Money on the face of the insurance company exclusions should be how to deal with-nrf905

Money on the face of the insurance company exclusions should be how to deal with the articles from the public number: insurance that point thing "when buying insurance salesman, attitude is very good, your skies, once to the claim, the clerk can not find a direct, the whole process of the people as a variety of fraud and review all boduantui." Net friend Xu Jieer spit, a lot of Netizens feel the same, followed by spit. It seems that "it’s easy to buy insurance, it’s hard to claim!" This phenomenon is not an example. Then why is the phenomenon of "easy to buy insurance and difficult to claim"? This is related to the quality of the employees in the insurance industry and the operation mode of the insurance industry. Insurance claims because it involves the vital interests of the insurance company, in order to prevent people from playing Wainian insurance company property insurance company idea deliberately pianbao, repeated verification confirmed details of the people boduantui, although hateful, but can also understand. The real problem is that it was too easy to buy insurance. Why is it so easy to buy insurance? Because most of the employees of insurance industry only want to sell the insurance and sell the products, but they are not worried about the terms and details of the products and the subsequent claims. The insurance company does not raise the requirement for the salesman, but only if they can sell the product. It encountered difficult, the claim was exclusions? In these cases, you can take a study. One case: the repair fee is higher than the market value was lowered after exclusions awarded in April last year, the public Mr. Ni in Yongan property insurance Qingdao branch of Limited by Share Ltd to buy the loss of vehicle insurance, third party liability insurance, non deductible special insurance, vehicle insurance for your car, the insurance amount is 67900 yuan. At 19:10 on October 31, 2015, Mr. Yan, a friend of Mr. Ni, opened a collision between his car and the bridge head, causing the vehicle to be damaged. Qingdao City Public Security Bureau Traffic Police Detachment of Licang team confirmed that Mr. Yan took all the responsibility for the accident. Mr. Ni also informed the insurance company at the same time that he heard the alarm after the accident. Because the vehicle was severely damaged, Mr. Ni car spent 39000 yuan, plus the assessment fee for a total of 4 yuan, but he did not expect to find the insurance company claims has suffered a decline. The insurance company is the reason given by the loss of the price is too high, the actual value of the vehicle claims now only 33000 yuan, and the amount of the claim has been higher than the value of the car itself. After many consultations, Mr. Ni immediately prosecuted the insurance company to the court. According to the court hearing in Licang, Mr. Ni has insured motor vehicle loss insurance, excluding deductible insurance and other insurance types to the insurance company. The insurance contract is legally established and effective, and is legally binding on the parties concerned. The focus of the original defendant’s dispute is that the defendant should pay the amount of the plaintiff’s insurance premium. The Court confirmed the loss of the insured vehicle to 39435 yuan in accordance with the law. According to the contract, calculation of vehicle loss for vehicles: date of March 6, 2009, the new car purchase price of 67900 yuan, the accident date is October 31, 2015, when the accident happened to the depreciation of 79 months, the monthly depreciation rate is 0.6%, the accident occurred when the actual value of the insured vehicle is 35715.4 yuan. The loss of vehicles claimed by the plaintiff exceeds the actual value of the vehicle, and the Licang