However, in this process, another problem often appears: the health notification questionnaire will be ignored.
This problem is related to whether the claim can be settled smoothly in the future, and there are many places to pay attention to. This article analyzes the part about telling the truth, which you must pay attention to when buying insurance products. In my column, there is a comprehensive analysis of this kind of problem: when you apply for insurance, you should fill in the health notice truthfully, otherwise the contract can be invalid. Why?
Some people may say: health advice is nothing serious. Even if there may be claims disputes in the future, it is not bad to go to court. Besides, isn't there a two-year defense in the insurance law? If the insurance company doesn't find out my health status within two years, it's over.
Two-year incontestability is not an imperial sword, but the principle of utmost good faith is the basis of the whole insurance contract. If there is a deliberate expiration, two years of irrefutability is not enough, and everything must be done on the basis of law. Don't listen to the bluff of some radical insurance companies. If there is a claim dispute in the future, your own business has nothing to do with him Besides, at that time, I was sick and busy with treatment. How could I find the energy to deal with this matter?
Let's talk about why we should fill out the health notification form truthfully, and what consequences we may face if we don't fill it out truthfully.
I. Legal basis
The definition of insurance in Chapter 2 and Article 11 of the Insurance Law:
An insurance contract is an agreement between the applicant and the insurer on the relationship between insurance rights and obligations. When concluding an insurance contract, the parties shall reach an agreement through consultation and determine the rights and obligations of each party in accordance with the principle of fairness. Unless insurance is required by laws and administrative regulations, an insurance contract is concluded voluntarily.
The principle of fairness is embodied in the practice of telling the truth by following the principle of utmost good faith.
1, for insurance companies:
As the drafters of insurance contracts, insurance companies have more power to decide and interpret contract terms. If the terms of the contract are not clearly informed to the insured, it is difficult for the insured to judge whether he is suitable to buy the product and what conditions are needed to buy insurance.
In the actual operation process, the insurance company or its agent must inform the insured of all insurance liabilities, exclusions and precautions, and focus on the exclusions so that the insured can understand clearly.
The insurer has the right to terminate the insurance contract if the applicant intentionally conceals the facts and fails to perform the obligation of truthful disclosure, or fails to perform the obligation of truthful disclosure due to negligence, which is enough to affect the insurer's decision on whether to agree to underwrite or increase the insurance premium rate.
If the applicant intentionally fails to fulfill the obligation of telling the truth, the insurer shall not be liable for compensation or payment of the insurance premium for the insurance accident that occurred before the termination of the insurance contract, nor shall it refund the insurance premium.
If the insured fails to fulfill the obligation of telling the truth due to negligence, which has seriously affected the occurrence of the insured accident, the insurer shall not be liable for compensation or payment of insurance benefits for the insured accident that occurred before the termination of the insurance contract, but may refund the insurance premium.
2. For the insured:
The insured is most familiar with the health condition of the insured. If the insured fails to inform the insurance company of the insured's risk status and the important facts and factors that affect the insurance company's underwriting, it is difficult for the insurance company to judge whether it can underwrite and in what way.
In the actual operation, the insured needs to inform the insurance company or its agent of the actual health status, medical records and physical examination results of the insured. , reflected in the insurance operation, that is, truthfully fill in the health notification questionnaire, and provide the corresponding inspection report and medical record for the notification part.
Second, why do insurance companies require truthful disclosure?
We buy insurance to transfer risks.
By concluding an insurance contract, I will pass on the risks that I can't bear and I don't know how much impact it will have on the insurance company.
Insurance companies are not charitable organizations, and not all insurance will be accepted unconditionally. When accepting an application for insurance, the risk of the insured will be evaluated, and then it will be decided whether to underwrite and under what conditions to underwrite the results.
Using risk management to explain the behavior of insurance companies is as follows:
1, risk identification:
When accepting the insurance application, you need to fill in the health notification questionnaire, which contains information such as MBI index (height/weight ratio), whether you have a certain disease, whether you have had a certain symptom, past medical records, physical examination results, occupation category, income status and so on.
The health notification questionnaire of an insurance company is as follows:
2. Risk assessment:
For the collected information, the relevant information is underwritten by personnel with medical professional knowledge, whether it has direct or indirect influence on the future health status of the insured, and whether there is adverse selection tendency-underwriting result.
3. Risk avoidance and loss control:
For those whose underwriting results fail to meet the underwriting standards, they will choose appropriate risk management countermeasures to transfer the risks of insurance companies, such as excluding underwriting, increasing underwriting and refusing underwriting.
