Starter: Wenwen Dabao Belle.
An insurance company that can directly contact the public owner.
Hello everyone, I'm Wenwen Dabao Belle, your heel insurance blogger.
Friends who have consulted with Wenwen Dabao Belle know that I am an insurance broker who has strict requirements for truthful information.
I'm not the kind of person who fools people into telling the truth just to sell insurance
BecauseI am responsible for the whole process of claims for the insurance policies purchased by me, so I will do a good job of checking everyone's health notice before applying for insurance, so as not to leave any hidden dangers and risks for everyone's claims.
"I don't want to tell the truth, I think I'm very reasonable;."But I'm vaguely worried, so I'm going to ask a few more people to be braveAfter asking, I didn't believe it, and I still didn't want to tell him the truth."
No one can wake up a person who is trying to pretend to be asleep.
With this consultation, I would like to tell you about the "two-year indefensibility".
It is the obligation of every policyholder to tell the truth.
The 10-million-dollar medical insurance guaranteed to be renewed for 20 years is a "1-year + long-term guaranteed renewal clause", which is defined by the regulator as long-term health insurance.
Let's take a look at the latest revision of the "Measures for the Administration of Health Insurance" in 2019:
The 10 million medical insurance during the 20-year guaranteed renewal period is a long-term insurance and is subject to the "two-year indefensibility clause" (I didn't tell the person above because I didn't want to deal with him too much).
But,"Incontestability for two years" simply means that the insurance company cannot terminate the insurance contract because the customer does not truthfully inform the insurance contract after two years of its effective date.
Please noteThe focus is on "termination of contract", which has nothing to do with claims.
Yes, it doesn't matter.
After two years, the insurance company cannot terminate the contract≠and if the insurance company is not truthfully informed, it will be compensated unconditionally.
The reason why I say this is also justified:
(1) The defense is the "right to terminate the contract" of the insurance company
The core content of the two-year incontestability is and only that "the insurance company shall not terminate the insurance contract for untruthful notification after the contract has been established for more than two years".
The above is a screenshot of the Insurance Law (2015 Revised Edition), which is simple and clear, and the two-year indefensibility means that "the insurance company shall not terminate the insurance contract for not truthfully informing the contract after more than two years after the contract has been established".
In the familiar parlance, "if the insurance company wants to terminate the contract on the grounds that the customer did not tell the truth, it should (terminate) within two years of the conclusion of the contract".
*Writing "can't be lifted" means "must be able to compensate"?We can't extend the legal terms ourselves.
So, under what conditions can the insurance company terminate the contract on the grounds of "not telling the truth"?
The following five must be met:
The policyholder deliberately or grossly negligently fails to tell the truth.
Failure to tell the truth can influence the insurance company's decision on whether to underwrite or increase the insurance rate.
At the time of signing the contract, the insurance company did not know that the policyholder had not informed the policyholder.
Within 30 days from the date on which the insurance company becomes aware of the cancellation of the insurance contract.
Within two years from the date of the contract.
In practice:
Obviously, they are all highly subjective, and the insurance company is dominant, so in practice, it also gives the insurance company a lot of room to operate, which is relatively unfavorable to customers;
It is basically up to the insurance company to have the final say;
Strictly speaking, only , i.e., "two years incontestable", is easy to quantify and uncontroversial.
However, the insurance law has never written that the insurance company cannot terminate the contract and the insurance company has to settle the claim without reason.
(2) Claims are approved as "insured accidents".
The core of whether to pay or not to pay is whether an insured accident has occurred.
This has little to do with whether the two-year incontestability applies.
The most typical is critical illness insurance.
Insured event for critical illness refers to "first occurrence of critical illness".
If a person has already suffered from a critical illness, applies for critical illness insurance, and is diagnosed with the same critical illness again two years later, it will definitely not be the "first time", so the claim will not be made.
For example, a person who buys insurance is already suffering from breast cancer but is not informed;
Two years later, if you go to the insurance company with the breast cancer diagnosis report to make a claim, then it is clear that you do not meet the definition of "first major illness" and therefore do not meet the definition of an insured event.
Therefore, the insurance company has good reasons to deny the claim.
Not to mention two years, in another twenty years you still can't compensate.
(3) Regardless of whether it is protected by the two-year indefensible defense, if you do not truthfully inform it when applying for insurance, you may face a claim dispute
This question is actually easy to understand:If the two-year incontestability is really so "valid", how can there still be so many insurance disputes?
You wouldn't think that no one else knew what this "two years of indefensibility" was, right?
The two-year incontestability clause is to prevent the insurance company from abusing the right to terminate the contract, and also to prevent people with ulterior motives from defrauding the insurance, which is a kind of protection for both parties.
In addition to critical illness insurance, the same is true for medical insurance products:
Pre-existing medical problems are classified as "pre-existing conditions" and do not meet the definition of "first occurrence".
