Many people think insurance is a scam and insist they don't buy insurance, which has never had a good reputation. Digging deeper into the reasons for this, which can not be dissociated from the difficulty of claims.
Insurance claims difficult, in the end, who should be responsible for this? Insurance companies, agents, or policyholders? Claims are a two-way street, and the difficulty of settling a claim is not a one-way street.
As a policyholder, you should get rid of the prejudice against insurance and calmly look at the requirements of claims. At the same time, in order to defend their own interests, in insurance to put more energy. Attach importance to insurance, learning insurance knowledge, enhance legal awareness, insurance does not violate the law, after an accident to follow the claims process, ready to claim materials, a clear understanding of the claims before and after these things.
Some of the best insurance companies have already started to improve their claims service, and are working to restore consumer confidence by establishing efficient and smooth claims systems. That's what policyholders are hoping for.
Is it really hard to settle insurance claims?
There aren't many insurance claims disputes in the press, and the amount of money involved is a drop in the ocean compared with the country's annual claims spending of more than 200 billion yuan (2007 statistics from the China Insurance Regulatory Commission). But why is there such a deep-rooted impression in the minds of many consumers that insurance claims are difficult to settle?
Insurance claims are difficult for a variety of reasons
Many consumers are hesitant to buy insurance because they are worried about the trouble of settling a claim afterward, or even not getting compensated; and even if they do buy insurance, they are still worried about the trouble they will encounter when settling a claim in the future. Insurance claims have become the biggest obstacle to the public's choice of commercial insurance.
Insurance companies are to blame
As the saying goes, no matter what, there is an objective phenomenon of claim avoidance in the actual settlement of claims by insurance companies. The insurance company is a phenomenon, but also an insurance company claims a state of mind. When an insurance company's operating pressure reaches a certain level, or an insurance company out of the need to obtain more profits, it will exercise some control over the claims, which is generally manifested as delayed claims, less claims, and refusal to pay claims. Of course, this is not unrelated to the fact that insurance companies encounter about 10 to 30 percent of fraudulent claims each year, and are cautious about insurance claims.
It is normal for insurance companies, as for-profit organizations, to maximize profits, but if there is a motivation to reduce claims expenses by sacrificing the interests of policyholders in their operations, it can only be a small loss, or even more than it is worth. A good reputation in the market is extremely important to the business development of insurance companies. It is very difficult and slow to build up a good reputation, but it is very easy to destroy it.
Many insurance companies are aware of the seriousness of this problem, coupled with the strengthening of regulatory efforts, the policyholder's rights to reduce the cost, and now deliberately make things difficult for the policyholder, the situation has been greatly reduced. However, there are many branches of the insurance company, the quality of practitioners varies, the insurance company has internal profit assessment requirements, this kind of case is unlikely to be completely eliminated.
Some data show that when a company provides a service to a policyholder, if the policyholder feels good, he will tell 10 people about his experience; if the policyholder does not feel good, he will tell 50 people about his experience. As the saying goes, "A good deed goes unnoticed, but a bad deed travels a thousand miles". Therefore, even if the insurance company's attitude towards claims has been corrected, it will take some time to eliminate the bad influence caused by the early problem of avoiding claims.
Some agents are of poor quality
Some insurance agents have low professional ethics or poor professional knowledge, which is also a major reason why consumers find it difficult to settle insurance claims.
False publicity and intentional or unintentional misinformation, irregularities in the process of enrollment, such as exaggerating the scope of coverage and the amount of claims, signing on behalf of the policyholder, encouraging the policyholder not to truthfully inform the existence of the disease, overstatement of the income, etc., all to the policyholder's future claims to lay a hidden danger. Some policyholders, because of the gullible salesman's propaganda, thought to buy a "everything" insurance, until the insurance accident, full of hope to the insurance company to collect the insurance benefits, only to find that they have been cheated. By then, disappointment and anger will be hard to avoid, and it is also easy to take the bad behavior of an agent, angry at the entire insurance industry, magnifying the difficulty of insurance claims.
