Many people think that insurance is deceptive and insist on not buying insurance. Insurance has always had a bad reputation. Digging into the reason, this is inseparable from claims.
Insurance claims are difficult, who should be responsible? Insurance company, agent or policyholder? Claim settlement is a matter for both parties, and the difficulty in claim settlement is not caused unilaterally.
As the insured, we should get rid of the prejudice against insurance and look at the requirements in claims calmly. At the same time, in order to defend our own interests, we should invest more energy in insurance. Pay attention to insurance, learn insurance knowledge, enhance legal awareness, don't violate the rules when applying for insurance, prepare claim materials according to the claim process after the accident, and clearly understand these things before and after the claim.
Some excellent insurance companies have begun to improve their claims service and rebuild consumers' confidence by establishing an efficient and smooth claims system. This is the hope of the insured.
Is it really difficult to make insurance claims?
There are not many insurance claims disputes in newspapers, and the amount involved is a drop in the bucket compared with the annual claims expenditure of more than 200 billion yuan (the statistics of the China Insurance Regulatory Commission in 2007). But why do many consumers have a deep-rooted impression that insurance claims are difficult?
There are many reasons why insurance claims are difficult.
Many consumers can't make up their minds to buy insurance because they are worried about the trouble of claiming compensation afterwards, or even get no compensation; Even if you buy insurance, you will worry about whether you will get into trouble in the future. Insurance claims have almost become the biggest obstacle for the public to choose commercial insurance.
Insurance companies are to blame.
As the saying goes, there is no smoke without fire. In the actual claims of insurance companies, there is an objective phenomenon of regretting the payment. Unwilling to pay compensation is a phenomenon, and it is also a kind of mentality when insurance companies claim compensation. When the operating pressure of the insurance company reaches a certain level, or the insurance company needs to obtain more profits, it will control the compensation to a certain extent, which is generally manifested as delaying compensation, underpaying compensation and refusing compensation. Of course, this is related to the fact that insurance companies encounter about 10% ~ 30% of fraudulent claims every year, and it is also related to being cautious about insurance claims.
As a profit-making organization, it is normal for insurance companies to pursue profit maximization. However, if there is a motive to reduce the claim cost at the expense of the insured in business, it can only be because of a small loss, or even the loss outweighs the gain. Good market reputation is extremely important for the business development of insurance companies. It is very difficult and slow to build a good reputation, but it is easy to destroy it.
Many insurance companies are aware of the seriousness of this problem. In addition, with the strengthening of supervision, the cost of rights protection for policyholders has decreased. Now, the situation of deliberately making things difficult for the insured has been greatly reduced. However, there are many branches of insurance companies, the quality of employees is uneven, and there are profit assessment requirements within insurance companies. It is unlikely that such cases will be completely eliminated.
Statistics show that when a company provides services to the insured, if the insured feels good, it will tell 10 people about its experience; If the insured feels bad, he will tell his experience to 50 people. The so-called "good things don't go out, bad things spread thousands of miles." Therefore, even if the attitude of insurance companies on the issue of claims has been put right now, it will take some time to eliminate the bad influence caused by the previous reluctance to pay compensation.
Some agents are of poor quality.
Some insurance agents have low professional ethics or lack of professional knowledge, which is also a major reason why consumers find insurance claims difficult.
False propaganda, intentional or unintentional misleading, irregularities in the insurance process, such as exaggerating the scope of protection and the amount of claims, signing on behalf of the insured, encouraging the insured not to tell the truth about the existing diseases, exaggerating income, etc. It has laid a hidden danger for the insured's future claims. Some policyholders believe the salesman's propaganda and think that they have bought a "universal" insurance. When the insurance accident happened, they hoped to get insurance money from the insurance company, but found themselves cheated. At that time, disappointment and anger will be inevitable, and it is easy to vent an agent's bad behavior to the whole insurance industry, thus amplifying the difficulty of insurance claims.
