Case: On June 30th, 2003, 165438+ Zhang Hong (pseudonym) signed a term insurance contract with a life insurance company, and the insured was Wang Gang (pseudonym, Zhang Hong's husband). On February 9, 2007, at 65438, Wang Gang was diagnosed with liver cancer, and later Zhang Hong asked the insurance company to settle the claim. The insurance company refused to pay the premium and decided to terminate the insurance contract on the grounds that Zhang Hong "failed to truthfully explain his fault".
But Zhang Hong said that he didn't know and couldn't know that Wang Gang was a hepatitis B patient, and he didn't have any intention or negligence. However, during the trial, the insurance company submitted to the court the medical record of Wang Gang suffering from hepatitis B for more than 20 years.
The judge held that although Zhang Hong didn't intentionally take out the insurance in spite of illness, she could know that the insured had been ill for a long time and was subjectively at fault. Finally, Zhang Hong applied to the court to withdraw the lawsuit, and the court agreed to this application. Five years after the payment, Zhang Hong and her husband didn't get the protection they wanted.
Analysis: This is not the first time we have heard of such a real case. When signing the insurance contract, the insured failed to fulfill the necessary obligation of informing, which led to disputes and even failure to obtain compensation.
Usually, when consumers buy life insurance or health insurance products, there is usually a health notification column on the insurance policy, requiring the insured to truthfully inform their health status and past medical history. According to the Insurance Law, the insurance company has the right to terminate the insurance contract if the applicant or the insured fails to provide health information intentionally or through negligence, which is enough to affect the insurance company's decision to underwrite or increase the insurance premium rate. Once out of danger, insurance companies often refuse to settle claims on the grounds of "taking insurance with illness and not telling the truth".
Of course, with the implementation of the new insurance law in China last year, Zhang Hong will not be denied compensation.
Because the new insurance law has added an "incontestable clause" (A 16), the specific expression is as follows:
"The insurer has the right to terminate the contract if the insured intentionally or due to gross negligence fails to fulfill the obligation of telling the truth stipulated in the preceding paragraph, which is enough to influence the insurer to make a decision to agree to underwrite or increase the insurance premium rate.
If the right to terminate the contract stipulated in the preceding paragraph is not exercised for more than 30 days from the date when the insurer knows the reason for termination, it will be extinguished. If it is more than two years from the date when the contract is established, the insurer shall not terminate the contract; In the event of an insured accident, the insurer shall be liable for compensation or payment of insurance benefits. "
Many insurance consumers have this experience. When applying for insurance, the agent will make himself say "no" in the column of health notification, regardless of whether the insured or the insured has a past medical history or smoking history. However, in the event of an insurance accident, the insurance company will take the medical records of major hospitals and finally give a sentence, "If you didn't tell us truthfully, we won't pay for it."
In fact, this is very unfair to consumers.
Because at the time of insurance, most consumers did not fill in the health history truthfully because of negligence or fault, and even some of them were "taught" by insurance agents, and only a few of them deliberately concealed or could cheat insurance. Whatever the reason, the insurance company is actually capable of investigating the health status of the insured during the underwriting process. The insurance company does not do this kind of active investigation and underwriting work, but only judges according to the materials filled in by the insured. As a result, after the accident, it was said that the insured and the insured did not tell the truth, so they refused to pay compensation.
To this end, China's new insurance law is also in line with international standards, adding "incontestable clauses". On the one hand, it is clear that the insurance company must ask for the obligation of telling the truth in advance, that is, the principle of "inquiring and telling", and the insured has no obligation of "actively telling". On the one hand, if an insurance company discovers that it has a serious medical history within two years after underwriting and underwriting, and fails to inform it, it can terminate the contract. However, if two years have passed, the insurance company still hasn't found the situation, or found the situation but didn't communicate with the insured, and then refused to pay for it when it happened, it wouldn't be established.
For the insured under the long-term life insurance contract, such an interest protection mechanism is of great significance.
In the future, if an insurance company refuses to pay compensation for similar reasons, consumers must know what their specific situation is, and whether Article 16 of the new Insurance Law can be used to refute the reasons for the insurance company's refusal.
Tips: On the other hand, consumers must be reminded that if the insured and the insured adhere to the principle of honesty and credit, and "honestly" fill in all kinds of written inquiries on the health notification form (please note that the insured only needs to answer the written inquiries of the insurance company), even if they have suffered from a certain disease or have suffered from a certain disease, it will not necessarily lead to the result of refusing insurance, but it will be a powerful guarantee for the insured to make normal claims in the future.
For example, "Have you ever had or ever had hepatitis?" This is a common question listed in the insurance policies of various insurance companies. This question should have been clear and easy to answer. But as in Zhang Hong's previous case, many people may be afraid to fill in "Yes". Why? I believe many people are afraid that telling the truth will lead to the adverse results of insurance companies such as refusing insurance or increasing fees.
But this is a misunderstanding. In fact, according to the requirements of the insurance policy, tell yourself the current physical health. Even if you have been or are sick and taking medicine, you may not be able to "buy insurance" or increase the cost or refuse insurance. On the contrary, hide some important facts, even if you buy insurance at a normal price, you will eventually
Further reading: How to buy insurance, which is good, and teach you how to avoid these "pits" of insurance.