There are also insurance agents who, although they do not violate any rules when consumers take out insurance, are very indifferent to after-sales service; or, when they find out that the policyholders have lost the ability to add insurance and make referrals, they will make a big difference in their service, and let them prepare their own information and go to the insurance company to apply for a settlement in the event of a claim. Many policyholders are not professionals and have done little research on claims, so they often have to make several trips back and forth to get things done due to incomplete preparation of information or failure to meet the requirements of the insurance company. Even if you don't object to the amount of the claim and get the claim payment, you will still be complaining about the difficulty of settling the insurance claim.
The above phenomenon is also likely to occur if the policy agent has left the insurance company and the policy has become an "orphan policy". As we all know, the majority of insurance agents have a very short time in the business, and the rate of job-hopping among insurance companies is higher than that of other industries.
Policyholders' own fault
Some policyholders, insured persons and beneficiaries' own faults are also a major cause of claims disputes.
The more common faults include: not telling the truth when taking out the policy, concealing medical history and taking out the policy with illness; not knowing the specific insurance responsibilities, such as not reading the terms and conditions carefully when taking out the policy, or sometimes even if the agent explains the terms and conditions at that time, but over a long period of time, they will not be able to remember or remember it incorrectly, and subconsciously they naturally hope to insure more and more; signing the policy in place of the insured person; triggering the exemption clauses, such as drinking and driving, or driving without a license, and so on. driving without a license, etc.
The most common misconduct is that the insurance company is worried about increasing the fee or refusing to cover the insurance, and the insurance company refuses to cover the insurance because they do not tell the truth about the health condition, hoping that even if there is an accident, they will be able to avoid the insurance company's investigation, and then the insurance company refuses to cover the insurance because of the disclosure of the medical history when the claim is made. These faults are related to the fact that many insured people do not pay enough attention to insurance, lack of insurance knowledge, and indifference to legal awareness.
Public Opinion Guidance Contributes
The reason for the formation of the impression that it is difficult to settle insurance claims also relates to the issue of media publicity and public opinion guidance.
A very simple truth, if it is a case of normal claims by the insurance company, newspapers and television generally do not report, because there is no news to speak of, "can not catch the eye of the public"; only the case of claims disputes, i.e., the negative news, may be seen in the media, and even be exaggerated, because it is in line with the public's concern orientation. After a long time, it will be easy for consumers to produce the impression that insurance claims are difficult.
Compared with the insurance company, the policyholder is a disadvantaged group, and when there is a dispute over claims, public opinion will tend to sympathize with the disadvantaged group emotionally, which will have a certain negative impact on the insurance company.
In word of mouth, blackmail is also common. When a person tells another person about a case of "insurance claims are really difficult", few people bother to look into the specifics of the case, such as the contract terms and conditions, the circumstances of the accident, and the reasons for the refusal to pay, etc., but are eager to spread the word that "insurance claims are difficult", a conclusion that seems to be well received by the public.
Rooting out the claims "chronic disease" also need to join hands
The crux of the problem of insurance claims lies in many ways, if you want to improve this disease has long been the problem, the need for regulators, insurance companies, policyholders, many **** with the same efforts.
Regulatory efforts to increase
From the regulatory side, the CIRC for the supervision and management of insurance companies, violation of the penalties increased year by year, strict supervision and high penalties increase the cost of violations of the insurance company, can cut off the source of the insurance company's subjective motivation to do things not according to the contract. At the same time, clean up a variety of overbearing terms is also one of the actions, such as "critical illness insurance fiasco" after the Insurance Association issued a "definition of the use of critical illness insurance disease specification", the definition of critical illness insurance disease, terminology, exclusions, etc. have been standardized.
Insurers' internal control strengthened
Insurers have also made efforts in agent recruitment, exposing irregularities, and strengthening education on agents' professional ethics and code of practice, and are trying to make 100% return visits to policies during the hesitation period. To address the short-sightedness of some agents, some insurers are also exploring new ways to increase their sense of belonging, such as increasing benefits, staffing, and employee stock ownership.