There are also insurance agents, although consumers have no illegal behavior when they apply for insurance, but their awareness of after-sales service is very indifferent; Or find that the insured has lost the ability to add insurance and referral, the service will be greatly reduced. When claims occur, let the insured prepare their own information and apply to the insurance company for claims. Many policyholders are not professionals, and there is little research on claims settlement. Often because the information prepared is incomplete or does not meet the requirements of insurance companies, they have to run back and forth several times to get things done. Even if there is no objection to the claim amount in the end, the successful claim amount will still send out the feeling that insurance claims are difficult.
If the policy salesman has left the insurance company, the policy becomes an "orphan list", which is also prone to the above phenomenon. As we all know, the working hours of most insurance agents are very short, and the turnover rate in insurance companies is higher than that in other industries.
The fault of the insured himself.
The fault of some policyholders, insured and beneficiaries is also a major cause of settlement disputes.
Common mistakes include not telling the truth when insuring and concealing medical history to insure against diseases; I don't know the specific insurance liability, for example, I didn't read the terms carefully when I applied for insurance, or sometimes even if the agent made it clear at that time, I couldn't remember it clearly or misremembered it after a long time. Subconsciously, I naturally hope that the more insurance, the better; Sign on behalf of the insured; Trigger exemption clauses, such as drunk driving or driving without a license, etc.
One of the most common mistakes is that you are afraid that the insurance company will increase the cost or refuse insurance, and you will not tell the health status truthfully when you apply for insurance. You are lucky and hope that you can escape the investigation of the insurance company even if an insurance accident occurs. Results The medical history was exposed when the claim was made, and the insurance company refused to pay compensation. These faults are related to many policyholders' insufficient attention to insurance, lack of insurance knowledge and indifference to legal awareness.
Public opinion orientation adds fuel to the fire.
The reasons why insurance claims are difficult to impress also involve media propaganda and public opinion guidance.
A very simple truth is that if it is a case of normal claims settlement by an insurance company, newspapers and television will generally not report it, because there is no news at all, "it can't catch the public's eye"; Only cases of settling disputes, that is, negative news, can be seen in the media and even hyped up, because this is in line with the public's concern. After a long time, consumers will naturally have the impression that insurance claims are difficult.
Compared with insurance companies, policyholders are vulnerable groups. When claims disputes arise, public opinion will tend to sympathize with the vulnerable groups emotionally, which will have a certain negative impact on insurance companies.
In word of mouth, misinformation is also common. When one person tells another about the case of "it's really difficult to make insurance claims", few people go into the details of the case, such as the terms of the contract, the situation of the accident, the reasons for refusing to pay compensation, etc. However, they are keen to actively spread the seemingly popular conclusion that "insurance claims are difficult".
To cure the "stubborn disease" of claims, we need to work together.
The crux of the difficulty in insurance claims lies in many aspects. To improve this long-standing problem, we need the joint efforts of regulatory authorities, insurance companies and policyholders.
Strengthen supervision
From a regulatory point of view, the CIRC's supervision and management of insurance companies and penalties for violations are increasing year by year. Strict supervision and high punishment increase the illegal cost of insurance companies, which can cut off the subjective motivation of insurance companies not to act according to the contract from the source. It is also one of the actions to clean up all kinds of overlord clauses. For example, after the "critical illness insurance storm", the insurance industry association issued the "Specification for the Use of Disease Definition of Critical illness insurance", which standardized the disease definition, terminology interpretation and exclusion liability of critical illness insurance.
Strengthen the internal control of insurance companies
Insurance companies have also made some achievements in recruiting agents, exposing violations, and strengthening the education of professional ethics and professional norms of agents, and are striving for a return visit to the insurance policy during the hesitation period 100%. In order to solve the short-sighted problem of some agents, some insurance companies are also exploring new ways to increase their sense of belonging, such as increasing welfare, staff system and employee stock ownership.
