The first thing you need to know is that you can't afford to pay for the cost of a new car, but you can afford to pay for the cost of a new car, and you can afford to pay for the cost of a new car.
In March 2019, Ms. He purchased a critical illness insurance policy with a million-dollar medical insurance policy for all three members of her family. Among the China Life insurance contract provided by Ms. He, we can see that Ms. He purchased China Life Insurance Company "Guoshou Xiangrui Whole Life Insurance" additional "Guoshou Additional Xiangrui Early Payment Critical Disease Insurance" and "Guoshou Ru E Kangyue Million Dollar Medical Insurance Paragraph A" for her family on March 27, 2019 The effective period of the contract is March 28, 2019 Date.
This insurance thing, to put it in a more complicated way, it is indeed quite cumbersome, why? Because the insurance contract is particularly thick and has a lot of clauses in it, and again insurance is very simple, why?
As long as you are healthy, and after passing the relevant processes, then as long as you pay the insurance policy next policy can come into effect.
Most of us are afraid of the trouble, usually choose the second "simple" purchase strategy, roughly after listening to the explanation of the sales staff, pay the money to underwrite, receive the original policy contract is generally very little careful study, this is due to such a situation, often there will be an unexpected The problem occurs.
Anyone who buys an insurance policy doesn't want to use it, but it's a shame that Ms. He's husband was hospitalized in June 2020 due to illness. According to Ms. He, her husband suddenly fainted and suffered a cervical spine fracture for no apparent reason, and then went to the Army General Hospital in Shenyang for treatment, a **** treatment costing around 150,000.
150,000 is not a small amount for any family. Ms. He took this policy of her husband's to China Life Insurance Company to make a normal claim after he recovered.
Ms. He thought she would be reimbursed for these expenses, but she didn't expect to get unexpected news. After about 20 days of waiting, the insurance company notified Ms. He that your application for this insurance policy was rejected, and the insurance company gave the reason for the rejection as: because Ms. He didn't inform her that her husband had had a relevant hospitalization back in October of 2019.
Ms. He said, her husband did have checkups and treatment in the hospital last year, but because the medical expenses were not enough to cover the reimbursement standard of 10,000 deductible for million-dollar medical insurance, so she didn't apply for a claim from the insurance company, and she didn't think it was necessary to inform the insurance company about the situation, which she didn't expect. This has become the main reason why China Life Insurance Company refuses to pay claims today.
Ms. He said that because her son had just joined China Life less than a month ago, she one was originally intended to buy insurance, and the second was also wanted to give her son a helping hand.
But although their son is a salesman, but because only a short time ago, the relevant provisions of the contract has not been fully understood, so his son asked his "master" to Ms. He introduced the content of these insurance.
Whether or not you need to inform your insurance company about your current medical insurance policy, and whether or not the insurance company has the right to deny you compensation, is not clear. The company's website is a great place to find out more about how to get the most out of your home, and how to get the most out of your home.
Subsequently, the reporter asked his son's master by phone:
"Master": refused to compensate for the matter of what exactly is the reason I'm really not clear
Reporter: Then I can clearly get the answer in which, and you at first! The first thing I want to say is that I'm not sure if I'm going to be able to do this, but I'm sure I'm going to be able to do it, and I'm sure I'm going to be able to do it.
"Master": This insurance is not sold by me, it is sold by her son, and I am not sure about the subsequent insurance service .
After that, Ms. He said that she has been reflecting the situation to China Life's official customer service since the end of June this year, but so far has not been able to straighten out why she was refused compensation. Ms. He believes that before I bought it, I was in good health, and the insurance company underwrote it before insuring me, so I didn't have to tell the insurance company about my health when I got sick at a later stage; and the insurance company didn't have anyone to say that I need to inform the insurance company about my headache or hospitalization in the future; and the insurance company has already charged me a premium this year. The insurance company has already collected my premiums for this year.
The reporter came with Ms. He to the Shenyang branch of China Life Insurance Company Limited, No. 40 Feng Yang Road, Sujiatun District, in the afternoon of the same day.