Individual effort
What the outside world is trying to change is the general environment, and it's the insured's personal attention to insurance that's key. If you can make an effort to learn some insurance knowledge, carefully select the agent, carefully read the terms and conditions of the policy, report insurance accidents in a timely manner, in accordance with the requirements of the insurance company to prepare claims information, and encounter problems at any time to communicate with the insurance company, I believe that insurance claims will no longer be a problem. (Li Xiaoyan)
9 Reasons for Reasonable Rejection of Claims
The insurance company is the assignee of risk and the manager of insurance funds. In order to keep the interests of the majority of policyholders intact, insurance companies will reject a small number of claims that do not comply with laws and regulations as well as terms and conditions. What exactly are the reasons why some people pay for coverage but do not receive claims service?
Not telling the truth
Failure to tell the truth tops the list of reasons why insurance companies refuse to pay claims. Before purchasing an insurance policy, the policyholder must be fully aware of the serious consequences of not telling the truth. If you hide or omit information that the insurance company specifies in the application form, you may not get the coverage you deserve, and you may not even get your premiums back.
Ms. Fang has suffered from cataracts for many years and has been diagnosed and treated by her doctor. When she bought her critical illness insurance, she didn't realize it was related to her purchase and her agent didn't ask her about it in detail. A year later, Ms. Fang felt that her eyesight was gradually declining and went to the hospital for a checkup, which resulted in the need for an operation and hospitalization. When Ms. Fang's family claimed compensation, the insurance company refused to pay on the grounds that they had not been truthful.
For several mistakes that are easy to make when fulfilling the obligation of how to inform, and how to fulfill the obligation of truthfulness, please refer to the small topic "Tighten the string of truthfulness" (Issue 3, 2008) in the insurance section of this magazine. Once again, policyholders are reminded that they should contact their insurance companies promptly if they realize that they have made mistakes in the notification process before an insurance incident occurs. Most insurance companies will deal with the matter in a fair and impartial manner.
Exceeding the scope of insurance liability
Insurance only provides protection against specific risks, and each insurance product has a defined scope of coverage. Only accidents within the scope of insurance liability are managed by the insurance company.
Mr. Ping, who has been engaged in long-distance freight transportation for a long time, bought an accident insurance (including accidental medical coverage) for himself at the end of 2007. during the Spring Festival of 2008, Mr. Ping's car caused a traffic accident, which led to the disability of both of his legs. During the treatment, Mr. Ping's relatives thought that Mr. Ping had purchased an accident insurance policy and therefore decided to use expensive imported artificial limbs. Mr. Ping's family went to the insurance company to make a claim after completing the relevant procedures, but the insurance company only covered the costs of Mr. Ping's hospital checkups and treatments, while the largest proportion of the cost of prosthetics was not covered, on the grounds that the prosthetics exceeded the scope of the national social security system, and the insurance company did not bear the responsibility of paying the claim.
Many insured people look at insurance in a simplistic way, such as thinking that if you buy a car insurance, you can claim for an accident; if you buy a critical illness insurance, you can ask for compensation for any serious illness. Each insurance, have their own specific content, rational policyholders, to their own responsible attitude to understand clearly beforehand to buy the product insurance liability scope, rather than just condemn the insurance contract is "bullying terms".
The scope of the exclusion clauses
In the insurance contract, the policyholder should not only look at what can be insured "liability" part, but also focus on the "exclusion (exclusion clauses)".
Mr. Qian bought an accident insurance policy in February 2007, and in June he went on a field trip with his friends and was injured in a rock climbing accident. After being discharged from the hospital, Mr. Qian went to the insurance company to make a claim, but was told that rock climbing was not part of the accident insurance coverage and refused to pay. Mr. Qian went home and looked up his insurance policy, only to find that it excluded rafting, horse racing and rock climbing.
All current insurance policies have exclusions, such as auto insurance, which excludes overloaded vehicles and drunken drivers; critical illness insurance, which excludes hereditary diseases; and death insurance, which excludes suicides and intentional homicides. Even for the same type of insurance, the exclusions vary from product to product and extra care should be taken. Generally, high-risk activities and hazardous items are included in the insurance company's exclusions.