Pay attention to personal efforts
The external efforts have changed the general environment, and the importance of the insured individual to insurance is the key. If you can study some insurance knowledge hard, choose agents carefully, read the terms carefully when you apply for insurance, report the insurance accident in time, prepare the claim information according to the requirements of the insurance company, and communicate with the insurance company at any time when you encounter problems, I believe that insurance claims will no longer be a problem. (Li Xiaoyan)
Nine Reasons for Reasonable Refusal of Compensation
Insurance companies are the transferee of risks and the managers of insurance funds. In order to protect the interests of most policyholders from infringement, insurance companies will refuse to pay a few claims that do not conform to laws, regulations and terms. What are the reasons why some people spend money on insurance but can't get claims service?
Not telling the truth
Among the reasons why insurance companies refuse to pay compensation, failure to tell the truth ranks first. Before buying insurance, the insured must fully realize the serious consequences of not telling the truth. If you conceal or omit the information listed in the policy, you may not get the protection you deserve, or even get the premium back.
Ms. Fang suffered from cataract for many years, and was diagnosed by a doctor and treated. When purchasing critical illness insurance, she didn't realize that it had something to do with her own insurance, and the agent didn't ask in detail. A year later, Ms. Fang felt that her eyesight was gradually declining and went to the hospital for examination. Therefore, she needs hospitalization. When Ms. Fang's family claimed compensation, the insurance company refused to pay compensation on the grounds of not telling the truth.
Please refer to the small topic "Tightening the String of Telling the Truth" in our insurance column (No.3, 2008) for several mistakes that are easy to make when fulfilling the obligation of how to tell the truth and how to fulfill the obligation of telling the truth. Remind the insured again that if you find yourself making mistakes in the notification link before the insurance accident, you should contact the insurance company in time. Most insurance companies will handle it fairly.
Out of insurance coverage
Insurance only provides protection for specific risks, and each insurance product has a prescribed scope of protection. Only accidents within the scope of insurance liability are managed by insurance companies.
Mr. Ping has been engaged in long-distance freight transportation for a long time. At the end of 2007, he bought himself an accident insurance (including accidental medical insurance). During the Spring Festival in 2008, Mr. Ping had a traffic accident while driving, which caused his legs to be disabled. During the treatment, Mr. Ping's relatives thought that Mr. Ping had bought accident insurance, so they decided to use expensive imported prostheses. After completing the relevant procedures, Mr. Ping's family went to the insurance company to make a claim, but the insurance company only paid Mr. Ping's hospitalization and treatment expenses, and the prosthesis expenses, which accounted for the largest proportion, were not paid, on the grounds that the prosthesis was beyond the scope of national social security and the insurance company was not liable for compensation.
Many policyholders are interested in insurance, for example, they think that if they buy auto insurance, they can claim compensation in case of an accident; If you buy serious illness insurance, you can pay for any serious illness. Each kind of insurance has its own specific coverage. Rational policyholders should know the insurance coverage of purchased products in advance with a responsible attitude, instead of blindly condemning insurance contracts as "overlord clauses".
Belong to the scope of the exemption clause
In an insurance contract, the applicant should not only look at what the "insurance liability" part can cover, but also focus on the "exclusion liability (exemption clause)".
Mr. Qian bought an accident insurance in February 2007. In June, he went on a field trip with friends and was unfortunately injured in a rock climbing. After leaving the hospital, Mr. Qian went to the insurance company to make a claim, but was told that rock climbing was not the insurance liability of accident insurance and refused to pay. Mr. Qian went home and looked at his insurance clauses, only to find that rafting, horse racing and rock climbing were listed as insurance non-loss items in the clauses.
At present, all insurance has exclusions, such as vehicle overload and drunk driving of drivers in auto insurance, which are not covered by insurance; Critical illness insurance excludes hereditary diseases; Insurance with death as the payment condition has exceptions for suicide and intentional homicide. Even if it is the same insurance, different products have different provisions on exclusion liability, so special attention should be paid to it. Generally speaking, high-risk activities and dangerous projects will be included in the exemption clauses of insurance companies.
