Case details
The newborn was found to have aspiration pneumonia on the day of birth. After she recovered from the hospital, her parents bought insurance for Xiao Xuan (a pseudonym) in order to make her daughter more secure in the future. Less than a year later, Xiao Xuan was admitted to a hospital in Zhengzhou for treatment of a chest tumor, but the insurance company refused to pay the insurance premium on the grounds of concealing his illness. Should the insurance company pay?
From July 2065438 to July 2007, Xiao Xuan was diagnosed with neonatal aspiration pneumonia on the day of birth. Less than a week in Xiangcheng County Hospital, Xiao Xuan recovered and was discharged. On September 30th of the same year, Ms. Yang, her mother, bought "Children's Supertreasure Old-age Security (Version 2.0)" and "Children's Supertreasure Critical Illness Insurance (Version 2.0)" for her daughter in an insurance company in Xuchang, and signed a life insurance contract with the insurance company, stipulating that Ms. Yang would insure her daughter. The two insurances will expire at 24: 00 on September 29th, 2047. The payment method is 10 year, and the insured amount of "Additional Children's Chaobao Critical Illness Insurance (Version 2.0)" is 200,000 yuan. After signing the contract, Ms. Yang paid the first year insurance premium of 2040 yuan.
Insuring her daughter is for her safety and health, but what Ms. Yang's family never imagined was that insurance is sometimes not "insurance".
From July, 2065438 to July, 2008, Xiao Xuan was admitted to a hospital in Zhengzhou for 40 days because of a chest tumor. The high cost of treatment puts the families who are not rich in trouble. Therefore, Ms. Yang's family asked the insurance company to pay compensation according to the amount agreed in the insurance contract, but the insurance company refused to pay compensation on the grounds that Ms. Yang did not truthfully inform Xiao Xuan of her physical condition before taking out the insurance.
The claim was unsuccessful. Ms. Yang and her husband brought the insurance company to court with a complaint, arguing that the salesman of the company did not ask about the past medical history when underwriting. However, their family decided to take out insurance only when the insurance salesman went home many times to promote insurance and they refused, and the other party proposed to pay the insurance premium in advance.
After finding out the facts, the Weidu District Court of Xuchang City held that Xiao Xuan's chest tumor did not belong to the secondary disease of neonatal aspiration pneumonia. Even if the applicant did not inform the plaintiff that he had neonatal aspiration pneumonia, the insurance risk of the defendant in this case would not necessarily increase. Therefore, it was decided that the insurance company should compensate Xiao Xuan for 202,040 yuan, and the case acceptance fee was 433 1 yuan, and the fee was halved to 2 166 yuan, which should be borne by the insurance company.
After receiving the judgment, the insurance company refused to accept the judgment and filed an appeal. Recently, the case was heard in the second instance of Xuchang Intermediate People's Court. The court of second instance held that the facts were clear and the applicable law was correct, so it upheld the original judgment.
Case study:
In the above cases, we need to pay attention to two points when buying insurance: first, reliable insurance service personnel are very important; Second, when buying insurance, you must remember the health instructions.
First of all, find a professional and reliable insurance service personnel.
Insurance is a very long-term thing. Whether you can buy the insurance that suits you and whether you can make a normal claim plays a very crucial role, so you must choose a reliable insurance service provider.
The professional qualities that reliable insurance service personnel should have;
1, strong professional ability
Reliable insurance service personnel must have strong professional knowledge, understand the differences of various types of insurance, analyze the places where various products are suitable for customers, and will definitely take customers to health notification professionally.
2. Don't blindly follow and cater to the opinions of the insured.
Some policyholders have a general understanding of insurance and may have some more inclined choices in their hearts.
And a qualified intermediary should help the insured objectively analyze their own specific situation, use their professional knowledge to point out the unreasonable parts of their ideas and give adjustment suggestions.
3. Willing and daring to provide written evidence.
Many professional and skilled agents can answer your questions almost 100% quickly, which is often the headline of company training and may not be the most responsible answer for you.
And a professional agent should come up with various clauses and laws and regulations in detail to explain the specific situation of insurance products to you.
Don't make any unrealistic promises.
Many insurance intermediaries always clap their chests when persuading people to take out insurance, not to mention whether they will work in the insurance industry for a lifetime.
Do you think you can believe his promise to be a salesman all his life?
If the insurance product has a clear income guarantee, it must also be clearly stated in the insurance contract; If not, and the insurance agent has made a generous guarantee, it is definitely unreliable.
5. Seek the best interests for customers, not afraid of trouble.
Some agents deliberately avoid medical examination by not involving high insurance schemes because they are worried that customers are afraid of trouble.
Second, health notification is very important when purchasing critical illness insurance.
As an ordinary policyholder, you must also know that you must give health information before buying insurance, especially the types of health insurance. Insurance companies have stricter requirements for health information.
To fill in the health notification form correctly, you need to master the following three principles:
1. Only inform the inquiry.
At present, most of the insured's health information is limited, which means that when the insurance company asks us questions, we need to answer them truthfully. We don't need to answer them if we don't ask them.
You may say that the terms of the insurance contract are ten or even dozens of pages long. How is it possible to fill in as many as a dozen or twenty health notices? Be sure to seek professional help.
2. Don't go for a medical examination on purpose.
Health notification is to inform the diagnosed disease. If it is not diagnosed in the hospital, it is unknown and does not need to be informed. This situation does not belong to concealment.
On the contrary, if after the physical examination, the physical examination report issued by the hospital shows that some indicators are abnormal, then it must be told that this is a known situation, and not telling is hiding.
It is precisely because the "truth" in telling the truth refers to the known and diagnosed, which belongs to the objective fact, not the subjective fact that you think exists or does not exist.
Therefore, unless the insurance company clearly stipulates that you need a physical examination, you should not deliberately have a physical examination, which is equivalent to finding trouble for yourself and raising the insurance threshold.
3. Timely supplementary notice.
In fact, supplementary health notification is the same concept as pre-insurance health notification, which supplements the situation of forgetting to inform or missing information in pre-insurance health notification.
The result of the supplementary notice is nothing more than standard underwriting, exclusive liability underwriting, fee increase underwriting and refusal.
Supplementary notice is divided into three time periods:
1. hesitation period: If supplementary notice is given during this period and the audit fails, all premiums can be recovered.
2. After the hesitation period and within two years of insurance: during this period, supplementary health notice will be given. If it fails to pass the examination, the insured company will ask for surrender and only get back the cash value.
3. Insured for more than two years: during this period, supplement the information. According to the provisions of the Insurance Law, an insurance company cannot terminate the contract, but still needs to perform the contract guarantee responsibility.
When we apply for insurance, we must truthfully answer and fill in the contents inquired by the insurance company to avoid disputes after the insurance accident.