No compensation for exceeding the payment grace period
Most life insurance policies are long-term contracts, with payment periods of up to several decades in some cases. During the premium payment period, the insured may be unable to pay the premiums on time due to business trips, forgetfulness, temporary financial constraints and other reasons. In order to prevent the insurance policy from lapsing easily, the insurance company usually gives the policyholder a grace period, during which insurance benefits will still be paid if an insurance accident occurs. However, if you have not paid your premiums after the grace period and are not protected by the automatic premium advance clause, your policy will lapse and you will not be compensated for any insurance accident.
Mr. Peng bought a whole life insurance policy from an insurance company on May 1, 2001, with a premium payment period of 30 years. 2003, Mr. Peng did not pay the premiums on time due to business losses, and in August 2004, Mr. Peng was killed in an accident. His family's claim was rejected by the insurance company on the grounds that Mr. Peng's policy had lapsed because it had exceeded the company's 60-day grace period.
The Insurance Law provides a grace period of two months. If, for some reason, the premium is not paid within 60 days, the policyholder has one last chance to bring the policy back to life, and that is to apply for reinstatement of the policy. The policy can be reinstated within two years from the date of suspension of the validity of the contract, the policyholder should fill out the reinstatement application form, and according to the requirements of the insurance company, to provide a new statement of health or to the designated institutions for medical examination.
Signing on behalf of others
Signing on behalf of others means that the insurance company requires the customer's (policyholder, insured, beneficiary or guardian) signature, but not his/her own, on insurance documents such as the application form, health notification, power of attorney, policy acknowledgement, and all kinds of change applications. If this provision is violated, the lack of handwritten signature of this element, the insurance contract will not be established, the claim is impossible to talk about.
Mrs. Ma took out a critical illness insurance policy for her husband last year. Because her husband was out of town on business and the agent didn't object, Ms. Ma signed the policy on her husband's behalf. But this year, Ms. Ma's lover suddenly suffered an acute myocardial infarction, and when she filed a claim with the insurance company, it refused to pay on the grounds that the signature on the policy was not genuine and the insurance contract was not established.
In order to avoid unnecessary trouble and disputes, even couples can't sign the policyholder's name as a matter of course, so as not to be caught in a passive situation later on. If you can't sign in person and need to have someone else sign on your behalf, be sure to get a written authorization from the other party when signing the insurance policy on your behalf. If you have already signed, you should contact the insurance company immediately and negotiate with them to solve the problem.
Accidents during the observation period
The observation period, also known as the waiting period, is a period of time after the insurance contract is signed (usually 3 months to 1 year) when the insurance company will not be liable to pay compensation if the insured person suffers from a disease stipulated in the contract or if he or she dies of the disease. This situation is most common in health insurance.
Mr. Huang bought a major disease insurance policy from an insurance company on Aug. 15, 2004, with an observation period of 90 days. on Oct. 8, 2004, Mr. Huang was found to be suffering from liver cancer. Mr. Huang learned from the terms and conditions of the policy that critical illness insurance is a timely payment type of insurance, and that he could receive the full amount of the insurance benefit in advance as long as the diagnosis was confirmed by the hospital. So on October 13, 2004, he filed a claim with the insurance company. After checking the status of the policy, the insurance company refused to pay the claim on the grounds that the policy was still in the observation period and did not need to be covered.
The fact that the observation period had not expired meant that the insurance contract had not officially come into effect, and the policyholder could not be compensated accordingly. The reason for this provision is that the insurance company is based on risk prevention considerations, but also to prevent with the sick insurance caused by the health of the policyholder unfair. The observation period is usually counted from the effective date of the contract when the insured is first insured, and generally only applies to the first insurance year; for renewable policies, there is no longer a waiting period for the renewal year.
Duplicate claims for medical expenses
Some insurance products pay out based on the principle of indemnity. Losses caused by insurance accidents are compensated according to the actual loss, and policyholders will not be allowed to profit from the loss compensation.