court believes that the amount of the insurance compensation should be determined in accordance with the actual value of the insured vehicle 35715.4 yuan. The first trial of the Licang court decided the Yongan property insurance Limited by Share Ltd Qingdao branch to pay Mr. Ni insurance RMB 35715.4 yuan. The certification fee is RMB 1000 yuan. Case two: the new rural cooperation has been reimbursed, insurance is not lost? No reimbursement costs also have to pay in May 2013, after the city of Pingdu liaolan town village committee to include Ms. Zhang, more than 20 people insured group accident insurance, the insurance amount of medical expenses for 10000 yuan, payment method for medical expenses more than 10000 yuan to 10000 yuan for medical expenses payment, not more than 10000 yuan 100 yuan the actual cost of the amount of compensation, according to 90%. The insurance period is one year, the beneficiary is Ms. Zhang. In September 8, 2013, Ms. Zhang was engaged in housework accidentally fell from the ladder, waist injury, the roughness City People’s hospital diagnosed as lumbar compression fractures were treated for 9 days, spent 37859 yuan for medical expenses, Ms. Zhang in the overall scope of rural cooperative medical management center in Pingdu City, reimbursement for 15815 yuan. After the incident, the family took the insurance contract and other materials for case insured insurance Limited by Share Ltd Qingdao branch claims has been rejected. The reason is: Ms. Zhang’s reasonable medical fee has been compensated by the rural cooperative medical service, and the defendant should not be responsible for the insurance again. Ms. Zhang had to bring the insurance company to court. Pingdu court held that the personal insurance contract signed between the parties is lawful and effective, and the nature of the defendant’s liability to pay is the expense reimbursement type, rather than the quota payment type claimed by the plaintiff. The defendant should deduct the plaintiff’s cost of 14966.17 yuan at the expense of the plaintiff and the plaintiff’s reimbursement of 15815.02 yuan in the rural cooperative medical management center of Pingdu City, and the defendant should compensate the plaintiff for 7707.89 yuan. According to this, the Pingan court decided the Limited by Share Ltd Qingdao branch of Ping an endowment insurance to compensate the plaintiff for 7707.89 yuan for the economic loss of Ms. Zhang. After the declaration, the insurance company was dissatisfied and appealed to the central courtyard of the city. The original sentence was revoked and the appeal was rejected by the appellant. After the trial of the central court of the city, the reasons for the appeal were not set up, and the appeal was rejected and the original judgment was maintained. Case three: because the insured is not refund two exclusions to hide the disease disease with no causal relationship can be awarded in September 2011, Huang in the Pacific Life Insurance Qingdao branch of Limited by Share Ltd has a serious illness insurance, the insurance amount is 60 thousand yuan, the insurance period for life. In July 2012, Ms. Huang was hospitalized for a sudden illness. It was diagnosed as "cerebral hemorrhage and broken into the ventricle; hypertension", and was hospitalized for 17 days. After leaving hospital, Ms. Huang asked the insurance company to pay 60 thousand yuan in accordance with the insurance contract. The insurance company’s answer is, because Ms. Huang to conceal the risk of coronary heart disease hospitalized in April 28, 2011, belongs to deliberately do not fulfill the obligation to truthfully inform the insurance company in April 1, 2013 notice, Ms. Huang cancelled the insurance contract, the insurance accident insurance prior to the termination of the contract, not be liable for paying insurance money, not