However, the insurance supervision and administration institution is only responsible for punishing the insurance company's refusal to perform the obligation of compensation or payment of insurance benefits stipulated in the insurance contract according to law, regardless of whether the insurance company can refuse compensation and the specific amount of compensation. If the insurance beneficiary disagrees with the insurance company's refusal to pay compensation and the amount of insurance compensation, he can only bring a lawsuit to the people's court, and the people's court will make a ruling.
After the occurrence of an insured accident, when the applicant, the insured or the beneficiary requests the insurer to compensate or pay the insurance money according to the insurance contract, they shall provide the insurer with the certificates and materials that they can provide to confirm the nature, causes and loss degree of the insured accident. According to the contract, if the insurer thinks that the relevant certificates and materials are incomplete, it shall promptly notify the applicant, the insured or the beneficiary to supplement them. The insurer shall, after receiving the request of the insured or beneficiary for compensation or payment of insurance benefits, give it timely approval; If the situation is complicated, it shall be approved within 30 days, unless otherwise agreed in the contract. The insurer shall notify the insured or beneficiary of the verification result; For the insured, the obligation to compensate or pay insurance money shall be fulfilled within ten days after reaching an agreement with the insured or beneficiary. If the insurance contract stipulates the time limit for compensation or payment of insurance benefits, the insurer shall perform the obligation of compensation or payment of insurance benefits as agreed. If the insurer fails to fulfill the obligations stipulated in the preceding paragraph in time, it shall compensate the insured or beneficiary for the losses incurred therefrom in addition to paying the insurance money. Upon verification, the insurer shall, within three days from the date of verification, issue a notice of refusal to pay compensation or insurance benefits to the insured or beneficiary, and explain the reasons. If the insurer cannot determine the amount of compensation or payment of insurance benefits within 60 days from the date of receiving the request for compensation or payment of insurance benefits and relevant certificates and materials, it shall pay the amount that can be determined according to the existing certificates and materials in advance; After the insurer finally determines the amount of compensation or insurance payment, it shall pay the corresponding difference. As can be seen from the above provisions, the time for the insurance company to determine whether to settle claims and the specific amount of claims shall first be subject to the contract agreement. If there is no agreement in the contract, the time stipulated in the insurance law shall prevail.
If the insurance company delays the payment, the parties concerned may complain to the CIRC, and in addition, they may also file a lawsuit with the people's court for compensation.