If you do not inform you of the disease before applying for insurance, and do not go through the intelligent underwriting and manual underwriting review of the insurance company, then you do not meet the requirements of "first occurrence".
For example, if you have high blood pressure before applying for insurance, and you are not informed about the insurance, and you are hospitalized for high blood pressure two years later, this obviously does not meet the definition of "first occurrence", then the denial of compensation is also reasonable.
It is the obligation of the policyholder and the insured to truthfully inform the health of the policyholder, and it must be complied with.
Everyone is an adult, there is no spirit of contract, if you don't want to abide by it, you don't have to obey it, you don't need to be uplifted, why the insurance company doesn't investigate the health status of the insured before applying for insurance, there is also a reason:
First of all, it is the policyholder's obligation to tell the truth, and we should be an honest person
Secondly, there will be costs in active investigation, if the insurance company spends money on this kind of malicious person who does not tell the truth, and they do not insure after the investigation, then the cost of this investigation is ultimately borne by the customer who is insured after being truthfully informed, why?
A true court precedent
I've said so much above, you can still not listen and don't believe it, no problem.
I found a real case of claims.
Case **, 2022 Cases of the Year of Chinese Courts, Vol. 15, Insurance Disputes.
This book was compiled by the National Judges College and the Judicial Case Study Institute of the Supreme People's Court, and there is no problem with its professionalism and authority.
One such case is from the Intermediate People's Court of Yichang City, Hubei Province, which states that "the insurer's right to terminate the contract applies if the policyholder fails to perform the obligation to truthfully inform".
The insurer is the insurance company).
Real cases, real cases, real cases, if you don't believe it, you can check it.
Here's the situation:
In October 2016, the policyholder purchased a critical illness insurance policy for the insured.
Moreover, there is no misleading sales of this policy, because the policyholder himself joined the insurance company, became the first person of the insurance company, and then insured the insured.
The insured has not been truthfully informed of the insured's physical health
In March 2019, almost 2 and a half years have passed since the insurance was applied, and the insured was hospitalized and discharged with the following diagnoses: malignant tumor follow-up chemotherapy, non-Hodgkin lymphoma (diffuse large R cell type).
The policyholder made a claim to the insurance company, but the insurance company refused to pay the claim: the reason was that the insured had been diagnosed with non-Hodgkin's follicular lymphoma in March 2016 and did not truthfully inform him of the above diseases when applying for insurance.
When the court heard the case again, it held that if the policyholder failed to fulfill the obligation to truthfully inform, the insurance company had the right to terminate the insurance contract and was not liable for the insurance accident that occurred before the termination of the contract.
Result: The insured's claim was rejected, and the court of second instance agreed with the judgment of the court of first instance.
At the end of this case, there is also a "judge's afterword", which is particularly well written:
Highlights:
The insurer's right to terminate the contract is subject to the premise that the insured event occurred within the term of the insurance contract, and the insurer will not pay compensation for the insured accident that occurred before the conclusion of the insurance contract.
Policyholders often ignore this applicable premise when applying for insurance, and it is not feasible to use the two-year period to defend it.
If the policyholder deliberately fails to fulfill the obligation to truthfully inform, the insurance company has the right to terminate the insurance contract and shall not be liable for the insured accidents that occurred before the termination of the contract.
The policyholder also argues that the insurer cannot terminate the contract during the two-year period from the time of the payment of the premium to the occurrence of the insured event, but this ground of appeal is untenable.
I've always thought thatTo learn knowledge, we must learn the right knowledge.
It is wrong to think that "two years cannot be defended" is "the insurance company will pay if you do not tell the truth after two years".
Wrong knowledge is not knowledge.
Two years can not be argued", the insurance company loses the right to terminate the contract, which is very different from whether many people are concerned about whether to settle the claim;
The important thing is not whether the "two-year indefensibility" is worthy or not, but more importantly, if we do not tell the truth, it will have a substantial impact on us.
Just like in this case, the child has cancer, and I think it must have cost a lot of money in the past two or three years.
For a family who can go to a family that wants to cheat insurance and change some claims for their children, maybe the 200,000 yuan is life-saving money for them.
Perhaps in order to treat the child, this small family has fallen apart;Or perhaps in order to treat their children, parents are already in debt.
Then I fought two lawsuits, both of which were lost, and my emotions gradually despaired, and it lasted for a very long time in the middle, and I had to bear an additional amount of money for the lawsuit.
Perhaps the family that is not wealthy is even worse.
The child is indeed pitiful, but what should not be compensated is what should not be compensated, otherwise it will be unfair to other policyholders who honestly and truthfully inform them.
Therefore, Wenwen Dabao Belle has repeatedly emphasizedWhen buying insurance, you must tell the truth, and you must tell the truth.
Of course, this is not for the insurance company, but to protect the interests of the insured.
It is really so that you can get the claim payment faster, smoother, and more smoothly without any disputes.
Insurance companies don't deceive people, let's not deceive insurance companies, okay?