Case details
Last November, 60-year-old Tan was recommended by others to buy an insurance company's "high-end hospitalization medical insurance". As the insurance needs to be insured through the insurance system on the smartphone and other devices, all the operations need to be completed on the smartphone and other terminals. Tan Mou older, no smartphone, not to mention the operation, so can only give the ID card to the introducer, so that the introducer to help complete the operation of the insurance payment, the same day Tan Mou paid the premium of 847 yuan, and received the "high-end hospitalization medical insurance policy" a. The insurance policy states that "the high-end hospitalization medical insurance" is the most important insurance policy in the world. The insurance policy records the middle and high-end hospitalization medical insurance and hospitalization medical, insurance amount, insurance premium, insurance period and other protection content.
Just this year, Tan felt unwell and went to the hospital for treatment, and ended up being hospitalized for a month in the People's Hospital, incurring more than 60,000 yuan in medical expenses during this period. In Tan's hospitalization medical record admission record recorded "patients 10 years ago due to rectal cancer surgery". Tan's family then reported the case to the insurance company and submitted medical records and other relevant claim information. After this, the insurance company served Tan with a Notice of Cancellation of Contract and Refusal of Claim, which stated that because Tan was diagnosed with cancer prior to enrollment and did not truthfully inform the Company of the above matters at the time of enrollment, it notified Tan of the cancellation of the insurance contract and refused to settle the claim. Subsequently, Tan sued the insurance company to Tongliang Court, and finally the insurance company lost the case.
Case Analysis
While we all know that if you are diagnosed with cancer before you buy a critical illness insurance policy, it is difficult for the insurance company to agree to sign an insurance contract or raise a certain portion of the premium. But in this case, the reason why the court ruled against the insurance company, is that although the policyholder needs to fulfill the obligation to "truthfully inform", but in this case the insurance company did not show sufficient and effective evidence to prove that it has asked Tan Mou about the relevant information about the disease, and in this case, the identity of the operator of the insurance system can not be verified, the insurance company as the obligation to prove that this information is not true. The insurance company, as the burden of proof in this case, should bear the adverse consequences of failure to prove. Tan purchased insurance is through the smartphone end of the insurance system operation, and the insurance process is Tan's own operation can not be determined, the existing evidence is insufficient to prove that Tan has intentionally or grossly negligent failure to fulfill the obligation of truthfulness, the insurance company does not have the right to terminate the contract as stipulated in Article 16 of the Chinese People's Republic of China Insurance Law, it should not be concluded that the insurance contract has been terminated.
From the above case, we can see that the policyholder is required to fulfill the obligation to truthfully inform. What is the policyholder's "obligation to inform truthfully"?
It means that in the conclusion of the insurance contract, the insurer on the subject matter of the insurance or the insured person of the relevant information, the policyholder should be truthfully informed, which is the legal obligation of the policyholder. Whether the policyholder to fulfill or properly fulfill this obligation, the effectiveness of the insurance contract has an important impact.
What will happen if the policyholder fails to fulfill his obligation to inform truthfully.
Article 16 of the Insurance Law has clear provisions:
If you intentionally fail to inform the insurance company, the insurance company will refuse to pay the claim and will not refund the premium. In case of negligent disclosure, the insurance company will refuse to pay but will refund the premiums.
According to this article, the insurance company must meet the following requirements:
The policyholder's intentional or grossly negligent failure to inform
The failure to inform is sufficient to influence the insurance company's decision on whether or not to underwrite the policy or to increase the premium rate
Though the policyholder fails to inform the policyholder, the insurance company waives its intention to terminate the policy by failing to mention the termination of the policy within one month of learning about it
The insurance contract can not be terminated two days after it has been signed. Two days after the conclusion of the insurance contract, you cannot terminate the contract on the grounds of "failure to inform truthfully".
Based on the above case, let's take a look at the process of buying health insurance online.
1. Choose an insurance product online
First of all, go to the insurance company's website to find out what products are available and the basics of the insurance product, what are the features, what kind of coverage it can provide, and how much it costs. Then combine your actual needs and financial conditions to pick the right product for you.
2. Fill in the insurance information to measure the premium
Customers need to fill in their personal information, payment method, and the number of years of payment online. The system will automatically generate an approximate premium. If you feel fine with yourself, then you can complete the online insurance booking.
3. Telephone callback
After the online insurance appointment is successfully made, there will be a telephone callback from the insurance company's salesman. This is the time to get a detailed understanding of the specifics of the insurance policy you are buying, such as the duration of the policy, the liability, the exclusion clauses and so on.
4. Make sure you get your policy
5. Pay your premium
Select your desired payment method to pay your premium online.
6. Policy Inquiry
After you pay the premium online, the system will automatically generate an electronic policy.
Buying insurance online is still very convenient, but it requires you to have a very detailed understanding of yourself and of the insurance situation.
If you do not understand the content of buying insurance online or do not know how to buy insurance online. You can go to a professional and good insurance broker to consult. Because professional insurance brokers will be all-round assessment, according to your problems and needs tailored to the program, Baibaojun - has a professional and strong team of insurance advisers.