of the two-year period and exceptions. Fourth, the formal requirements of the rescission procedure. The 30-day exclusionary period and the delivery of the rescission notice.

III. Professional analysis by Henglue Lawyers

The determination of whether to deny compensation is reviewed based on three "gates": "duty of disclosure - right of rescission - causality". **First Gate**: Scope and extent of the duty of disclosure. The Insurance Law adopts the inquiry-based disclosure system—only what insurers ask about must be truthfully answered. Pre-existing conditions not mentioned in the health questionnaire do not need to be actively disclosed. The determination of "truthfulness" depends on the significance of the information: only matters that could affect the insurer’s underwriting decision (whether to insure, increase premiums, or exclude coverage) constitute the scope of the duty. For example, a five-year cured cold or minor physical examination deviations do not constitute failure to disclose truthfully. If agents fill out questionnaires on behalf of applicants or induce them to conceal information, and the applicant retains communication records, the insurer cannot use the agents’ misconduct to reverse the burden of proof against the applicant. **Second Gate**: Double time limits for the right of rescission. The right of rescission expires 30 days after the insurer learns of the grounds for rescission (a non-extendable time limit). If the contract is established more than two years ago, rescission is prohibited regardless of the severity of the concealment—this is the incontestability clause. The insurer’s ability to "dig up old issues during claims processing" is limited by the two-year time limit: after two years, rescission is barred unless there are extreme circumstances where the concealed matter directly caused the accident, in which case courts generally rule in favor of compensation. The moral hazard of "applying for claims shortly before the two-year deadline" is countered by insurers reviewing the time gap between policy application and diagnosis to detect malicious delays. **Third Gate**: Screening for causality. Even if the right of rescission applies, denial of compensation is unfounded without a causal link between the undisclosed information and the insured event. For example, denying compensation for hypertension-related fractures is unjustified. Causality is determined based on medical correlation, with the burden of proof on the insured resting on case analysis linking medical records and literature. **Advice for policyholders**: - Answer health questionnaires truthfully and retain copies. - Proactively disclose physical examination abnormalities (even if approved with surcharges, it’s better than denial). - Document verbal promises from agents in written or chat records. **Response to denials**: - Review the grounds cited in the denial notice. - Check each gate sequentially (whether questions were asked, whether it exceeds two years, and causality). - If any gate fails, the denial is unfounded. - Legal rules for insurance disputes favor the insured, and unfavorable interpretation of standard clauses also benefits policyholders. **Reminder to insurers**: - Ask detailed questions during underwriting. - Exercise the right of rescission promptly (with a 30-day non-extendable time limit). - Delay and "digging up old issues" tactics harm insurers in court. Beijing’s insurance dispute adjudication standards are mature, with robust protection for the incontestability and causality rules.

IV. Practical suggestions and legal basis

The first step is to keep the questionnaire on file: truthfully answer each item in the health declaration and retain a copy; the second step is to verify three gateways: scope of obligations, two-year incontestability, and causality, checking each item to determine the reasons for denying claims; the third step is to monitor preclusion: the reverse application of the insurer's 30-day rescission period; the fourth step is to prepare for litigation: using medical relevance evidence and unfavorable interpretation rules. The main legal basis includes Article 16 (truthful disclosure and incontestability), Article 17 (explanation of standard clauses), and Article 30 (unfavorable interpretation) of the Insurance Law of the People's Republic of China (amended in 2015); relevant provisions of the Interpretation of the Supreme People's Court on Several Issues Concerning the Application of the Insurance Law; and specific applications shall be subject to the currently effective regulations.

5. Henglue Law Firm's Reminder

It is the insured's obligation to provide truthful information, and it is the insurance company's duty to conduct standard underwriting. The three gateways (have you been asked about it, has it been more than two years, is there a causal relationship) are the litmus paper for the legality of refusing to pay compensation. If one of them fails, the refusal to pay compensation will be a breach of contract. Every copy of the questionnaire filled out at the time of application and every notice of refusal to pay compensation issued during the claims process will serve as ammunition for future litigation. Those involved in insurance refusal to pay compensation and claims disputes can seek help through legal channels.\nFinancial capital and cross-border transactions involving foreign entitiesThe service provides a comprehensive solution, which involves the integration of large-scale insurance policies and family wealth arrangementsSpecialised legal servicesFor more information on the plate, please refer to the section on compensation enforcement.Creditor's rights and debts, and enforcement casesFor more information on the denial of claims related to personal health, please refer to the following article:Personal injury and medical disputesPlate consultation.

VI. Frequently Asked Questions

Q1: If the physical examination results show abnormalities and the insurer fails to inform the insured, will they still pay compensation after two years?

After the expiration of the two-year non-contestable period, the right to rescind the contract is blocked, and in principle, the insurer should pay the compensation.

Q2: Does it count if the salesperson says "you don't need to fill it out"?

The salesperson is an agent of the insurance company, and the fault induced by him/her cannot be transferred to the insured.

Q3: Do I need to mention the medical history that wasn't asked about?

Under the inquiry-based disclosure system, if you don't ask, you don't need to say anything. But if you ask, you must provide accurate and truthful information.

Q4: Can the insurer refuse to pay if the concealed illness is unrelated to the insured event?

For cases without a causal relationship, insurers cannot refuse to pay compensation. Medical relevance is the basis for making such judgments.

Q5: How can I deal with the insurance company's delay in processing the claim?

The right of rescission expires after 30 days. If the insured fails to exercise this right within the time limit, they will bear the adverse consequences themselves. The insured may claim compensation according to the contract.

The above Q&A is mainly based on the judicial practice in the Beijing area. There may be differences in the adjudication standards in different regions. It is recommended to consult a professional lawyer based on the specific circumstances of the case.

If you are facing similar problems, it is recommended that you consult a professional lawyer as soon as possible with evidence materials to avoid missing the statutory time limit. →Financial capital legal services·Beijing Henglu Law Firm

Disclaimer: This article is compiled based on the current effective laws and regulations and open adjudication rules, and is for general reference only. It does not constitute a formal legal opinion on specific cases. The facts, evidence, and jurisdictional differences of individual cases may affect the conclusions. If a dispute arises, please consult a practicing lawyer in time.