to refund the premium. There is no consultation between the two parties, and Ms. Huang brings the insurance company to the court. Jimo court found that in September 9, 2011, the plaintiff and the defendant signed the gold life insurance company (Bonus) and additional gold enjoy life insurance contract in advance payment of major disease insurance, during the period from September 10, 2011 to the life insurance, share 6 copies, each of the basic insurance amount of 10 thousand yuan. Additional gold enjoy life to pay in advance of major disease insurance clauses, Ms. Huang has 180 days after the date of entry into force of the insurance contract, diagnosed with major diseases, the first additional insurance contract (including cerebral hemorrhage), the insurer shall effectively sum insured critical illness insurance, the main risk of contract and additional insurance contract termination. Jimo court held that the insurance company to Ms. Huang not truthfully inform obligation due to the April 1, 2013 notice to terminate the insurance contract, in accordance with the insurance law and insurance terms, but the court also believes that coronary heart disease (or pneumonia) no causal relationship exists with cerebral hemorrhage broken into ventricles of the insurance company, the court does not therefore exclusions support. The first trial insurance company paid 60 thousand yuan for the major disease insurance of the plaintiff. More than three inspirational stories tell us, once the insurance company exclusions, and the negotiation fails, don’t be sad, don’t despair, quickly picked up the legal weapons to court to argue. Now the domestic law is still biased to protect the insured, the odds of winning the lawsuit are very big! Finally, the three insurance company rejected the usual practice, and we can choose the release method. 1 routine exclusions: non disclosure of many insurance consumers have such experience, when insured, inform the column in health, the agent will let their all play "no", regardless of the insured, the insured or the past disease history, smoking history. But when an insurance accident happens, the insurance company will take the medical records from the major hospitals, and finally give a sentence "you didn’t tell the truth, we don’t lose it." Release method: the new insurance law use the new "incontestable clause" of China’s new added a "incontestable clause". On the one hand, it is clear that the principle of "inquiring and informing", that is, the insurance company must inquire before, insure the talented person to inform, the insured person itself does not have "the initiative to inform" the obligation. On the other hand, it is found that the insurance company may be relieved of the contract if it is found to have not been informed of the major medical history in the first two years after accepting insurance and underwriting. But if the past two years, the insurance company is still not found, or is found but not communicate with the insured, wait for this reason due to the exclusions, is untenable. In the future if the insurance company to not truthfully inform the exclusions, first recall ever ask and see them before, or whether you have insurance for more than two years. If any situation exists, whether the insurance company exclusions are still stands leeway. However, the undefensible terms are based on the integrity of both the insurance company and the insured, and it is best not to conceal the situation. Exclusions: 2 routine "observation period" exemption in March 26th last year, Wang bought a life insurance for yourself, additional lifetime risk of major diseases. After the money hit the insurance company account, the policy also got on the hand. When Lao Wang went to the insurance company for physical examination, there were no symptoms of any disease. However, 5 