Core Insights - The ongoing disputes regarding "pre-existing conditions" in critical illness insurance are highlighted, with several policyholders being denied claims due to reasons such as "suspected symptoms" or "undiagnosed conditions" [1][2] Group 1: Case Studies - In a case from Guangdong, a policyholder named Li was denied a claim for malignant tumor treatment based on pre-insurance imaging reports suggesting cancer, which the insurance company classified as a pre-existing condition. The court ruled in favor of Li, leading to a full payout of 38,000 yuan and an additional 12,000 yuan as contract termination compensation [1] - Another case from Shanghai involved a policyholder named Yin, who was also denied a claim for lung cancer based on a pre-existing condition clause. The court found that the insurance company failed to clearly define the term "disease" in the pre-existing condition clause, resulting in the insurer bearing the responsibility for the ambiguity [2] Group 2: Legal and Regulatory Insights - The Shanghai Financial Court emphasized that insurance companies must fulfill their obligation to clearly explain and define pre-existing condition clauses to policyholders. This includes actively inquiring about the insured's health status to prevent cases of "illness at the time of application" [3] - Insurers are advised to provide clear definitions for diseases and complications listed in pre-existing condition clauses and must have sufficient evidence to prove that the insured had the specified conditions at the time of application when invoking these clauses to deny claims [3]