No compensation will be made if the payment grace period is exceeded.
Most life insurance contracts are long-term contracts, some of which last for decades. During the payment period, the insured may be unable to pay on time due to business trip, forgetfulness, temporary financial constraints and other reasons. In order to prevent the policy from becoming invalid easily, the insurance company will generally give the insured a grace period, and if an insurance accident occurs within the grace period, the insurance premium will still be paid. However, if there is no payment after the grace period and there is no automatic premium payment clause, the policy will expire and the insurance accident will not be compensated.
On May, 20065438 1 day, Mr. Peng purchased the whole life insurance of an insurance company, and the payment period was 30 years. Since 2003, Mr. Peng has not paid the premium on time due to operating losses. In August 2004, Mr. Peng died in an accident. When his family claimed compensation, the insurance company refused, on the grounds that Mr. Peng's policy had exceeded the 60-day grace period stipulated by the company, so the policy had expired.
The grace period stipulated in the insurance law is 2 months. If, for some reason, the premium is not paid within 60 days, the insured has one last chance to bring the policy back to life, and that is to apply for the reinstatement of the policy. Policy reinstatement can be handled within 2 years from the date of termination of the contract. The applicant shall fill in the application form for reinstatement, and resubmit the health declaration or go to the designated institution for physical examination according to the requirements of the insurance company.
Signature of others
Agency signature means that the insurance company requires the customer (the insured, the insured, the beneficiary or the guardian) to personally sign the insurance information, such as insurance application, health notification, power of attorney, policy receipt, various change applications, etc., but not his own signature. If you violate this regulation and lack the requirement of autograph, the insurance contract will not be established and it is impossible to claim compensation.
Ms. Ma took out a critical illness insurance for her husband last year. At that time, because her husband was on a business trip in other places, the agent did not raise any objection, so Ms. Ma signed his name on the policy for her husband. But this year, Ms. Ma's lover suddenly suffered from acute myocardial infarction. When she filed a claim with the insurance company, the insurance company refused to pay on the grounds that the insurance policy was falsely signed and the insurance contract was not established.
In order to avoid unnecessary troubles and disputes, even couples can't take it for granted to sign the name of the insured, so as not to be passive in the future. If it is really impossible to sign in person, if someone else needs to sign, they must also obtain the written authorization of the other party when signing the insurance policy. If you have signed it, you should contact the insurance company immediately and negotiate with the insurance company to solve it.
An insurance accident occurred during the observation period.
The observation period, also known as the waiting period, refers to a period of time after the insurance contract is signed (generally 3 months to 1 year). The insurance company shall not be liable for compensation if the insured suffers from the disease stipulated in the contract or dies due to the disease. This situation is most common in health insurance.
Mr. Huang bought a critical illness insurance of an insurance company on August 65438+May 2004, and the observation period was 90 days. On June 8, 2004, Mr. Huang was diagnosed with liver cancer. By reading the relevant clauses, Mr. Huang learned that critical illness insurance is a kind of timely payment insurance. As long as the hospital is diagnosed, you can get the full insurance premium in advance. So he filed a claim with the insurance company on June 65438+1October 65438+March 2004. After checking the insurance policy, the insurance company refused to pay on the grounds that the policy was still under observation and did not need underwriting.
No observation period means that the insurance contract has not come into effect formally, and the insured cannot get the corresponding compensation. The reason for this provision is that insurance companies are based on the consideration of risk prevention, and also to prevent the unfairness caused to health policyholders by taking out insurance in spite of illness. The observation period is generally when the insured applies for insurance for the first time, and generally only applies to the first insurance year from the effective date of the contract. For renewable policies, there is no waiting period in the renewal year.