months later, Wang found himself suffering from stomach cancer, they claim to the insurance company, but the insurance company has not informed the responsibility of insurance policy, because Wang in March 26th has been in force, but there are major diseases of the 180 day observation period, the observation period of suffering from serious diseases, the insurance company does not assume insurance responsibility. In health insurance, often have the exemption period (or the observation period, the waiting period): refers to the provisions of the insurance contract in force within the specified period of time, even if the insurance accident occurs, the insurer cannot receive insurance compensation. However, the observation period of different products is different, such as the observation period of short-term medical insurance is generally 30 days, and the observation period of major diseases is generally 90 days, 180 days, or 1 years. But the observation period generally only in the first second years before the establishment of the insured, the insurance company started in the same period of exemption renewal does not exist. Release method: short observation period of insurance products at the risk of major diseases are generally prescribed period of exemption. For the insured, the probability of a serious illness in the period of disclaimer is very small, but this period is after all the "vacuum period". From the point of view of the maximum risk prevention, the length of the disclaimer should be considered in the selection of health insurance. As far as possible, the insurance of the relatively short period of disclaimer should be chosen as far as possible. Twelve routine 3: when not promptly report the Shanghai stone to the field of business car accident after the local traffic police detachment identified, stone negative secondary responsibility in the accident, the car should bear 30% of the liability. To this end, stone in the local garage after the car, the actual payment of $12230. Because in the field and work in the body, and the car was delayed one day, stone third days back to Shanghai, and call the insurance company call. The insurance company, however, refuses to pay compensation. 理由是其保险合同条款中有“被保险人应当在保险事故发生的48小时内通知保险公司,否则保险公司有权拒绝赔偿”的规定,而史东报案已是事发后的第三天,超过了48小时,因此拒赔。 Stone feel is evening of one day, but was not intentional, then sued the insurance company for compensation. Release method: to prove that they are not intentional, and without gross negligence of our "insurance law" the twenty-first stipulation: "the applicant, the insured or the beneficiary to know the insurance after the accident, it shall timely notify the insurer. It is difficult to determine the nature, cause or extent of an insurance accident if it is not informed in time due to intentional negligence or serious negligence, and the insurer is not liable for the part that cannot be determined. However, the court holds that, first, what is "timely", the law does not specify clearly. Second, if not timely notice, also cannot become the reason of China Insurance company. Unless there is evidence that the insured or the beneficiary of the existence of subjective intention or due to gross negligence and not timely notice, stone failed to report out on business in busy work, negligence, not intentionally, the insurance company exclusions reasons obviously insufficient. So the court final judgment in favor of stone, ordered the insurance company in accordance with the contract of insurance compensation for the loss of stone. This article from the Tencent news client from the media, does not represent the views and positions of the Tencent news (Tencent Finance) free consultation

