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A friend often sent me a document directly, saying: "This is the insurance plan that so-and-so helped me do, he said that everything is included in it, and you can pay for illness accidents, cat scratches and dog bites, can you take a look?" "I think that the insurance products in the plan themselves are not a big problem, the key is that we need to combine the needs of the parties, family members, economic status and other factors, and then choose the right product or product combination, just like the saying in the insurance industry: "There is no good or bad insurance, only suitable and unsuitable." ”
This article mainly talks to you about the main types of insurance involved when applying for insurance and my personal understanding of them, for readers to refer to when applying for insurance.
1. Accident insurance: spend a small amount of money to drive away big worries
What can be covered by accident insurance, let's first go through the following ** to see what accident insurance can cover.
In the Internet era, information spreads rapidly, we pick up our mobile phones every day, and we can always see news such as a fire in a certain place, a major traffic accident in a certain place, and a falling object in a community that hurts people, etc., these events make us feel the impermanence of life again and again, and risks are everywhere. We can try to maintain good health through balanced nutrition, strengthened exercise, regular work and rest, etc., and we can also detect and prevent certain diseases in time through regular physical examinations, but for the risk of accidents, prevention can play little role. It is often said that "tomorrow or the unexpected, you never know which will come first", which is a kind of lament for the unexpected and impermanence.
In general,The premium of accident insurance is low, and you can get hundreds of thousands of yuan or even millions of yuan in insurance (hereinafter referred to as the insurance amount) for a few hundred yuan. Accident insurance can play a very big role in making up for the losses caused by accident risks, and everyone and every family should allocate it.
It is not necessary to purchase accident insurance to cover all five liabilities in the table above. "Accident insurance" here is a type of concept that refers to accident-related insurance, including "personal accident insurance", "accident medical insurance", "accident hospitalization allowance insurance", and accident insurance for specific occupational groups and specific vehicles.
So, there are so many types of accident insurance, how to choose?
If you have purchased comprehensive medical insurance with a low deductible, or if the main purpose of purchasing accident insurance is to leave a sum of money for your family in the event of an accident, and you are not particularly concerned about small medical expenses, you can purchase personal accident insurance that only covers accidental death and accidental dismemberment.
If you have not purchased any commercial insurance, or if you have purchased medical insurance with a high deductible, you can choose a comprehensive plan that includes accidental death, accidental dismemberment, accidental medical treatment, and accidental hospitalization allowance when applying for accident insurance.
The following picture shows part of the introduction page of a comprehensive accident insurance, which includes four insurance liabilities: accidental death, accidental disability, accidental medical treatment and accidental hospitalization allowance, and consumers can choose different insurance plans according to their own needs.
2. What does "accident" mean in accident insurance?
"Accident" in the scope of insurance is not the same as "accident" as we usually understand it. In life, we generally think that accidents refer to unexpected circumstances, such as sudden death, heat stroke, altitude sickness, etc., but they do not belong to "accidents" in the sense of insurance.
The definition of "accident" in the first national standard of China's insurance industry, Insurance Terminology (GB T 36687-2018), which came into effect on April 1, 2019, is: in life insurance, it refers to an external, sudden, unforeseeable, unintentional and non-disease objective event that causes the insured's bodily injury.
Taking sudden death as an example, the World Health Organization defines sudden death as "the sudden death of a person who is ordinarily healthy or appears to be healthy due to a natural disease in an unexpectedly short period of time." This definition reflects the connotation of sudden death, ie:"Sudden death due to illness".。Since sudden death is caused by one's own illness, it does not meet the conditions of "foreign, non-disease" in accident insurance. Therefore, sudden death in the strict sense is not covered by accident insurance, and most insurance companies also include sudden death in their accident insurance contracts.
For example, while an accident insurance contract lists sudden death as a scope of exemption from liability, it also makes the following special explanations on the issue of non-compensation for sudden death in its insurance instructions:
Even if it is clearly stipulated in the contract, there is still no shortage of accident insurance claims disputes about sudden death, because there is a dispute between the parties as to whether the cause of death is an illness or an accident. The family believes that the "sudden" death of the insured is an accident and has purchased accident insurance, and the insurance company should pay compensation; The insurance company believes that sudden death is caused by illness and is not an accident and is not covered by insurance liability. When the court decides on such cases, it mainly relies on relevant evidence to determine whether the cause of death of the insured is an intrinsic illness or an external accidental injury.
Here are two cases of accident insurance claims for sudden death, and the court's verdict is different due to different evidence.
Case 11.1
Mr. Ran was an employee of Company A, and Company A entered into an insurance contract with Insurance Company A, and purchased group accident insurance for Mr. Ran and other employees, with a death insurance amount of 800,000 yuan per person.
The definition of accidental injury in the insurance contract is: "Accidental injury refers to physical injury caused by an external, sudden, unintentional and non-disease objective event as the direct and main cause, and sudden death is not an accidental injury." Sudden death is a non-violent sudden death of a seemingly healthy person within 24 hours of the onset of symptoms due to an underlying disease, dysfunction or other cause. For the determination of sudden death, if there are legal documents from public security organs, procuratorates, courts, etc., medical institutions, etc., the above-mentioned legal documents, medical certificates, etc., shall prevail. ”On July 6, 2018, Ran suddenly fell into a coma when he went to the bathroom after lunch, and was found and sent to Hospital B**, and the emergency medical records stated: the time of consultation was 13:58 on July 6, 2018, the chief complaint (colleague complained) suddenly fell into a coma for half an hour, and the time of referral or discharge was 15:00 on July 6, 2018, and he was transferred to Hospital C.