Underwriting results of insurance companies:
Underwriting results of life insurance and critical illness insurance: underwriting results of medical insurance: The above underwriting results are based on the information provided by the insured. Once the information is incorrect or untrue, the underwriting results will be greatly biased. It is unfair to the insurance company if the symptoms do exist but are not told. According to insurance laws and regulations, after understanding the actual situation, the insurance company can consider the contract invalid and not bear the corresponding insurance liability.
In this way, the original intention and desire to buy insurance can not be realized, and it can only be stolen and suffered heavy losses.
3. Failing to tell the actual situation truthfully:
The following cases are all clients I have served. Because privacy, real name and specific insurance contract information are exempt.
1; A female customer insured AIA's all-You-times critical illness insurance and a certain hospitalization medical insurance on June 20 15. The AIA agent filled in the insurance information all the way, and only signed his name on the ipad. He was not asked about his health status before the insurance, nor was he told that he needed to fill out a health notification questionnaire when he was insured.
In June this year 165438+ 10, after paying the premium for the second year renewal, I accidentally read an article about health notification on the internet, remembering my surgery history of left breast fibroma in April 12, atrophic gastritis and mild asthma, and my experience of borrowing medicine with my social security card. Can't help but pay attention to your own insurance. After many consultations, it was confirmed that the effectiveness of the policy did not meet the insurance requirements. At present, we are faced with the problem of returning supplementary notice or re-insurance.
(The screenshot is for discussion only and does not represent the actual basis. )
For this problem, the actual fault lies in the fact that the agent of the insurance company failed to fulfill his due obligation of inquiry and reminder, while the customer himself failed to exercise his due right to verify the insurance information, which led to the consequences that he had to bear in the end.
2. I am still a female customer. I have insured Ping An Fu 20 15 and Supplementary Medical Care 20 15 with China Ping An Life Insurance Company of China Insurance Company. There were hyperthyroidism symptoms during physical examination, but the symptoms improved obviously after taking the medicine. After hospital examination, it is proved that I have returned to normal level.
Customers are very risk-averse and take the initiative to inform the insurance agent of the symptoms. The insurance agent is new here and unfamiliar with the business. After asking the business supervisor, he told the agent that there was no hospitalization record for this kind of problem, and reminded the agent that the symptoms of hospitalization did not need to be informed, otherwise the insurance would be prone to problems, which would be troublesome to handle and affect the performance.
None of the parties involved in this question are wrong. Due to the ignorance of the agent and his supervisor, failure to record the information of the insured may lead to settlement disputes. It should be reminded that in recent years, the incidence and claims rate of thyroid cancer have remained high, and insurance companies have avoided this risk to the extreme. Symptoms that can be normally covered in the previous two years are now all excluded.
The recent underwriting results of a customer are as follows:
Four, in the actual insurance, the customer did not tell the truth, the main reasons are as follows:
1, network connection insurance:
Forwarded by friends or friends, buy directly at a low price.
The insured does not know the need to tell the truth, or does not pay attention to the content.
The content presented by the online insurance link is relatively simple in my network, and the purpose is to make insurance for the insured convenient and quick. If you don't pay attention, you will ignore the notice, or if you don't have insurance professional knowledge, you can't understand the questions you ask, so you can insure against illness and fail to meet the standards.
(The screenshot is for discussion only and does not represent the actual basis. )
2. The insurance company official website insures itself:
Because official website didn't remind and inform, the insured took out insurance directly at will when he saw the cost-effective advertisement, but he noticed some beauty that should be paid attention to. Even if they pay the premium, there will be disputes in the future. At this time, surrender will also suffer economic losses.
3. Insurance salespeople are eager for quick success and instant benefit, but they fail to fulfill their obligation of reminding due to fatigue:
This situation exists not only in the agents of insurance companies, but also in a large number of people who claim to be brokers or insurance intermediaries. This phenomenon is not less than the first two, especially in insurance companies or areas with low personnel quality.
Final reminder:
There is no such thing as a free lunch, and don't think about taking advantage of anyone. There are too many phenomena that the loss outweighs the gain. The purpose of the little girl's answer is to remind everyone to eat less and take advantage of it.
Please stay away from those insurance practitioners who actively advise not to talk about it. This is not only irresponsible for one's professional ethics, but also irresponsible for the future of the insured. The insurance industry doesn't need such people.
Buying insurance is not so simple, it is easy to take for granted. What we have spent a lot of time learning can be understood just by browsing a few web pages or listening to others say a few products.
Insurance product claims are not that complicated. As long as the claim conditions are met and the claim standard is met, it does not mean that the insurance company does not dare to pay. Neither the Insurance Law nor the China Insurance Regulatory Commission is a decoration. The most important thing is whether you know how to meet the claim conditions and how to meet the standards.