Unluckily, all the relevant persons in charge of the company went to a meeting abroad and were not received. Taking advantage of this time, Ms. He provided the reporter with a notice of refusal issued by China Life Insurance Company Limited Shenyang Branch on September 2:
Why do you say that the sales of insurance companies nowadays are more and more difficult to do, a lot of people flirted with the idea that some insurance companies are afraid of accidents, and others are afraid of you recognizing the word, and when we found that this joke really happened, it was not so The first thing you need to do is to get rid of all the stuff you've got.
I'll briefly summarize the main story of this case:
In March 2019 , Ms. He purchased China Life's "Guoshou Xiangrui Whole Life Insurance" for her husband, which is supplemented by the "Guoshou Xiangrui Early Payment Critical Disease Insurance", and the "Guoshou Ru E Kangyue Million Dollar Healthcare Insurance, Paragraph A."
In October 2019 , the insured was diagnosed with ankylosing spondylitis, osteoporosis, coronary atherosclerotic heart disease, and unstable angina, and did not file a claim with the insurance company because the cost of treatment did not meet the 10,000 deductible.
June 2020 , the insured was hospitalized again, during which time *** cost 150,000 dollars.
October 2020 , applied for a claim to China Life Insurance Company (Million Dollar Medical Insurance Liability), the insurance company refused to cover the cost of this hospitalization and refunded the premiums paid in 2020, and the contract was terminated (Million Dollar Medical Insurance) on the basis that the insured was hospitalized in October 2019, which did not qualify for the renewal of the underwriting for the second year of the insurance policy.
Through the above case, we may all feel that this is another case of "insurance companies playing tricks", from Ms. He's encounter and rights experience, there is indeed the insurance company "dragged the mud", "introduced the insurance company", "the insurance company", "the insurance company", "the insurance company", "the insurance company", "the insurance company", "the insurance company", "the insurance company", "the insurance company". " "The introduction of insurance coverage responsibility is not clear" "the second medical insurance renewal audit is not clear" and so on, but sometimes we can not unilaterally only look at the media after editing processing, or even scripted reports, you have to know
This is the first time I've ever seen a news report from an organization that has a certain amount of influence in the community, and it's very easy to "favor" a certain group of people.
Insurance company refused to claim disputes have always been with "black" nature of the popular subject matter, attributed to its natural causes of its own insurance company for many years of accumulation of "persistent problems", but also contract terms "traps" and some management problems. "and some management problems but in fact there are also some social injustices colored view, the most terrible of which is as a television station this influential organization "chaotic rhythm".
The media made a misleading mistake of guiding the insiders from the beginning, and in fact, this is a kind of misperception of insurance that some of us "think" we have, and this is the first time we have seen this. The idea is that whether you are healthy or not, as long as you pay the premiums after the insurance company's "audit", the insurance will take effect, and since the contract is in force, the insurance company will not have any reason to refuse to pay for the insurance on the basis of past medical history, hospitalization, or even what medicines you have bought before the policy was issued. The first thing you need to do is to get a good deal on a new product.
I've seen a lot of people commenting on insurance claim disputes, expressing the view that since the insurance company didn't investigate the policyholder's health before taking out the policy, it's the same as recognizing the policyholder's health, and that since the insurance company is underwriting the policy, it should fulfill its responsibility to pay for the insurance in the later stages of the process. Excuse me, but what we think of as "common sense" is fundamentally wrong in insurance.
In the rules of insurance, without triggering the necessary "medical" rules (e.g., if you are very old, or if you do not meet the requirements of the health notices you need to remind the insurance company of), the insured's physical condition has to be determined by the contractual terms. If the insured is dishonest or conceals the insured's health condition, resulting in the insurance company investigating the insured's dishonesty, then the consequences of refusing to pay the claim will naturally be more severe.
These are the first time I've ever seen a policyholder who has been in the market for an insurance policy, and I've never seen one before.
There are also many people who would say that the insurance company will first investigate and decide whether to cover the case.
First, the insurance industry itself has a mature insurance process system , according to the content of the health information, will trigger different response mechanisms. For example, in some cases where the future risk is not clear, medical checkups will be provided; in some cases where the situation is not so good, the underwriting results will be increased, extended, or exempted from liability; and in cases where the insurance company's experience shows that the risk of future claims is high, the insurance company will simply refuse to cover the claim.