Repeated claim for medical expenses
The payment of some insurance products is based on the principle of payment. For the losses caused by the insured accident, compensation should be made according to the actual losses, so that the insured will not benefit from the loss compensation.
Ms. Guo bought accident insurance before and experienced an accident. Although the insurance company paid, the final payment did not completely make up for the medical expenses already paid. So Ms. Guo wants to buy another medical expense insurance. Even if the insurance company can't fully compensate after the accident, it can get two compensations. In early 2007, she bought an additional medical expense insurance from another insurance company. From June 5438 to February 2007, Ms. Guo was hit in the head by a plate falling from the top of the restaurant while eating in the restaurant, and was admitted to hospital for treatment. She paid successfully in the first insurance company, but was told to refuse to pay when she went to another insurance company to pay for it.
Paragraph 4 of Article 4 of the Measures for the Administration of Health Insurance, which came into effect on September 1 2006, stipulates that "the payment amount of medical insurance with cost compensation shall not exceed the actual medical expenses incurred by the insured." In other words, the amount paid by several insurance companies will not exceed the amount actually used when going through the discharge formalities in the hospital.
In addition, at present, hospitalization medical expenses insurance is mostly based on urban basic medical insurance, and self-funded drugs and some special inspection expenses in urban basic medical insurance cannot be reimbursed by commercial medical insurance.
Claims materials are incomplete.
The insurance company's identification of the nature of the accident and the degree of compensation for the loss largely depend on the relevant certification materials provided by the insured. If the materials are incomplete, the insurance company will not be able to judge the accident, and some materials will be lost or difficult to obtain in a short time, which will delay the claim, and in serious cases, the claim will be invalid within the validity period of the insurance.
In 2007, Mr. Li bought a hospitalization medical insurance for his children, valid for 10 years. At the end of 2007, Mr. Li's child was hospitalized for tuberculosis, and the cost of treatment for half a year was 45 thousand yuan. When he was discharged from the hospital, he only took a receipt and went home. After settling down the child, Mr. Li thought of the medical insurance for the child and immediately applied for compensation from the insurance company. When applying for insurance claims, he found that he had to hand in medical records, expense lists and other materials, so he ran to the hospital several times. I'm exhausted from the toss. According to him, completing these procedures even made him feel more tired than taking care of the children.
In order to settle claims more smoothly and quickly, after an accident, you should immediately ask the insurance company what claims data are needed, and prepare carefully according to the requirements, and submit all claims data at one time to avoid trouble and delay.
Omit the necessary formalities
Many claims disputes are caused by the insured's ignorance of the insurance clauses or failure to follow the approval procedures or formal procedures required for claims settlement. For example, the phenomenon of not handling the transfer formalities may cause unnecessary contradictions in claims settlement.
In July 2006, Hu bought a car from Lang for 80,000 yuan. The registered owner of the car is Lang. In May 2006, Langmou insured the car with 50,000 yuan of third-party liability insurance, and the insurance period was from 0: 00 May 2006 to 0: 00 May 2007. After buying the car, Hu didn't go through the formalities of vehicle transfer registration and didn't inform the insurance company. On June 5, 2006, 165438+ Hu was driving the car and had a traffic accident, resulting in 1 death. After being identified by the traffic police, Hu took full responsibility. When making claims, the insurance company refused to pay on the grounds that Hu did not inform the insurance company in time and did not go through the insurance transfer procedures.
Article 34 of the Insurance Law stipulates: "The insurer shall be informed of the transfer of the subject matter insured, and the contract shall be changed according to law after the insurer agrees to continue underwriting." Transfer of the subject matter insured (resale, transfer, gift, change of use, etc.). ) more common in property insurance, such as auto insurance, family property insurance, etc. Therefore, when the vehicle or house is transferred, the insurance company must be informed in writing according to the insurance contract, and the examination and approval procedures must be handled.
