The basic points that cannot be compensated are as follows:
1 think that buying insurance is omnipotent and you should pay for everything. But there are still several categories of life insurance, such as serious illness, medical treatment, accident, life insurance and annuity. Suppose you buy an annuity and get sick, you won't lose money. If you only buy accident insurance, you will definitely not pay for the disease. Therefore, when buying insurance, you must know what insurance you are buying, and don't pay for it. After all, it's a lifetime thing.
Insurance has payment conditions, such as critical illness insurance, and many kinds of diseases need to meet certain conditions to pay. For example, acute myocardial infarction (figure 1) needs to meet three of the four conditions. Some people will say, isn't this just digging holes for customers? In fact, if the three conditions are not met, it means that it has not reached the level of serious illness. Moreover, for the benefit of customers, at present, seriously ill products generally contain mild/moderate diseases, and even if they are not serious, they can be compensated (Figure 2). Mild/moderate diseases are additional compensation, not the total amount. So sometimes it's not that the insurance company doesn't pay, but that it doesn't meet the claim conditions.
I didn't tell you the truth when I bought insurance. This is the reason why there are the most claims disputes at present. When buying insurance, you need to fill out a health questionnaire. We asked for information in Chinese mainland. If there is anything on the health questionnaire, be sure to let us know. Check No if nothing happens. When buying insurance, the insurance company thinks that the customer has told the truth and will not check the medical record, but it needs to submit the medical record when making claims. Most hospitals now have online medical records. If you didn't tell me when you bought insurance before, the insurance company could easily find it. Moreover, the sooner the claim is settled, the stricter the insurance company will check, and even the investigation company will be activated, so don't take any chances when buying insurance, and be sure to tell the truth.
So it is very safe to buy insurance. Don't worry about buying insurance! But two suggestions:
1 Be sure to consult a professional agent, don't blindly worship big companies, and don't follow the trend and believe in some big V's with goods. It is very important to shop around, not only to compare products and companies, but also to compare services.
Be sure to tell the truth when buying insurance.
In this impetuous society, most people prefer to magnify many normal disputes infinitely under the microscope and don't understand the disputes themselves at all. If you can step on a few feet while watching, you will feel more involved.
Just like people who win lottery tickets have to wear masks to receive prizes; Most people who have been exposed to insurance will find that almost no one will take the initiative to publicize that they have obtained insurance claims, and more insurance agents are promoting them.
Even insurance salesmen and insurance companies have to obtain the consent of the beneficiaries before they can make publicity. Otherwise, it will be called soft articles and advertisements. What is serious is that people are dead and sick. ...
Ignorance and fearlessness are close to the truth.
Most people's understanding of insurance still stays at "I just need to buy an insurance, and I have to pay the bill anyway". Personal experience: I bought auto insurance, and my daughter went to the auto insurance company for reimbursement when she was sick. After being exposed in public, she kept swearing.
In most people's cognition, I don't know that insurance is the most honest "telling the truth about insurance", I don't know the insurance liability, and I don't know that there is a deductible clause. In their minds, they stay in "I think how to pay for insurance claims, I think this is the way to pay for insurance claims."
In the same way, they also stay in "I think critical illness insurance is enough, I think medical insurance is enough, I think I just want accident insurance".
Even, they don't want to believe in various insurance payment methods, and the payment mechanism is different, let alone distinguish between various insurances.
As a profit-making organization, insurance companies often have thousands of branches. A salesman calculated 10 thousand.
Therefore, insurance companies have their own assessment mechanism for salesmen to sign bills, and many times they will default to certain violations.
More insurance companies train salesmen on "telemarketing", because "telemarketing" can quickly push a salesman to the market in a few days.
I have to say that the reputation of insurance is very poor, and the insurance company's own way of "asking customers to be saints and asking themselves to be bitches" is a bit shameless!
Although I have said a lot about the ignorance of the insured, I personally think that the insurance company's practice of "asking customers to be saints and asking themselves to be bitches" is really shameless, and it is an organizational shame, which is more terrible than the ignorance of customers.
Insurance policy is a special economic contract. Say the important things three times: contract, contract, contract.
