Case summary

The plaintiff surnamed Yan joined a program for severe illnesses on a mutual-funding platform in 2016 with a maximum medical coverage of 300,000 yuan ($44,940). The platform began deducting membership fees as soon as she joined. In 2019, Yan was diagnosed with cancer and had surgery in hospital. Afterwards, she applied to the platform to cash the medical coverage, but it was turned down by the platform, which claimed she didn't qualify under the revised coverage standards for a cash out. Yan then sued the platform at the Beijing Internet Court (BIC). 

The defendant argued that its requirements, which were revised in 2018, said anyone who joined the program should be healthy and specifications of health were provided in the new provisions. High blood pressure was on the list of conditions that disqualified a person for coverage. Yan had had high blood pressure for six years which disqualified her from the program. An independent assessment institute also gave an opinion of disqualification. 

Focuses of the dispute:

1. Which standard should be used to determine whether Yan qualified for membership?

2. Did Yan qualify for membership under that standard? 

After trial, the BIC concluded that:

Yan registered with the platform as a member and joined the mutual-funding program for severe illnesses. The contract was valid and the parties shall enjoy the rights and interests as well as fulfill the obligations as stipulated in the contract.

1. When Yan joined the platform in October 2016, the platform's rules at that time (the 2016 version) did not specify that high blood pressure disqualified her for coverage. The 2018 version of the rules added more details which impacted old members' rights and interests. But the platform did not provide channels of reconfirmation or plans to solve the problem for historical members. Therefore, the evaluation standards for membership qualification should be those when the members joined the platform, instead of the revised ones.

2. The 2016 version of the rules did not specify that high blood pressure disqualified a person for membership. Those disqualifying conditions were diseases much worse than high blood pressure at that time. Yan therefore regarded herself as qualified for membership, which should be supported. 

Details of the judgement:

The BIC's judgement of first instance rendered the mutual-funding platform to start a mutual-funding campaign for Yan and give the raised 300,000 yuan to Yan. The platform appealed, but the appellate court upheld the original judgement. The verdict is now in force. 

Tips from the judge:

When online platforms plan to revise their regulations, they need to fully consider the impact brought by the changes and develop solutions in advance. Unless otherwise agreed, members are governed by the rules in effect when they joined a platform. A change of rules should not hurt the legitimate rights and interests of historical members.

Online mutual assistance platforms should improve their rule reviews on applications as well as dispute resolution procedures so that the decision-making power on major issues related to the vital interests of members can be truly exercised by members themselves and online mutual-funding platforms can really be a supplement to the social security system.

This article is transferred from Beijing Internet Court, and I would like to thank you.