Four steps to settle claims smoothly
Mr. Zhao from Beijing took his father to travel to Xinjiang, but his father died unexpectedly. Without reporting to the insurance company, Mr. Zhao hastily handled the funeral in the local area. After returning to Beijing, when he went to the insurance company to claim compensation with bereavement, he could not get compensation immediately because he could not produce the necessary accident certificate, corpse disposal certificate and other materials. It's far from Beijing to Xinjiang. In order to obtain the complete claim materials, Mr. Zhao had to make another trip, which wasted a lot of money and delayed the claim for many days.
When it comes to the claims process, many people feel that their heads are big. Reporters have also met readers like Mr. Zhao who are exhausted by claims. In fact, as long as you know the links and steps of insurance company's claims and know what to pay attention to in each step, you will find that the threshold of claims is not as high as you think, and the procedures of claims are not complicated, so you will be much more practical.
Timely report
Article 22 of the Insurance Law stipulates that "the applicant, the insured or the beneficiary shall notify the insurer in time after knowing the occurrence of the insurance accident." After the occurrence of an insurance accident (accident), the relevant personnel (the insured, the insured and the beneficiary) should notify the insurance company of the occurrence of the insurance accident as soon as possible. This is called reporting the case and is a legal obligation.
Reporting a case is the first step in the claim application. It is very important for insurance companies to report cases in time, which may be related to whether they can settle claims. On the one hand, necessary measures can be taken to prevent the loss from expanding, on the other hand, the incident can be investigated and collected in time.
Different insurance products have different restrictions on reporting time. Among them, accident insurance, family property insurance, auto insurance and major accidents have the most stringent requirements for reporting time, and some even limit it to 24 hours after the insured accident occurs. There is an "insurance accident notice clause" in the insurance contract, which must be done as required. If there is no specific reporting time limit on the policy, it is best not to exceed 7 days.
The report can be written or oral. For example, you can call the insurance company's service hotline (report phone number), send a fax, entrust an agent or go directly to the insurance company's outlets to report the case.
There are several things to explain when reporting the case.
1. Basic information of the insured: name, ID number (or date of birth of the insured).
2. Basic information of policy: policy number, insurance type, insurance amount, insurance period, payment, etc. The policy number is particularly important.
3. Basic information of the insured accident: the time and place of occurrence, the cause of the accident, the damage and the current situation of the insured. If it is property insurance, it is also necessary to inform the relevant institutions of the handling situation; If it is medical insurance, the contents of the notification should also include the hospital and diagnosis results.
4. Basic information of the informant: name, certificate number, relationship with the insurer, contact information, etc. Contact information is very important and should be made public at any time.
In addition, for cases that have the possibility of insurance accidents due to abnormal reasons, such as car accidents, murders, unexplained deaths and cases that may lead to lawsuits due to insurance accidents, in addition to reporting to insurance companies, they should also report to government law enforcement departments such as public security and traffic police in time, so as to detect cases and settle claims as soon as possible.
Tip 1
It is more convenient to report a case by telephone. Many insurance companies' service calls are free of charge, and most insurance companies will record the call and keep the recording for a certain period of time. To be on the safe side, the whistleblower can also write down the time of reporting and the number of the operator so as to retrieve the recording when necessary.
Submit relevant materials
Article 23 of the Insurance Law stipulates: "After the occurrence of an insured accident, when the applicant, the insured or the beneficiary requests compensation or pays insurance money from the insurer in accordance with 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." The insurance company will decide whether to file a case according to the supporting materials provided, so providing the claim application materials is the most critical and cumbersome step. Many claims applications need to provide supplementary certificates and materials because the supporting materials are incomplete and unclear, which delays the time.
Necessary materials for claim settlement include: the original ID card of the insured and the original ID card of the applicant, the original insurance contract, the latest payment voucher, the claim application form, and the power of attorney for claim settlement (indicating the scope of authorization). If the insured is unable to settle the claim, it needs to be handled by others. Filling in all kinds of information completely and correctly and keeping a copy of the customer's claim application form are two things that the insured should pay attention to.
