Then I will talk about the "Ping An Fu Refusal to Pay" that happened before, and talk to you about what we need to pay attention to when purchasing insurance, so as to effectively avoid refusing to pay!
First, the real case
2065438+March 2009, Ms. Ma insured herself with a "Ping An Fu" whole life insurance in an insurance company, with a premium of 3,645 yuan and an additional critical illness insurance amount of/kloc-0.2 million yuan.
In August of the same year, Ms. Ma was diagnosed as papillary thyroid carcinoma in a large local hospital. During the eight days of hospital treatment, Ms. Ma spent nearly 20,000 yuan. Shortly after leaving the hospital, Ms. Ma applied with an insurance one-way insurance company. However, it is unacceptable that the insurance company did not directly compensate, but made an accommodation and returned the premium of more than 1 000.
After learning that there was no hope of settlement, Ms. Ma took the insurance company to court and demanded that the insurance company compensate1.20 thousand insurance money according to the regulations.
Second, the case analysis
Why did the insurance company pay 1000 when it cost 20,000 yuan in 8 days?
In this regard, insurance claims personnel believe that Ms. Ma had a history of hospitalization before insurance. Generally speaking, people with a medical history belong to the risk group restricted by the insurance company, and when the insurance company called back, Ms. Ma did not explain the matter, which seriously affected the underwriting decision of the insurance company, so the insurance did not claim compensation.
If the insurance company decides not to pay, then must it? In fact, under the further investigation of the court, the staff found that although Ms. Ma did not tell the truth, her concealed hospitalization history was only caused by minor ailments and pains, and it was not related to papillary thyroid cancer. Therefore, the court finally ruled that the insurance company paid Ms. Ma 6.5438+0.2 million insurance money.
Third, the case summary: How to avoid the rejection of critical illness insurance claims?
As can be seen from the above cases, in fact, as long as more attention is paid to the details of critical illness insurance before insurance, it is not difficult to get compensation smoothly!
(1) fulfill the obligation of informing before insurance.
The obligation of telling the truth is a legal obligation that the insured must fulfill according to the insurance law. The insurer has the right to terminate the contract if the applicant fails to fulfill the obligation of telling the truth when applying for insurance, and the undisclosed matters are enough to affect the insurer's decision on whether to agree to underwrite or increase the insurance premium rate.
According to the analysis of relevant statistical data, more than 60% of serious illness insurance disputes are caused by the insured's failure to "tell the truth", so Brother Bao reminds everyone that before applying for insurance, the obligation of health information must be faithfully fulfilled, otherwise even if the insurance is successfully underwritten, the insurance company will definitely refuse to pay compensation.
(2) Buy according to your own needs
Be sure to buy insurance products according to your own needs. Don't listen to online promotions, last week, discounts, etc. Otherwise, you will be waiting to surrender and deduct money.
After determining your own needs, you only need which products can meet your own needs, because there are many types of critical illness insurance, including long-term/short-term, consumption/return, children/adults and so on. Different products contain different guarantees. If it is insured by women, it is necessary to focus on ensuring serious diseases covering women's diseases. Children's critical illness insurance should pay attention to high-risk serious diseases such as childhood leukemia.