Mrs. Guo had previously purchased an accident insurance policy and experienced an accident. Although the insurance company paid out the claim, the final amount of the claim did not fully cover the medical expenses incurred. In December 2007, Ms. Guo was hospitalized after being struck in the head by a plate that fell from above while she was dining at a restaurant. She was successfully paid by the first insurer, but when she went to the other insurer to make a claim, she was told that the claim was denied.
Article 4, paragraph 4, of the Measures for the Administration of Health Insurance, which came into effect on Sept. 1, 2006, stipulates that "the amount of benefit for cost-compensating medical insurance shall not exceed the amount of medical expenses actually incurred by the insured." That is, the insurance amount paid by several insurance companies will not end up exceeding the amount that has already been used when the actual hospital discharge procedures are checked out.
Additionally, most of the current hospitalization medical expense insurance is based on urban basic medical insurance, and commercial medical insurance will not reimburse you for the proportionate out-of-pocket expenses for medicines and some special tests in urban basic medical insurance.
Improper claim documents
The nature of the accident and the extent of compensation for the loss rely heavily on the relevant documents provided by the applicant. If the materials are incomplete, the insurance company will not be able to make a judgment on the accident, and some materials are lost or difficult to obtain in the short term, which will result in a delay in the settlement of the claim, and in serious cases, the claim will be invalidated during the validity period of the insurance policy.
Mr. Li bought a hospitalization medical insurance for his child in 2007, which is valid for 10 years. at the end of 2007, Mr. Li's child was hospitalized for tuberculosis, before and after *** half a year, and the treatment cost 45,000 yuan. When discharged from the hospital only took an invoice and went home, after settling the child Mr. Li thought of the child to buy health insurance, then immediately to the insurance company to file a claim, in the subsequent application for insurance claims found to make up for the submission of medical records, cost lists and other information, and then ran a few times to the hospital. He was exhausted. According to him, these procedures are even more exhausting than taking care of the child.
In order to make the claim smoother and quicker, you should ask the insurance company what claim information you need right after the accident and prepare it carefully according to the requirements, and submit it all at once when you make the claim, so as not to give yourself both trouble and trouble.
Missing the necessary procedures
Many claims disputes are caused by policyholders' lack of understanding of the terms of the insurance policy or their failure to follow the formalities or procedures required for settling a claim. Phenomena such as failure to follow transfer procedures can cause unnecessary claims conflicts.
July 2006, Hu to 80,000 yuan price from the Lang a car, the car registered owner of Lang a. In May 2006, Lang a car insured 50,000 yuan of third-party liability insurance, the period from May 15, 2006 zero hour to May 15, 2007 zero hour. After the purchase of the car did not handle the vehicle transfer registration procedures, and did not notify the insurance company. November 5, 2006, Hu driving the car traffic accidents, resulting in one person died. The traffic police determined that Hu Mou bear full responsibility. When claiming for compensation, the insurance company refused to pay for Hu's purchase of the car without notifying the insurance company in a timely manner and without going through the insurance transfer procedures.
Article 34 of the Insurance Law stipulates: "The transfer of the subject matter of the insurance shall be notified to the insurer, and the contract shall be changed in accordance with the law after the insurer agrees to continue to underwrite the insurance." The transfer of the subject matter of insurance (resale, assignment, gift, change of use, etc.) is mostly seen in property insurance, such as car insurance and home insurance. Therefore, in the event of a transfer of a vehicle or home, you must notify the insurance company in writing and go through the approval procedures as agreed in the insurance contract.
4 Steps to a Smooth Claim
During a trip to Xinjiang with his father, Mr. Zhao from Beijing, his father unfortunately died in an accident. Mr. Zhao did not report the accident to the insurance company and hurriedly handled the funeral affairs in the area. After returning to Beijing, with the pain of losing his husband, he went to the insurance company to claim compensation, but due to the inability to get the necessary proof of the accident, the body disposal certificate and other materials, can not immediately get paid. It's a long way from Beijing to Xinjiang, and Mr. Zhao had to run again in order to get a complete set of claim materials, wasting a lot of money on travel expenses and delaying his claim for many days.
