What happens when there is a dispute regarding insurance compensation? In future it may be common for policyholders to get a say. It's already happening.
In the first application of its kind in China, Ant Financial has launched an online group mediation mechanism which gives customers of an insurance company a say in compensation dispute resolution. Ant Financial, a technology company that aims to bring “inclusive financial services to the world”, is an affiliate company of Alibaba Group.
On 29 March, the first case was placed before the system, involving a seven-year-old girl who had contracted leukaemia. More than 5,000 members of Ant Financial's Baby Protection Plan and Trust Mutual Life Insurance formed a mediation panel to vote within 24 hours on whether the insurer should pay out a claim to her family. 76% voted against the compensation.
On 8 February, Beijing-based Trust Mutual Life received a claim for the child who had been diagnosed with leukemia. After reviewing the relevant claim data, the insurer concluded that no compensation was payable because the claim failed to meet requirements under the Baby Protection Plan. The family members of the patient were advised of the decision and asked too whether they would like to apply for a review by the mediation panel.
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The insurer's decision to refuse compensation was based on the fact that the patient was hospitalised on 22 January, complaining of feeling unwell. The doctor issued a report showing that the patient's blood test results were abnormal. The white blood cell count was described as of a “critical” level. The diagnosis was that the patient was suffering from "bronchial pneumonia, hypokalemia, and blood disease". She was discharged from the hospital on 26 January, which was also the day her family bought the insurance plan for her.
In turning to the online mediation panel to argue for compensation from the insurer, the family members of the patient said that she was diagnosed to be suffering from acute leukemia on 8 February, and that when the insurance cover was bought, there was no pre-existing condition.
However, after reviewing the facts, the majority in the mediation group felt that the patient had suffered from a pre-existing condition when the insurance was purchased.
Mr Fang Yong, assistant to the CEO at Ant Financial said that the objective of the online group mediation mechanism is to give consumers a say in the compensation process and to resolve disputes in a transparent and open environment.
At present, the online group mediation mechansim is currently available only for the Baby Protection Plan in a trial of sorts. It will be made available to other types of insurance plans on the Ant Financial insurance platform once the mechanism has been finalised.
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