Case details
1 1 In June last year, 60-year-old Tan bought the "medium and high-end hospitalization medical insurance" of an insurance company under the recommendation of others. Because insurance needs to be insured through the insurance system on devices such as smart phones, all operations need to be completed on terminals such as smart phones. Tan is older, doesn't have a smart phone, and can't operate. He can only give his ID card to the introducer to help him complete the insurance payment operation. On the same day, Tan paid an insurance premium of 847 yuan and received a "high-end hospitalization medical insurance policy". The insurance policy records the high-end hospitalization medical insurance, hospitalization medical care, insurance amount, insurance premium, insurance period and other protection contents.
Just this year, Tan went to the hospital for treatment because of physical discomfort, and finally stayed in the People's Hospital for a month, during which he incurred more than 60,000 medical expenses. In Tan's hospitalization medical record, it is recorded that "the patient 10 years ago was operated on by rectal cancer". Subsequently, Tan's family reported the case to the insurance company and submitted relevant claims information such as medical records. Later, the insurance company served Tan with the Notice of Refusing to Pay Compensation for Termination of Contract, which stated that Tan had been diagnosed with cancer before the insurance, and did not truthfully inform the company of the above matters when the insurance was applied, so he was informed to terminate the insurance contract and refused to pay compensation. Subsequently, Tan sued the insurance company to Tongliang Court, and finally the insurance company lost the case.
case analysis
Although we all know that if cancer is diagnosed before purchasing critical illness insurance, it is difficult for insurance companies to agree to sign insurance contracts or increase the premium of a certain part. However, in this case, the reason why the court ruled that the insurance company lost the case was that although the insured had to fulfill the obligation of "telling the truth", in this case, the insurance company did not produce sufficient and effective evidence to prove that it had inquired about Tan's illness, and the identity of the insurance system operator in this case could not be verified. As the burden of proof in this case, the insurance company should bear the adverse consequences of not providing evidence. The insurance purchased by Tan is operated through the smart phone insurance system, and it is uncertain whether the insurance process is operated by Tan himself. The existing evidence is not enough to prove that Tan intentionally or grossly failed to fulfill his obligation of telling the truth. The insurance company does not have the right to terminate the contract as stipulated in Article 16 of People's Republic of China (PRC) Insurance Law, so it should not be considered that the insurance contract in this case has been terminated.
As can be seen from the above cases, the insured needs to fulfill the obligation of telling the truth. So what is the "obligation to tell the truth" of the insured?
It means that when an insurance contract is concluded, the insurer inquires about the subject matter of insurance or the insured, and the applicant shall truthfully tell it, which is the legal obligation of the applicant. Whether the applicant fulfills this obligation has an important influence on the effectiveness of the insurance contract.
What will happen if the insured fails to fulfill the obligation of telling the truth?
Article 16 of the Insurance Law clearly stipulates that:
If the insurance company deliberately fails to inform, it will refuse to pay compensation and will not refund the premium. If the fault is notified, the insurance company refuses to pay compensation but will refund the premium.
According to this clause, insurance companies must also meet the following requirements:
The applicant intentionally or seriously neglects to inform.
Failure to inform is enough to affect whether the insurance company underwrites or raises the insurance rate.
Although the insured did not inform, the insurance company knew that if it did not cancel the contract within one month, it would mean giving up the cancellation.
Two days after the insurance contract is signed, it cannot be terminated on the grounds of "not telling the truth".
According to the above cases, let's take a look at the process of purchasing medical insurance online.
1. Choose insurance products online.
First of all, let's know what products are available on the insurance company's website, as well as the basic situation of insurance products, what characteristics they have, what kind of protection they can provide and how much they cost. Then combine your actual needs and economic conditions to choose the products that suit you.
2. Fill in the insurance information and calculate the premium.
Customers need to fill in their personal information, payment methods, payment terms and so on online. The system will automatically generate an approximate premium. If you feel no problem, you can complete the online insurance appointment.
return cable
After the online insurance booking is successful, the salesman of the insurance company will call back. At this time, it is necessary to know the details of the insurance purchased in detail, such as the insurance period, guarantee responsibility, exemption clause and so on.
Confirm insurance
Pay insurance premium
Just choose the payment method that you need to pay the premium online.
6. Policy survey
After the online payment is successful, the system will automatically generate an electronic insurance policy.
It is convenient to buy insurance online, but you need to have a very detailed understanding of yourself and the insurance situation.
If you don't understand or know how to buy insurance online. You can consult a professional and excellent insurance broker. Because professional insurance brokers will make comprehensive evaluation and tailor-made plans according to your problems and needs, Baibaojun has a professional and powerful insurance team.