What is the contract? A contract means that both parties to a contract shall perform their rights and obligations stipulated in the contract according to law. Therefore, in layman's terms, there is no agreement not to pay for the guaranteed things. Insurance companies don't pay compensation, first of all, it depends on whether the insured items are insurance liabilities. If it meets the insurance liability in the terms of the insurance contract, it will be paid. If it is inconsistent, it belongs to the deductible content and will not be settled. Therefore, when you apply for insurance, you should understand the insurance liability and exemption clauses in the insurance contract. As a professional who has been engaged in insurance claims for more than 20 years, it is responsible to say that insurance companies refuse to pay less than five thousandths.
The reasons why insurance companies don't pay anything are as follows:
1, the spread of unknown truth. Because there is no claim, only that there is no compensation, not why there is no compensation.
2. The public's expectation of insurance exceeds the contract. I think I should pay for everything.
3. Misleading of insurance company sales staff. In order to complete the performance, the sales staff went beyond the contract terms and commitments.
Remember: 1, what to protect and what to lose!
Please read the terms and conditions carefully before insurance.
Myth 1: As long as you buy insurance, you can pay for everything.
Many people don't know that the contents of different types of insurance are different. They think that as long as they buy an insurance casually, they can compensate if something goes wrong. They don't know what their insurance covers or doesn't cover, so they are often asked if they can use life insurance contracts to compensate for minor illnesses in hospital.
Myth 2: Insurance companies will try to refuse compensation.
It is also said that insurance companies make money by collecting premiums. If they pay more, they earn less, so they will try to let you buy it when they buy it, and they will try not to lose money when they settle claims.
In fact, I want to say that the insurance company will not lose a point because of claims, nor will it lose a point that should not be settled. No matter whether the claim is based on the terms of the contract, if your risk accident is within the insurance coverage you bought, you will pay for it. If it is not within the scope of claims, of course you won't pay! So we must do it according to the contract in the end.
Moreover, when making insurance contracts, insurance companies have estimated how much money they will pay in the future through actuaries, and the claims are within their acceptable range. How could it deliberately not pay?
Nothing more than these reasons:
1. False notification can be divided into intentional concealment and negligent concealment.
Deliberate concealment: the insured deliberately conceals the health status and past medical history of the insured in order to insure smoothly.
Negligence and concealment: Salespeople mislead customers' health for their own benefit. Fill in all the forms.
In this case, the biggest advice is to tell the truth and honestly answer the questions raised by the health consultation, otherwise the final loss will be borne by yourself.
2. Lack of understanding of terminology.
Many people only buy when they are recommended, but they don't know what the insurance clause is.
For example, heart bypass surgery requires thoracotomy. If you have minimally invasive surgery, the insurance company will refuse to pay for it on the grounds that it does not meet the requirements of the terms.
Therefore, before buying any insurance, you must read the insurance terms clearly, including the waiting period, deductible, coverage and exemption scope, so as to know when to pay and when not to pay, and stop blaming the insurance company!
3, information asymmetry, different understanding of the definition.
Because not everyone understands the medical disease clauses written in the insurance contract, customers can only passively accept them because of their weak professional knowledge, which leads to information asymmetry, which leads to the deviation between the insurance company's definition of disease and the customer's understanding, thus leading to disputes.
For example, sudden death, accident insurance does not compensate, nephrectomy does not belong to the category of major diseases and so on.
Generally avoid the above points, you can avoid most claims disputes! In addition, we should also pay attention to reporting the case in time and prepare the claim information according to the requirements of the insurance company.
Of course, if the insurance company refuses to pay, it can also protect its rights and interests through legal means!
I have been familiar with this question for 23 years, and I have a simple and concise answer to this question.
To sum up, insurance is: how to pay; Pay what you guarantee; Pay as much as you want.
In other words, insurance does not mean that you can lose everything if you are insured. Only the specific guarantee content can compensate this aspect. If the content is not guaranteed, there will be no compensation in this respect. Even if you insure the content, the project still depends on your content and the project.
For example, the same death depends on what causes the death. If the insurance is accidental injury insurance, only accidental injury can be settled. If the death is caused by disease, it can't be compensated. However, if the insurance is aimed at the death of a major illness, then there is compensation for accidental injury, because the terms have made it clear that there is compensation for death, and there is no reason to pay compensation for death.