Many people find the claims process a big headache. This reporter has also come across readers like Mr. Zhao who are exhausted by the claims issue. In fact, as long as you understand the links and steps of the insurance company's claims, each step needs to pay attention to the matters of the heart, you will find that the threshold of the claim is actually not as high as imagined, the claims process is not complicated, the heart will be a lot more down-to-earth.
Timely reporting
Article 22 of the Insurance Law stipulates that "the policyholder, the insured or the beneficiary shall promptly notify the insurer when they know that an insurance accident has occurred." After the occurrence of an insurance accident (insurance), the relevant persons (policyholder, insured, beneficiary) should notify the insurer of the occurrence of the insurance accident as soon as possible, known as the report, which is a legal obligation.
Reporting is the first step of claim filing. Timely reporting is important to the insurance company and may have a bearing on whether the claim can be settled or not: on one hand, necessary measures can be taken to prevent the loss from expanding, and on the other hand, the occurrence can be investigated in time and evidence can be collected.
Different insurance products have different restrictions on the time to report a case, with accident insurance, home insurance, car insurance and major accidents having the most stringent requirements on the time to report a case, and some are even limited to 24 hours after the occurrence of the insurance accident. In the insurance contract, there is an "insurance accident notification clause", which must be done in accordance with the requirements. If the policy does not indicate a specific time limit, it is best not to exceed 7 days.
The report can be made in writing or verbally. For example, you can report a case by calling the insurance company's service hotline (report phone number), sending a fax, appointing an agent or going directly to the insurance company's branch.
There are several things that need to be stated when reporting a case.
1. Basic information about the insured: name and ID number (or the insured's date of birth).
2. Basic information about the policy: policy number, type of insurance, amount of insurance, duration of insurance, payment status, etc., of which the policy number is particularly important.
3. Basic information about the insurance accident: the time and place of occurrence, the cause of the accident and the status of the damage, and the current situation of the insured. If it is property insurance, but also inform the relevant organizations to deal with the situation; if it is medical insurance, the content of the notice should also include the hospital, diagnostic results, and so on.
4. The basic information of the person who reported the case: name, identification number, relationship with the insured, contact information, etc., of which the contact information is very important and should be kept open at all times.
Additionally, for cases where there is a possibility of insurance accidents due to unusual causes, such as car accidents, homicides, unexplained deaths, and insurance accidents resulting in damages to the third party, which may lead to lawsuits, etc., in addition to reporting the case to the insurance company, the case should also be reported to the public security, traffic police, and other government law enforcement agencies in a timely manner, so that the case can be investigated as soon as possible to settle the claim as soon as possible.
Tip1
It is more convenient to report the case by phone. Many insurance companies' service calls are free of charge, and most of them record the calls and keep the recordings for a certain period of time. To be on the safe side, the person making the report can also make a note of the time of the report and the operator's number so that the recording can be accessed if needed.
Submitting relevant materials
Article 23 of the Insurance Law stipulates, "After an insurance accident occurs, when requesting the insurer to make compensation or payment of insurance premiums in accordance with the insurance contract, the policyholder, insured or beneficiary shall provide the insurer with such proofs and information as he can provide in connection with the identification of the nature of the insurance accident, the cause, and the extent of the loss." Insurance companies will determine whether to file a case or not based on the supporting materials provided, so providing claim application materials is the most crucial and tedious step. Many claim applications are delayed by the need to provide additional proofs and information just because the supporting materials are incomplete and unclear.
The necessary materials for claim application include: the original identity document of the insured and the original identity document of the applicant, the original copy of the insurance contract, the most recent proof of payment, the Application for Claims, and the Claims Entrustment Letter (indicating the scope of authorization) if the policyholder can't go to handle the claim and needs someone else to do it on his behalf. Filling out all the documents completely and correctly and keeping the customer's copy of the Claim Application Form are two things that applicants need to pay attention to.
In addition, depending on the circumstances, the applicant will have to provide other necessary supporting documents.