In addition, according to different situations, the applicant should also provide other necessary supporting materials.
Accident certificate generally includes accident certificate, disability certificate, death certificate, account cancellation certificate, etc.
Medical certificates include diagnosis certificates, operation certificates, outpatient medical records and prescriptions, pathological and blood test reports, receipts and lists of medical expenses, etc.
The identity of the beneficiary and the relationship with the insured prove the identity of the beneficiary (that is, the beneficiary can only hold an ID card; If you entrust others to collect it on your behalf, you need to provide a notarial certificate issued by the local notary office and your identity certificate) and proof of the relationship between the beneficiary and the insured (such as husband-wife relationship, parent-child relationship and child relationship).
Tip2
Claims related certificates and materials can be prepared according to the specific requirements of the "Claim Application" in the insurance contract. However, the relevant personnel of the insurance company also said that due to some reasons, the specific requirements in actual operation may be slightly different from those stated in the contract. After the accident, you should read the insurance policy carefully, consult the staff of the insurance company when reporting the case, and master the claims materials to be collected and their effectiveness. Conditional, you can also record the consultation process.
Awaiting approval
According to the requirements of the insurance company, after the applicant provides all the certificates and materials, the staff of the insurance company will collect relevant evidence in accordance with the regulations to verify the authenticity of the insurance accident and related materials. If no problems are found, the claim application will enter the review state. After confirming the objective facts and determining the insurance liability according to the relevant evidence, the case-handling personnel calculate the amount of compensation and make a claim conclusion. After the approver closes the case, the beneficiary of the policy can be paid.
It will take some time from the submission of materials to the closing of the case, which will be different according to different situations. If the case is simple, the insured amount is small and the materials are complete, a settlement decision will be made soon; On the contrary, the investigation process will take a long time, and applicants will have to wait for a long time. Article 24 of the Insurance Law stipulates that the time limit for insurance companies to make claims is "timely approval". In the Interpretation of the Supreme People's Court on Several Issues Concerning the Trial of Insurance Dispute Cases (Draft for Comment), the interpretation of "timely" is "generally 30 days, unless there are difficulties".
At present, regulators and insurance companies are trying their best to shorten the waiting time for insurance claims. For example, the Beijing Insurance Industry Association issued the "Beijing Insurance Industry Accident Insurance and Health Insurance Service Specification (Trial)" in 2006, which stipulates that "an insurance company shall make a claim settlement decision within 10 working days from the date of acceptance, and inform the customer of the processing result in time. For claims that cannot be determined within 10 working days, the insurance company shall inform the customer of the processing progress. "
Tip3
In the investigation stage of insurance company staff, not only the cooperation of relevant departments and organs is needed, but also the insured should actively cooperate with the demands put forward by the insurance company, otherwise it will affect the timely settlement of claims.
claim reimbursement
After the insurance company makes a compensation decision, it will contact the relevant beneficiaries to receive compensation according to the contact information and address on the application form.
Succession order
If the beneficiary is the designated beneficiary, the insurance money shall be collected in the specified order according to the contract.
If the beneficiary is the legal beneficiary, it must be collected by the heirs in the first order (spouse, children, parents), and the recipient must sign a written guarantee before collecting it, ensuring that other heirs in the first order will be notified.
If the beneficiary is a person without civil capacity, his guardian will collect it on his behalf.
Collection method
For the convenience of the insured, the payment methods provided by the insurance company are: cash, cash check, transfer check or bank remittance. If cash payment is used, the payee needs to provide relevant certificates.
Tip 4
It is suggested to provide a copy of the beneficiary's passbook as much as possible, and collect the insurance money by transfer to reduce the cash risk. Before using this method, you need to sign a contract with the insurance company and entrust the bank to remit money. In addition, the beneficiary is reminded not to disclose the bank account password to outsiders.