Insurance: How to answer the health notice?

The data shows that more than 80% of claims disputes are caused by "health notification". To do a good job in health notification, we must keep in mind two principles:

1. maximum honesty: that is, you must answer truthfully.

Article 16 of the Insurance Law stipulates that when an insurance contract is concluded, if the insurer makes an inquiry about the subject matter insured or the insured, the applicant shall truthfully inform him.

What are the consequences of ignoring health advice?

Article 16 of the Insurance Law also stipulates that the insurer has the right to terminate the contract if the insured fails to fulfill the obligation of truthful disclosure stipulated in the preceding paragraph intentionally or due to gross negligence, which is enough to affect the insurer's decision on whether to agree to underwrite or increase the insurance premium rate.

2. Limited notice: it means answering questions and not answering questions.

At present, China's mainland implements a limited disclosure obligation, that is, the insured only needs to inform when the insurance company makes an inquiry, and the scope of notification is limited to the contents of the inquiry. As for matters other than inquiry, there is no need to inform even if there are problems.

In addition, there are some details that need special attention:

1. Most of the medical history asked by health notification has a time range.

For example, have you been hospitalized, operated or taken medicine continuously for more than 30 days due to abnormal health in the last two years, or have you been advised by a doctor to be hospitalized or operated?

If you have a relevant medical history within the time limit, you need to be informed. Suppose you were hospitalized three years ago, needless to say. If you have been taking medicine for 28 days instead of 30 days, you don't need to tell.

Another example: Do you have the following symptoms, diseases or surgical history at present or in the past? As long as diseases and symptoms are involved, whether it is 10 years ago, 20 years ago or 30 years ago, you need to be informed.

Ask too general questions, don't answer what you don't know.

Judicial Interpretation of Insurance Law (II) Article 6 stipulates that the people's court shall not support the insurer's request to terminate the contract on the grounds that the applicant has violated the obligation of truthful disclosure. However, unless the general terms and conditions have specific contents.

3. The medical records and medical reports shall prevail.

Insurance medicine and clinical medicine are not the same thing, and should be based on medical records and physical examination reports, and cannot be judged by themselves. Insurance medicine focuses on the evaluation and prediction of the morbidity and mortality of the insured population, focusing on the probability of future risks; Clinical medicine focuses on the prevention, diagnosis and treatment of diseases, emphasizing the relatively short-term survival rate.