Accidental certificatesAccidental certificates broadly include accidental certificates, disability certificates, death certificates, cancellation certificates and so on.
Medical certificates include diagnostic certificates, surgical certificates, outpatient medical records and prescriptions, pathology and blood test reports, and receipts and lists of medical expenses.
Proof of beneficiary identity and relationship with the insuredBeneficiary identification (meaning that the beneficiary himself/herself with an ID card is sufficient; if he/she entrusts another person to lead him/her, he/she needs to provide a notary certificate of entrustment and his/her own identification issued by a local notary public office), and proof of the relationship between the beneficiary and the insured (e.g., proof of the husband and wife relationship, parent relationship, and child relationship).
Tip2
Certificates and information related to claims can be prepared in accordance with the specific requirements of the "claim application" in the insurance contract. However, the insurance company also said that for some reasons, the actual operation of the specific requirements may be slightly different from those written in the contract. After the accident, you should read the policy in detail and consult with the insurance company staff when you report the case, in order to grasp the materials that should be collected for the claim and its validity. If possible, you can also make a recording of the consultation process.
Waiting for approval
After the applicant has provided all the proofs and information as required by the insurance company, the insurance company staff will follow the rules and regulations and collect the relevant evidence to verify the authenticity of the insurance incident as well as the related materials. If no problems are found, the claim application will go into review. After the case manager determines the objective facts and insurance liability based on the relevant evidence, he/she will calculate the amount of payment and make a conclusion on the claim. The case is then reviewed by the approving officer and the case is closed, and the policy beneficiaries will be able to receive their benefits.
It takes time from submission of documents to closing the case, which varies depending on the circumstances. If the case is simple, the insured amount is small, and the documents are complete, the claim decision will be made quickly; on the contrary, the investigation process will take longer and the applicant will have to wait longer. Article 24 of the Insurance Law stipulates that the time limit for insurance companies to settle claims "shall be approved in a timely manner". In the "Supreme People's Court on the trial of insurance disputes on a number of issues in the interpretation (draft)", the "timely" interpretation of "generally for thirty days, except for genuine difficulties".
At present, regulators and insurance companies are trying to shorten the waiting time for insurance claims. For example, the "Beijing Insurance Industry Service Standards for Accidental Injury Insurance and Health Insurance (for Trial Implementation)" launched by the Beijing Insurance Association in 2006 stipulates that "for claims that meet the conditions of the claim, and for which the application information is complete and does not require further verification, the insurance company shall make a decision on the claim within 10 working days from the date of acceptance, and inform the customer of the result in a timely manner. For claim applications for which the processing result cannot be determined within 10 working days, the insurance company shall notify the customer of the processing progress."
Tip3
The investigation stage of the insurance company's staff not only requires the cooperation of the relevant departments and authorities, but also, as an applicant, the need for active cooperation with the insurance company's proposed needs, otherwise it will affect the timely payment of claims.
Notification of claim
After the insurance company has made a decision to pay the claim, it will contact the relevant beneficiaries according to the contact information and address on the application form to collect the claim.
Order of Inheritance
If the beneficiaries are designated beneficiaries, they will receive the insurance benefits in the designated order according to the contract.
If the beneficiary is a legal beneficiary, it must be received by the first-order heirs (spouse, children, parents), and the recipient must sign a written guarantee that he will notify the other first-order heirs before receiving the benefit.
If the beneficiary is an incapacitated person, his/her guardian will receive the pension on his/her behalf.
Methods of collection
For the convenience of the insured, the insurance company provides payment methods such as cash, cash check, transfer check or bank remittance. In case of cash collection method, the recipient needs to provide relevant proof.
Tip4
It is recommended to provide a copy of the beneficiary's bankbook as much as possible and choose to receive the insurance benefit by transferring money to minimize the cash risk. Before using this method, you need to sign a contract with the insurance company to agree to entrust the bank transfer. In addition, the beneficiary is reminded not to disclose the bank account password to outsiders.
Extended reading: insurance how to buy, which is good, hand to teach you to avoid the insurance of these "pits"