Secondly, the contract originally required the policyholder to be honest and trustworthy, you play mindful, comply with the rules of the insurance company's insurance requirements, but let the insurance company directly out of the cost to investigate you? The insurance company will have to pay more for the survey; if the survey comes up with a problem, the premiums will not only be forfeited, but will also be subsidized; even if the insurance company can take such a way to control the underwriting methods in the future, the costs incurred will certainly be reflected in the premiums, then the future premiums will certainly be more expensive, so that the extra cost will certainly be passed on to the healthy body population, do you think that this is reasonable?
Third, the insurance company's insurance rules have to follow the requirements of the relevant laws and regulations, playing the game does not comply with the rules of the game, even if, but also want to destroy the rules of the game, is not a little bit out of line.
And the reason why this report is a bit of a "layman's guide to the suspicion of the insiders" is that the wrong insurance company's normative requirements, insurance company's "underwriting" is part of the "insurance". The insurance company's "underwriting" is a system of "recovery and investigation" in the event of an accident, which does not mean that the insurance company's "underwriting" policy is necessarily valid, and the premise of the validity of the policy is that the customer actually fulfills the "honesty and trustworthiness" requirement.
And the report lacks a content is the customer insurance refused to prioritize the first investigation of the customer's own insurance whether there is a problem , but only "blame" the insurance company's "inaction", this This in itself is unfair, if there is the fact that the customer "with sick insurance", then as a large influential news media organization how to end? So I think there's something wrong with that, and I'm going to raise further questions later.
The main point of the report about Ms. He's refusal to pay was to ask whether the "change in the insured's health during the second year of the policy renewal period affects the insurance company's responsibility to fulfill its obligation to pay out benefits at a later date.
But we should note that the type of illness described in the diagnosis of Ms. Ho's husband's previous hospitalization is highly problematic.
Ms. Ho's husband was hospitalized in October 2019, and the diagnostic case states that he suffers from: ankylosing spondylitis, osteoporosis, coronary atherosclerotic heart disease, unstable angina. Anyone with a little bit of life experience should know that none of these four diseases can develop in a short period of time.
And Ms. He insured her husband in March 2019, so we don't know if she was already suffering from the disease before she bought the policy, or if she was just "holding on" to it and not going to the hospital. But the insurance company, based on its own "big data" claims experience and the causes and timing of these illnesses, naturally had reason to suspect that Ms. He had "taken out an insurance policy with a disease" for her husband, but the media didn't say anything about it, and the insurance company had no evidence to support its claim. The fact is that the company's insurance policy is not based on any evidence, but on the fact that it is not based on any evidence, and that it is not based on any evidence.
Even if the insurance company is skeptical, there's not enough evidence to support it, so it's obvious that the reason for denying the claim is untenable. So let's assume that Ms. Ho's husband did meet the healthcare requirements of the policy, and let's look at the relevant renewal requirements for this MMP policy.
The fact that Ms. He's husband's insurance claim did not involve a major disease means that the disease he suffered did not meet the conditions for a major disease insurance claim, but since he incurred 150,000 in treatment costs and exceeded the 10,000 deductible condition of the MMP insurance policy, he would normally be able to apply for reimbursement for the MMP insurance policy, which is why I want to emphasize that the purchase of a commercial insurance policy should be based on a critical illness insurance policy + a MMP insurance policy.
This is why I emphasize that the purchase of commercial insurance must be based on critical illness insurance, but there is also a need for us consumers to pay attention to the million medical insurance.
The reported dispute, the main focus of the discussion is whether the insurance company can terminate the right of the contract individually due to changes in the insured's health during the second year of the renewal period of the Guoshou Ruikangyue Millionaire Medical Insurance A.
This is the first time that we have discussed the right of the insurance company to terminate the contract.
Historically, the issue of renewing a million-dollar medical insurance policy has been of great concern to many insurance customers, who are afraid that if their health changes during the renewal period, the insurance company will no longer cover them, resulting in the absence of medical insurance coverage afterwards.
China Life's "Guo Shou E Kang Yue Million Medical Insurance A paragraph", when launched on the claim that it is a "super social security", that its renewal terms in the end how?