Accidental injury refers to: accidental injury is called foreign, sudden and unintentional, and it is called accidental injury when these three conditions are met at the same time. This is one aspect caused by the controversy or misunderstanding caused by the scope of protection. Here is just an example to illustrate.
There is also a problem arising from medical reimbursement: one is the minimum compensation, and the other is the maximum compensation limit, which is stipulated in the specific contract. Again, how to pay and how much to pay.
In short, the misunderstanding that "the insurance company is cheating" is caused by the incomplete understanding of the insurance clauses. As for this reason, it is nothing more than that the agent of the salesman didn't say it or didn't make it clear, or that the salesman said it but the insured didn't understand it or forgot it. It is impossible for an insurance company to cheat.
Therefore, when the insured chooses the agent of the salesman, it is also very important to choose the quality, character and professional knowledge of the agent. At the same time, the customer policyholders themselves should also strengthen their study, understanding and thorough understanding of the insurance clauses. Only in this way can unnecessary disputes and troubles be avoided.
These problems should be reflected and paid attention to as insurers and policyholders.
I think as long as the agent makes it clear to the applicant and listens clearly, such problems will not arise.
The insurance company won't pay for this or that.
First of all, let me show you a set of internal claims assessment indicators of insurance companies. The following figure shows the names of six indicators of an insurance company's claims. Among them, the claim yield is an important assessment index for claim adjusters, and the assessment ratio of claim yield has increased from 3% in 20 18 to 5% in 20 19. It can be said that this indicator has been paid more and more attention by insurance companies.
The next picture shows the details of the claim odds of a tertiary institution of an insurance company in Hubei. It can be seen that the overall claim rate has reached 98.49%.
Therefore, through the internal data of these insurance companies, we can see that less than two of the 100 claims can't be paid, and the insurance companies regard the claim odds as an important assessment indicator for the claim adjuster. We can also see that the guidance of the insurance company is to find reasons for paying for customers.
Then you may have to ask, why is payout ratio so high, and we have heard everywhere that insurance companies will not pay, so why not?
Personally, I think the reasons are as follows:
One: good things don't go out, but bad things spread thousands of miles. Excuse me, among the 98 customers who have paid, will anyone tell the news about how much the insurance company has paid me? However, those two people who didn't pay will be outraged and ask for advice everywhere, or tell others that it's useless to buy insurance, and insurance is a liar. Word of mouth, even the media will intervene in publicity reports, so that everyone thinks that insurance will not pay for this or that.
Second, some insurance company salesmen did not explain clearly to customers when selling insurance, which led to a big gap in customers' psychological expectations. This has deepened the impression that customers are "easy to insure and difficult to settle claims".
Three: The insurance contract is actually very professional and complicated. Because it is necessary to clearly explain which circumstances can be compensated and which circumstances cannot be compensated, it is necessary to have a detailed explanation. However, this detailed description may become a slogan in the eyes of customers. In fact, the more general the contract description, the more unfavorable it is to the customer. What the contract needs to do is to write clearly in black and white what can and can't be compensated.
Four: Some claims are indeed controversial. But this kind of contract dispute exists not only in insurance contracts, but also in contracts in other fields. Contract disputes exist objectively. If there is a dispute, it is enough to solve it in an appropriate way through consultation. But that doesn't mean that insurance doesn't pay for this or that.
The above answers, I hope to help you understand insurance.
Don't!
There are still many insurance claims. Of course, there is no compensation, but that is very small data.
China Insurance News released the semi-annual claims reports of companies in the first half of 20 19. The data shows that more than 97% people have received claims from insurance companies, and the claims rate of individual companies has reached 100%.
The data show that malignant tumor is still the first claim for serious illness, followed by cardiovascular and cerebrovascular diseases. The average protection of critical illness insurance for middle-aged and high-risk people is insufficient, and the protection needs to be strengthened.
The overall claim data of 20 19 in the first half of the year shows that the odds are obviously on the rise, both in claims cases and claims amount.
To a large extent, people hear what others say, not what they have experienced.
Insurance has not developed for a long time in China, but it has developed rapidly. It is inevitable that there will be some problems during this period. Any industry will face such problems in the early stage of development.
