But in fact, the essence of insurance is good. Why do you often refuse to pay compensation is not only the reason of the insurance company, but also has a lot to do with our policyholders.
0 1, real case
Gao, who lives in Hangzhou, bought a critical illness insurance for himself and her husband in his insurance company, with the insurance coverage of10.6 million. Gao was treated in the hospital for thyroid cancer and asked the insurance company for compensation after discharge. However, on the third day after the insurance company received the application, Gao received the "Notice of Refusal" from the other party, and detailed the relevant matters concerning the termination of the contract.
Gao refused to accept the insurance company's intention not to pay compensation and filed a lawsuit in court. But unfortunately, the court finally rejected Gao's claim.
02, case analysis
Obviously suffering from cancer, why does the insurance company not only refuse to pay compensation, but also cancel the contract? It turned out that after investigation by insurance companies, Gao had insured the critical illness insurance in another 12 insurance company before his own insurance company. According to his understanding of high insurance coverage, all products are the maximum amount of free medical examination, and the policy of 13 adds up to 8 million.
The reason why the insurance company will see the flaw is that the insured's high accident time is too coincidental. 13 critical illness insurance products all apply for claims after the waiting period. Such a bad insurance fraud is obviously not settled.
To tell the truth, cancer is unbearable for any family. This insurance fraud incident actually reflects the sadness of ordinary people. But from another angle, while accusing the insurance company of refusing to pay compensation, we should also reflect on our own practices, whether it really meets the conditions for claim settlement and whether it is really reasonable and legal to insure.
03, how to prevent the claim from being rejected, keep these two points in mind.
In fact, insurance claims are not as difficult as we thought. As long as you do what you have to do, insurance will not lose money if something goes wrong. So what exactly should we do?
In this regard, I have two views:
(1) Real Health Notice
If you want to ensure that the insurance you buy will not be refused compensation, you should tell the insured's physical condition truthfully before you go out of danger. Of course, some people may ask: I haven't had an examination, and I don't know if there are any symptoms. What should I do?
Actually, Brother Bao has consulted this question before. If everyone encounters this situation and doesn't know how to solve it, Brother Bao suggests that it is best to go to an authoritative hospital for a physical examination before taking out insurance. Don't take chances. You know, the ability of insurance companies to check past medical history is far better than your cleverness. In addition, there is a time limit for health notification now. When asked about the time, you only need to answer the information in the last six months, the last two years and the last five years.
(2) Don't buy sickness insurance.
I believe many people have heard of the "two-year incontestability principle" in the insurance industry, and think that as long as you carry it for two years, you can pay for your illness insurance. In fact, this idea is wrong. In fact, this sentence means that the insured has not concealed his illness (I don't know if he is sick) and has taken out insurance. If the insurance company finds this situation after two years, it shall not terminate the contract and the contract shall remain valid. After the accident, you can also apply for compensation.
However, if the insured knows that he is sick before buying insurance, but he still has to bear the risk, even if the contract is normal at this time, the insurance company will not pay for the accident.