According to the terms of the contract, the insurance period and the renewal of the specific provisions of the contract are as follows:
This content is really quite professional, but also quite mouth-watering, I translate the adult language is: This million medical insurance from time to time divided into two parts, the first part of the first time, the validity of the period of a year, if the first year The first part is the first insurance, valid for one year, if the first year of insurance should be paid, the contract is terminated; the second renewal of the insured person's body can not change (including hospitalization, medical examination abnormalities, medical card to buy drugs), and pay the premiums. After that, when the third year of payment begins, the insurance company will not reject the policyholder's application for renewal because of changes in the insured's health, until the insured is 80 years old. In short, you can't renew the policy if you are not insured in the first two years or if there is a detectable change in your health.
So the root cause of Ms. He's husband's refusal is that the insurance company believes that Ms. He's husband doesn't meet the conditions for the second renewal that need to be reviewed and approved by the insurance company. Then the question arises, this clause may be right if you stand in the position of the insurance company, because one of the two conditions is not met, but how is the point in time when the insurance company's review and approval is determined? To a layman's understanding, it should be before the second premium is collected, as to whether we need to inform the insurance company of the changes in our clients' health, or whether the insurance company is independently checking on our clients' health is not clear; From the client's point of view, since the second premium is collected, it should be the default time for the insurance company to review and approve the policy, and then the insurance company will not be responsible for any changes in our clients' health. From the customer's perspective, since the second premium was charged, it should be tacitly assumed that the insurance company's review was agreed upon, and naturally, the responsibility to continue the coverage should be fulfilled.
There is a great deal of ambiguity here. According to the relevant laws and regulations in China, since the contract is issued by the insurance company, the insurance company should take responsibility for the consequences of disputes over the terms of the contract or unclear interpretations, so I think it's clear that the insurance company's direct refusal to pay is not justified, and the correct approach is to pay Ms. Ho's husband the amount he paid this time, in accordance with the contract. The right way to do this is to pay for the costs associated with the hospitalization of Ms. He's husband, and then the contract is terminated, and the renewal of the policy is no longer available, which is a fairer approach.
In fact, the situation of Ms. He's about the "Guoshou E Kangyue Million Medical Insurance A" is not an isolated case in the industry. Some of the customers who purchased this insurance could not renew it after the first year's insurance claim; and there were cases like Ms. He's, who didn't meet the conditions of the first year's claim, but was indeed hospitalized, or was examined for chronic diseases such as high blood pressure and heart disease and was rejected by the insurer in the second year.
These are the cases in which the insurance company has rejected the claim.
Not only does China Life's "E-Comfort Million Medical Insurance" have this kind of renewal trap, but also AIA's "Smart Choice Healthcare", NWS's "Kang Jian Hua Gui", and Taikang Life's "Healthy Premium" all have this kind of similar requirement for the second year of renewal, but we can't be fully aware of this, so we need to be aware of it, and we can't be sure that we'll be able to get the best out of it. The first thing you need to know is that you're going to need to be able to get your hands on some of the most popular products in the world, and you're going to need to be able to get your hands on some of the most popular products in the world.
No matter how good the description of the insurance coverage is, there is certainly something that is not favorable to us as consumers.
This is the first time I've ever seen an appliance that was designed to be used as an appliance, and I've never seen one that was designed to be used as an appliance, but I've never seen one that was designed to be used as an appliance.
An experienced insurance agent who is responsible for their clients will always make sure that they are aware of the disadvantages of the insurance contract, so that consumers are aware of the disadvantages, such as the case of Ms. Ho's purchase of a new insurance policy. For example, if the insurance agent had explained to Ms. Ho before and after she purchased the Critical Illness Insurance or the Million Dollar Medical Insurance that she should try not to take out any insurance in the first two years and not to take out any unnecessary tests, or to say that taking out insurance in the first two years or taking out an abnormal test would have a negative impact on us as consumers, then we would have paid more attention to ourselves, and we would not have had to face any dispute.
If the insurance agent does not provide adequate explanation and prompting of the terms of our contract that are unfavorable to us as consumers, then the dispute over the claim payment will naturally be the "main responsibility" of the insurance agent, and the insurance company will have to bear the responsibility. The insurance company has to bear the responsibility. However, such disputes are usually resolved through civil litigation, then the evidence obtained by the agent is the decisive key to the success of the defense.