Insurance claims are settled according to the contract. What is agreed in the contract has happened, and the insurance company will pay according to the contract. That's understandable. But there were some difficult situations, and then there was an insurance claim dispute.
It is more common for people to buy accident insurance, but the cause of this death is sudden death, which is more difficult. It is difficult to determine whether it was an accident or illness. However, pathologically, the common cause of sudden death is that there are many deaths caused by diseases, so many insurance companies will cover sudden death as an exclusion when designing accident insurance.
Policies also have problems in the early stage of sales, such as adverse selection, which can't tell the truth. Once an insurance claim occurs, the insurance company has the right to file an investigation. If one item is not told truthfully, and this item is decisive for insurance underwriting, then it will be more troublesome to settle claims.
Old gun suggestion: it's not that insurance doesn't pay for this or that, but that there are some problems in the early stage of purchase, which leads to the settlement problem in the later stage. When buying insurance, don't let your policy be flawed. Telling the truth, abiding by the law and utmost honesty are the most important things in buying and selling insurance.
Is it really like this without paying? Actually, it's people's hearts at work!
From the beginning of its establishment to today, insurance companies can continue to exist, and the bigger they get, the more we know which is true and which is false.
It is actually normal for this kind of voice to appear in society. Good things stay indoors while bad things will go far away.
Families who have settled their claims are unwilling to share. After all, once they settle the claim, they won't invite anything good and then expose their scars. Most of the reasons for not paying claims are that they do not meet the conditions for paying claims, or the types of insurance purchased are wrong. What needs to be eliminated is that you can pay for everything when you buy insurance, and insurance salesmen can't pay for everything for the benefit, which requires both sides to strengthen communication and understanding.
Customers who buy insurance should also read the insurance clauses carefully and what insurance to buy. Insurance salesmen should also learn insurance clauses to help customers solve their doubts!
Generally speaking, insurance is a good thing. There is nothing wrong with insurance. What is wrong is the human heart!
What did you say?/Sorry? Do you have any insurance experience to share? Or you can make a selfless voice when you make a claim, so that people who want to buy insurance can give their families a guarantee, instead of patting their thighs and regretting afterwards!
Does the insurance company really not pay for this or that?
Although the insurance industry has developed in China for so many years. But some people still have this question. I think. It is mainly caused by the following two aspects.
First, the main reason is that our sales staff are not professional enough to mislead sales. Or the security configuration is not good, resulting in the risk can not be compensated.
And second? It is because some of us are biased or have such problems because of poor solutions. Still didn't tell the health questionnaire truthfully, and some people? Because I don't understand. I always think that insurance is a basket, and everything is put in it. If you have insurance, you should pay for it.
So what is the reality?
After so many years of development, the insurance industry has become a booster of China's economy and a stabilizer of society. Many companies have become the top 500 companies in the world. Then there are more and more insurance products. Segmentation is getting deeper and deeper into our ordinary life. We often have diseases, accidents, medical care, education, old-age care and so on. And our car insurance. What about these products? The function and emphasis are different.
So the risk of his insurance is different. So when the risk matches our insurance, our insurance can settle the claim. But we don't know. What risks will happen? Therefore, the current product is more of a combined product, which enables us to cope with unknown risks in the future. This can be avoided. Paying only one bill is more comprehensive. For example, I only bought an accident before, not a serious illness. Then you can't afford the disease. There are still some people who are lucky enough not to tell the health questionnaire truthfully. There was a past medical history when making claims, which led to the company not making claims.
Let's look at a set of claims data of an insurance company from 2065438 to September 2009. The limitation of claim has been shortened by less than two days. The number of claims has exceeded 36,000. The claim amount is also close to 36 million. This is just the claim data of an insurance company. Then there are hundreds of insurance companies in our country. These damages. Relieved the economic gap of our family and enabled our life to continue. Therefore, the view that insurance does not pay for this or that should stop. Buy the right insurance, and it is correct to buy enough insurance.
They are liars and the university doesn't believe them. This is fake insurance for people who sell insurance. It's a real scam, with deep routines and many scams. If you don't bite the fish, you won't be caught. Be careful not to be cheated.