收了钱就变脸 保险公司拒赔应该怎样应对 文章来源于公众号:保险那点事儿“买保险的时候,业务员态度非常好,把你捧上天,一旦要理赔,业务员直接找不到了,整个过程把人当成诈骗犯各种审查各种跑断腿。”网友徐洁儿吐槽,一大堆网友感同身受,跟着吐。看来“买保险容易,索赔难!”这个现象不是个例。那为什么会出现“买保险容易、索赔难”的现象呢?这跟保险业从业人员的素质以及保险业的作业模式有关。保险理赔因为涉及到保险公司的切身利益,为了防止有人起了歪念打起保险公司财产的主意蓄意骗保,保险公司反复核查确认细节让人跑断腿,虽然可恶,但还可以理解。真正的问题在于,当初买保险的时候太容易了!买保险为啥这么容易?因为保险从业人员多数一心只想把保险卖出去,拿产品的销售提成,至于产品的条款、细节,以及后续的理赔,有公司兜着呢,他们压根儿不操心。保险公司对业务员也不提高要求,只求他们能把产品卖出去就成。那真遇到索赔难、遭拒赔的情况咋办?这几个案例,你可以收着学一学。案例一:修车费高于市值遭拒赔调低之后再获赔去年4月份,市民倪先生在永安财产保险股份有限公司青岛分公司为自己的爱车购买了车辆损失险、第三者责任险、不计免赔特约险、机车辆损失险,保险金额为67900元。2015年10月31日19时10分,倪先生的朋友阎先生开他的车与桥头发生碰撞,致使车辆损坏。经青岛市公安局交通警察支队李沧大队认定,阎先生承担事故全部责任。倪先生在得知事故后报警的同时也通知了保险公司。由于车辆损毁严重,倪先生修车花了39000多元,加上评估费一共是4万余元,可他没想到,找保险公司理赔时却遭遇了拒赔。保险公司给出的理由是定损的价格过高,理赔车辆现在的实际价值只有33000元,而索赔金额已经高于汽车本身的价值。多次协商未果,倪先生随即将该保险公司起诉到法院。李沧法院审理认为,倪先生向保险公司投保机动车损失险、不计免赔特约险等险种,保险合同依法成立并有效,对双方当事人均具有法律约束力。原被告争议的焦点问题是被告应当赔付原告保险金的数额。法院依法确认保险车辆损失为39435元。据合同条款中规定,车辆损失的计算方式为:车辆出厂日期为2009年3月6日,新车购置价为67900元,事故发生日期为2015年10月31日,至事故发生时折旧79个月,月折旧率为0.6%,事故发生时被保险车辆的实际价值系35715.4元。原告主张的车辆损失超过该车实际价值,李沧法院认为应按照保险车辆实际价值35715.4元来确定保险赔偿金额。李沧法院一审判决永安财产保险股份有限公司青岛分公司赔付倪先生保险金人民币35715.4元。认证费人民币1000元。案例二:新农合已报销,保险不赔了?没报销的费用还得赔2013年5月,平度市蓼兰镇后宅家村民委员会为包括张女士在内的二十多人投保团体意外伤害保险,医疗费的保险金额为10000元,赔付的方法为医疗费超过10000元按医疗费10000元赔付,未超过10000元在实际花费的数额内减100元,按90%赔偿。保险期间为一年,受益人为张女士。2013年9月8日,张女士因从事家务不慎从梯子上摔下,腰部受伤,经平度市人民医院诊断为腰椎压缩性骨折入院治疗9天,花医疗费37859元,张女士在平度市农村合作医疗管理中心统筹范围内报销15815元。事发后,家人拿着保险合同和病例等材料找投保的平安养老保险股份有限公司青岛分公司理赔时却遭到了拒赔。理由是:张女士的合理医疗费已由农村合作医疗全部赔偿,被告不应再承担保险责任。张女士只好将该保险公司告上法庭。平度法院认为,当事人之间签订的人身保险合同合法有效,被告承担给付责任的性质应为费用报销型,不是原告主张的定额给付型。被告应在原告实际花费医疗费的范围内扣除原告自费应付部分14966.17元和原告在平度市农村合作医疗管理中心报销的15815.02元,被告应向原告赔偿7707.89元。据此,平度法院判决平安养老保险股份有限公司青岛分公司赔偿原告张女士经济损失7707.89元。宣判后,保险公司不服,上诉至市中院,要求撤销原判,驳回被上诉人诉讼请求。市中院审理后认为上诉理由不成立,驳回上诉,维持原判。案例三:因投保人隐瞒病情拒赔还不退费两病无因果关联能获赔2011年9月,市民黄女士在太平洋人寿保险股份有限公司青岛分公司投保了重大疾病保险,保险金额为6万元,保险期间为终身。2012年7月,黄女士突发疾病住院,经诊断为“脑出血并破入脑室;高血压”,住院17天。黄女士出院后要求保险公司按保险合同赔付6万元。保险公司给出的答复是,因黄女士隐瞒了其2011年4月28日患冠心病住院的事实,属于故意不履行如实告知义务,该保险公司于2013年4月1日通知黄女士解除了保险合同,对保险合同解除前发生的保险事故,不承担给付保险金的责任,并不退还保费。双方协商不成,黄女士将保险公司告上法庭。即墨法院审理查明,2011年9月9日,原告与被告签订了金享人生终身寿险(分红型)和附加金享人生提前给付重大疾病保险合同,保险期间自2011年9月10日起至终身,投保份额6份,每份基本保险金额1万元。附加金享人生提前给付重大疾病保险条款约定,黄女士在保险合同生效之日起180天后,被确诊初次发生本附加险合同约定的重大疾病(含脑出血),保险人按照有效保险金额给付重大疾病保险金,主险合同和附加险合同终止。即墨法院认为,保险公司以黄女士未尽如实告知义务为由于2013年4月1日通知解除保险合同,符合保险法规定和保险条款的约定,但法院同时认为,冠心病(或支气管肺炎)与脑出血并破入脑室之间不存在必然的因果关系,保险公司因此拒赔法院不支持。一审判决保险公司支付原告黄女士重大疾病保险金6万元。以上三个励志案例告诉我们,一旦被保险公司拒赔,又协商不成,不要悲伤,不要丧气,赶紧拿起法律的武器,上法院说理去。现在国内的法律还是偏向保护咱投保人的,胜诉的几率挺大哦!最后再看三个保险公司拒保的惯用套路,以及咱们可以选择的解套方法。拒赔套路1:未如实告知不少保险消费者有这样的体会,投保的时候,在健康告知那一栏,代理人会让自己全部打“否”,不论被保险人、投保人是否有过往疾病史、吸烟史等。但是一旦发生了保险事故,保险公司就会从各大医院调取病历,最后给一句“你当初没有如实告知,我们不赔。”解套方法:善用新增的“不可抗辩条款”我国新保险法新增加了一条“不可抗辩条款”。一方面,明确了“询问告知”原则,即保险公司必须先行询问,投保人才告知,投保人本身没有“主动告知”义务。另一方面,认定保险公司在接受投保、承保过后两年内,如果发现当初有重大病史未告知的,可以解除合同。但如果两年过去了,保险公司仍然没发现情况,或是发现了情况但不与被保险方沟通,等到发生了再以此为理由拒赔,就不能成立了。今后如果保险公司以“未如实告知”之由拒赔,先回想看看他们之前是否曾主动询问,或你投保是否已超过两年。若有任一情况存在,保险公司拒赔是否占理都还有回旋的余地。不过,不可抗辩条款是建立在保险公司和投保人双方都诚信的基础上的,最好不要蓄意隐瞒情况哦。拒赔套路2:“观察期”免责去年3月26日,老王给自己买了一份终身寿险,附加终身重大疾病险。钱打到保险公司账户后,保单也拿到了手上。当时老王去保险公司体检时并无任何疾病症状。然而5个月后,老王发现自己罹患胃癌,便向保险公司索赔,但保险公司却告知不承担保险责任,因为老王的保单虽然在3月26日已生效,但还有180天的重大疾病观察期,对观察期内罹患重大疾病,保险公司不承担保险责任。在健康保险中,常常有免责期(或曰观察期、等待期)的规定:指的是保险合同在生效的指定时期内,即使发生保险事故,保险人也不能获得保险赔偿。不过,不同的产品观察期不同,如短期医疗险的观察期一般为30天,重大疾病的观察期一般为90天、180天或者1年。但观察期一般只在第一次投保时才设立,第二年开始在同一保险公司续保则不存在免责期了。解套方法:选观察期短点儿的保险产品目前重大疾病险普遍都有免责期的规定。对被保险人来说,在免责期内罹患重病虽然概率很小,但这段时间毕竟是保险“真空期”。从最大限度防范风险的角度出发,在挑选健康险时也应该考虑免责期的长度,尽可能选择免责期相对短点的保险吧。拒赔套路3:未及时报案上海人史东驾车去外地谈生意的时候遭遇了事故,后经当地交警支队认定,史东在事故中负次要责任,应承担30%的车损责任。为此,史东在当地的修理厂修理完车后,实际支付了12230元。由于在外地还有工作在身,加上修车耽误了一天,史东第三天才回到上海,并拨打了保险公司的报案电话。然而保险公司却拒绝赔偿。理由是其保险合同条款中有“被保险人应当在保险事故发生的48小时内通知保险公司,否则保险公司有权拒绝赔偿”的规定,而史东报案已是事发后的第三天,超过了48小时,因此拒赔。史东觉得自己只是晚报了一天,而且并非故意,于是起诉该保险公司要求赔偿。解套方法:证明自己不是故意的,并且无重大过失我国《保险法》第二十一条规定:“投保人、被保险人或受益人知道保险事故发生后,应当及时通知保险人。故意或者因重大过失未及时通知,致使保险事故的性质、原因、损失程度等难以确定的,保险人对无法确定的部分,不承担赔偿责任。”然而法院认为,首先,何为“及时”,法律并没有明确规定。第二,就算没有及时通知,也不能成为保险公司拒赔的当然理由。除非有证据证明投保人、被保险人或受益人主观上存在故意或者因重大过失而没有及时通知,史东未能及时报案是出于出差在外工作繁忙,一时疏忽,并不是故意为之,该保险公司拒赔的理由显然不够充分。因此法院最后判决史东胜诉,责令该保险公司依照保险合同赔偿史东的损失。本文来自腾讯新闻客户端自媒体,不代表腾讯新闻的观点和立场(腾讯财经) 免费咨询相关的主题文章: