In fact, every time I see such remarks, Bao Yujun is very sad. The development of insurance needs rules, and the operation of insurance companies needs articles of association. The reason why there are claims disputes is that many people lack understanding of insurance, thus entering a misunderstanding. So today, Baoyu Jun will talk about those things that settle disputes:
Insurance claim procedure
Factors that easily lead to claims disputes
Matters needing attention in claim settlement
I. Insurance claim settlement procedures
Insurance is purchased to get compensation for losses in the event of a risk accident. Even if there are all kinds of troubles when insuring, as long as the claims can be settled smoothly, everything is worth it. However, in insurance, the most difficult problem is to settle claims.
Let's look at the claim process first:
Normal claim process:
Report the case: the relevant personnel report the case and submit all kinds of information according to the requirements of the insurance company. Claim: the claim meets the standard, the claim is normal, and the payment is made within the specified working day.
In case of claim dispute:
Reporting: The relevant personnel report the case and submit all kinds of information according to the requirements of the insurance company. Preliminary examination: if the preliminary examination is unqualified, it will be transferred to the negotiation procedure. Negotiation: there will be special negotiators to communicate with the insured, and the content of communication is to discuss whether and how to compensate according to the results of the preliminary examination. If the two sides can't reach an agreement, they will enter the investigation procedure. Investigation: The insurance company entrusts a third party to conduct an investigation and communicate with the insured again according to the investigation results. If no agreement can be reached, then the follow-up can be resolved through legal procedures.
Many people have misunderstandings about insurance companies, thinking that insurance companies will try their best to refuse compensation. In fact, claims settlement is the source of reputation of insurance companies. As long as it meets the claim standard, the insurance company has no reason to refuse to pay compensation.
Second, the factors that easily lead to claims disputes
1, the difference between common understanding and standard definition
For some definitions of accidents, there will be some differences between our general understanding and the definition of accidents in insurance, and these differences will easily lead to claims disputes.
Like sudden death. We usually understand that sudden death is an accident. However, from a medical point of view, sudden death, also known as "sudden illness death", is a heart disease factor. Accident insurance claims are prone to disputes.
Such as carcinoma in situ. Literally, there is the word "cancer" in it, which naturally belongs to the scope of serious illness claims. But strictly speaking, cancer in situ is not a real cancer at all, it is only a mild disease, and the treatment scheme is relatively simple and the treatment cost is not expensive. Therefore, some critical illness insurance excludes cancer in situ from claims for critical illness, and some critical illness insurance includes it in the protection clause of minor illness.
2. Failing to tell the truth about health.
There are usually two situations when you don't tell the truth, one is intentional concealment, and the other is negligent concealment. In addition to deliberately concealing, sometimes unqualified insurance agents will make false sales to make the insured fill out all the forms, which leads the insured to conceal the health status of the insured in unknown so, leading to claims disputes when they are out of danger.
Bao Yujun is also very angry about this misleading sales. Their irresponsibility makes consumers bear the losses that they should not bear, and makes insurance lose the meaning of protection.
3. The product does not meet the demand.
There are many kinds of insurance products, and the same type of insurance products may be very different. When buying insurance, the insured must carefully study the insurance protection clauses and don't buy products that are not suitable for them.
For example, I originally wanted to buy accident insurance, but I bought an insurance product with accident traffic coverage 1 10,000 and comprehensive accident coverage 1 10,000. This product is also accident insurance. It seems that the insurance coverage is quite high, but because the comprehensive accident protection is too low and the protection is not perfect, the available premium for accidents other than traffic is very low. If you don't pay attention to this when buying, it is easy to have disputes when making claims.
4. Lack of understanding of terminology.
If you rely too much on insurance agents and don't read the insurance clauses carefully, you will easily be led by the nose. Inadequate understanding of the terms will become an obstacle to claims.
In the insurance clauses, besides the content of protection, we also need to pay attention to exemption and other issues. Once the insurance policy comes into effect, it has legal effect. What has been written in the exemption clause, whether you know it or not, cannot be the reason for violating the insurance contract.
There are also accidents during the waiting period. The insurance company's refusal to pay compensation is legal and reasonable, but it is indeed a huge loss to consumers.
Third, matters needing attention in claim settlement
In addition, what other points need more attention when making claims?
1, report the case in time.
Be sure to report the case in time, and the insurance company will record the accident and identify the responsibility. Once the responsibility is successfully determined, the claim will be settled quickly. The longer it takes, the more troublesome it is to identify the accident. If the responsibility is unclear because of too long, it may affect the claim settlement.
This kind of dispute settlement is very unnecessary. Therefore, it is necessary to report the case as soon as possible to facilitate the identification of responsibility.
2. Claim materials
When preparing the claim materials, you must follow the requirements of the insurance company and don't take it for granted. Each insurance company has its own perfect claim settlement process, and has its own rules and regulations on what information is needed for liability identification and how to identify the information.
When we apply for claims, we only need to make preparations according to the needs of insurance companies, and we must not cut corners. The lack of information will make it difficult to make claims, which we don't want to see.
3. Protect your legitimate rights and interests.
If you have prepared enough information according to the requirements of the insurance company, and the accident is within the scope of protection, but the insurance company still refuses to pay the claim, you must safeguard your rights and interests through legal channels. Negotiate with insurance companies, complain to the CIRC, and even file a lawsuit when necessary. The law does not favor anyone or organization, it protects the legitimate rights and interests of every citizen.
Bao Yujun has something to say: the development of the insurance industry has a process and the system is constantly improving. Compared with the history of HK insurance industry 150 years, the development of Chinese mainland insurance industry is only 30 years.
However, in the development of these years, the distance between insurance companies and consumers is gradually narrowing. When both sides know each other well enough, many insurance disputes will be solved.
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