And coincidentally, Ms. Ho's insurance agent was her own son. Although Ms. He's son emphasized that he was his "master" in introducing the insurance policy to Ms. He, Ms. He's son was the salesperson who made the most profit from the sale, and naturally, he had to bear the responsibility of interpreting the insurance contract incompletely. The main responsibility". If the self-insurance pieces want to defend the rights of this situation, it is difficult to protect their own interests , after all, their own family members to sell their own insurance, there will be no "subjective" intention, by their own people "pit", it is difficult to make others "responsible". The first thing you need to do is to get your hands on a new one, and you'll be able to do that.
So, now many insurance companies through the "enrollment" of the way to recruit insurance agents in the name of the actual recruitment of the "customer" itself, some people are also running to "their own sales of insurance to themselves" to achieve the purchase of insurance to save money. "The first thing you need to do is to get your hands on a new pair of shoes or boots, and you'll be able to get your hands on a new pair of shoes or boots.
But insurance is an industry that requires a lot of specialization, and it's not something you can do simply by thinking you can "read" the contract. Ms. Ho's son would not have "victimized" his own family, and I'm sure he could have read the terms of the contract, but why did this happen? This shows that in addition to the professionalism of insurance work, there is also a certain amount of time to accumulate experience. Without having experienced many claims, it is very difficult for a salesman to find out how much these terms and conditions will affect the actual situation, you said that you can't even understand your own family's claims, so how can you believe that he will be able to serve the customer well?
First of all, through the previous narrative, Whether Ms. He can finally get her claim or not depends on what the prerequisites are.
If the insurance company investigated Ms. Ho's husband's past medical history or medical exams, or even evidence that he had purchased medication on his health insurance card, then it would be a no-brainer that he would have to return the premiums.
If Ms. He really does not exist "with the disease" situation, encountered this kind of contractual terms due to the lack of clarity brought about by the claims dispute, we have to look at the responsibility of who.
If the salesperson is not Ms. Ho's son, then as long as there is evidence to prove that the salesperson did not inform Ms. Ho of the relevant unfavorable terms of the situation, you can negotiate, complain, and sue to protect their interests, and the best result would be that the insurance company pays for the hospitalization expenses and terminate the contract of the Million Dollar Medical Insurance, and no longer provide the renewal of the insurance service.
But the salesperson is Ms. He's son is another story, because the salesperson and the customer have a relationship of interest ****, who can guarantee that it is not a family negotiation, But even so, you can still complain, the reason is that the insurance company charged the second year of premiums, the same as the insurance company has agreed to the customer's request for renewal.
This situation in the insurance company to find negotiation is obviously no use, only through the CBI complaint or directly sued to the court, to the insurance company to charge the second year of premiums, so that the insurance company to bear the responsibility of compensation.
The end result is that Ms. He will definitely get her claim paid, but the renewal of the MMD policy is out of the question.
I've always emphasized the importance of having a critical illness insurance policy and a medical insurance policy to ensure that if you have a medical condition that does not meet the criteria for a critical illness claim, then the medical insurance policy will cover most of the cost of the medical treatment. But million-dollar medical insurance is not without its pitfalls, as in the case of Ms. He bought this million-dollar medical insurance renewal there is a "second review" of the problem.
In fact, now many can be purchased separately million medical insurance basically does not exist "second review" of the problem, as to why China Life still has such a million medical insurance also as the "main" with the insurance recommended! The first thing you need to do is to get your hands on a new one, and you'll be able to do that.
It's true that insurance contracts are complex, with a lot of content, and a little bit of inattention is likely to lead to damage to our consumers' interests, and that China Life is not a big enough brand. The fact is that the company's products and services have been widely recognized by the public and the public. We can only say that the product itself who have no ability to change, but as an insurance salesman is not in the sale of insurance to do our best to the unfavorable provisions of the full description; and as a consumer we should likewise know, we not only want to understand the purchase of the contract are governed by what we have to know what is not to care about, or is unfavorable to us.
Insurance is different from other commodities, in that if something goes wrong, you don't want it or you replace it with something else, but insurance is different, especially multimillion-dollar health insurance.
This is the first time that we've seen an image of the world's most popular TV show, and it's the first time that we've seen the world's most popular TV show, and it's the first time that we've seen an image of the world's most popular TV show, and it's the first time that we've seen an image of the world's most popular TV show, and it's the first time that we've seen an image of the world's most famous TV show. The ability to "recognize" the core defects of the product, in the health of the time must be more comparisons and consultations, do not be afraid of trouble, so as not to leave their future "trouble", then it is really late.