I'll talk to you through a real case. What problems will we encounter when we claim accident insurance? How can we solve it?
First, the real case
At the end of March, 2065438+06, a 42-year-old man, Wang, unfortunately fell into the reservoir and drowned while driving through a large reservoir. After the accident, relevant departments immediately intervened in the investigation. After excluding the suspicion of drunk driving and drug driving, the police issued Wang's accident analysis report.
The circular pointed out that the accident vehicle did not take any braking measures before falling into the reservoir, but accelerated, and the scene of the accident belonged to the national highway, so there was no road condition problem. Therefore, the police believed that the traffic accident belonged to Wang's "conscious".
In addition, when sorting out Wang's relics, the family members found that Wang had purchased two insurances in succession before the accident, one was whole life insurance with a coverage of 3 million yuan, plus 6.5438+million yuan in accidental death compensation (if he was driving by himself, he would pay 20 million yuan); The other is two-way insurance, with the insured amount of 6.5438+million, but it is particularly emphasized in the contract that the self-driving car will pay 6.5438+million insurance money in case of accidental death or total disability.
After Wang's wife, Ms. Jiao, learned of these situations, she filed a claim with the insurance company with two insurance policies, with the insured amount of 24 million. After receiving the report, the insurance company immediately investigated the matter. However, when the adjuster looked at the accident analysis report, he found that there was something fishy about it and refused to pay compensation on this ground.
Second, the case analysis
24 million insurance money, why does the insurance company say it won't pay if it doesn't pay?
It turned out that according to the accident analysis report, the insurance company believed that the deceased Wang was not the death caused by traffic accidents or accidents, but "intentional suicide". Suicide is an exemption clause in the contract, so the insurance company has the right to refuse to pay the claim.
Although in court, Ms. Jiao resolutely disagreed with the insurance company's statement, but she has been unable to provide strong evidence to overturn the accident analysis report issued by the public security department, so the court finally concluded that "Wang's death in driving into the river was completed under his own consciousness", which was not an accident, so she rejected Ms. Jiao's claim.
Third, the case summary
In fact, it can be seen from here that although the terms of accident insurance are simple and the price is cheap, there are many different neglected details in claims settlement, such as not paying for suicide, not paying for sudden death and so on. It is worth noting that in real life, some people still have deep misunderstandings about insurance, especially those who have bought insurance but have been refused compensation.
1. Why are accident insurance disputes frequent?
The fundamental reason is that people are not clear about the concept of accident insurance claims.
Generally speaking, accident insurance only pays for "external, sudden, unintentional and non-disease" objective events that cause harm to the body. It is not like everyone thinks, as long as you pay the money, no matter what happens, accident insurance will pay.
You know, insurance companies are not charities. If accident insurance can cover everything, what's the point of setting an exemption clause? In addition, some netizens said before that as long as the accident insurance lasts for two years, suicide can definitely be compensated. In fact, this statement is not entirely correct. This method can only be applied on the premise of "buying long-term insurance".
Special note: insurance for one year in a row cannot be considered as "long-term" insurance; Instead, it is stated in the contract that the insurance period is: 5 years, 10 years, 30 years, to 60 years old, 70 years old, for life. Only when this period exceeds 2 years is it called long-term insurance.