Ran failed to be rescued in Hospital C and was pronounced dead at 23:12 on July 7. On the same day, Hospital C issued a medical certificate (inference) of the resident's death, stating that the date of death was July 7, 2018, and the cause of death was cardiorespiratory failure.
On July 30, 2018, the police station of Ran's place of household registration issued a certificate of household registration cancellation, stating: Ran is a resident under the jurisdiction of our police station, and his household registration was cancelled on July 8, 2018 due to illness and death.
Ran's relatives authorized Company A to handle all matters related to Ran's accident insurance on their behalf.
The insurance company believed that the death of the insured Ran was not caused by accidental injury, but due to his own illness, so Ran diedInsurance liability that does not fall under accident insurance and is not paid.
On November 27, 2018, Company A filed a lawsuit with the court, requesting that the insurance company be ordered to pay 11,279 medical insurance benefits for accidental injuries83 yuan, and pay 800,000 yuan of accidental injury death insurance.
After the first instance of the case and the second instance of the Beijing No. 1 Intermediate People's Court, the Beijing Yanqing District People's Court held that Company A, as the owner of the insurance claim, should provide evidence to prove the nature and cause of the insured accidentThe existing evidence is insufficient to prove that Ran's death was caused by an external, sudden, unintentional, and non-diseased objective event, and that Ran's body was cremated on July 20, 2018, and that the cause of Ran's death could not be more accurately determined through autopsy, so the courts of second instance did not support Company A's claims.
Case 11.2
The insured, Mr. Han, purchased short-term accident insurance with an insured amount of 300,000 yuan.
On June 5, 2018, Han suddenly lost consciousness during a meal, accompanied by convulsions. When 120 emergency personnel arrived, Han had died. According to the description of the family, Hospital A noted on the emergency medical record: "Cardiac and respiratory arrest, sudden cardiac death? "Because the hospital does not allow question marks on the death certificate, the hospital deleted the question mark when issuing the medical certificate (inference) of the resident's death, and marked the cause of Han's death as "sudden cardiac death"; The family objected to this, and the hospital, after expert consultation, issued a certificate that did not rule out the possibility of death from food suffocation.
(1) Regarding whether the death of the insured Han was caused by accidental injury
According to the insurance clause involved in the case, "accidental injury" refers to an objective event in which the body is injured by an external, sudden, unintentional or non-disease. Now, according to the emergency medical records, death certificates, and expert consultation results issued by Hospital A, and combined with the investigation results of the court of first instance, the emergency personnel did not conduct further examination of Han at that time, and the cause of Han's death was uncertain, and the hospital later stated that "the possibility of death by food suffocation cannot be ruled out", so the hospital did not give a clear opinion on the cause of Han's death. Now that Han's body has been cremated, the cause of death cannot be identified, and other evidence submitted by both parties is not sufficient to prove it.The cause of Han's death, therefore, this case can neither rule out that the death of the insured was caused by accidental injury, nor can it be ruled out that it was caused by other causes that were not accidental injuries. (2) On the issue of whether the insurance company should pay compensation and the amount of compensation
According to Article 25 of the Interpretation (III) of the Supreme People's Court on Several Issues Concerning the Application of the Insurance Law of the People's Republic of China (hereinafter referred to as the "Judicial Interpretation (III)") of the Insurance Law, "if the loss of the insured is caused by an insured accident or a non-insured accident or an exemption from liability, and it is difficult to determine, and the party requests the insurer to pay the insurance money, the people's court may support it in accordance with the corresponding proportion." Based on the available evidence and the aforesaid analysis, the court of first instance was not sufficient to rule out that Han was caused by an accidental injury, and at the same time, considering the liability of both parties for the inability to determine the cause of death and the fact that the insured was an elderly person who had suffered from illness, the court of first instance considered that the insurance company should pay the beneficiary Geng (Han's daughter) an insurance premium of 150,000 yuan (50% of the insured amount of 300,000 yuan).The court of second instance upheld the judgment of the first instance.
Through the analysis of the meaning of unintentional injury, combined with two cases, we can draw the following conclusions:
Accident insurance is liable for personal injuries caused to the insured by "external, sudden, unintentional, and non-diseased" objective events, including common traffic accidents, accidental drowning, electric shock, falls, burns, and falling objects. Therefore, accident insurance is essential for everyone.
Accident insurance generally does not cover sudden death or other deaths directly related to bodily functions or diseases, but some insurance companies have added sudden death coverage to their comprehensive accident insurance plans, which can also be selected at the time of application. Since accident insurance does not cover sudden death, we can purchase life insurance in addition to accident insurance, which is more inclusive and does not limit the cause of death to accidents or illnesses.
According to the Insurance Law of the People's Republic of China (hereinafter referred to as the "Insurance Law"), in the process of insurance claims, the customer shall provide the insurance company with the certificates and materials that it can provide to confirm the nature, cause and extent of loss of the insured event. Be specific.
In accident insurance, relevant certificates and materials include but are not limited to the insured's medical records, medical certificates of death, etc. These materials are important evidence to determine the cause of the insured's injury and should be taken seriously by both the customer and the insurance company. Insurance Act
Article 22After the occurrence of an insured event, when requesting compensation or payment of insurance money from the insurer in accordance with the insurance contract, the policyholder, the insured or the beneficiary shall provide the insurer with the relevant certificates and materials that it can provide to confirm the nature, cause and extent of loss of the insured event.
If the insurer finds that the relevant certificates and materials are incomplete in accordance with the provisions of the contract, it shall promptly notify the policyholder, the insured or the beneficiary to provide supplementary information in a one-time manner.
3. Precautions when purchasing accident insurance.
1) Whether the accident insurance is for a one-year period or a long term.
Classified according to the insurance period, accident insurance can be divided into:One-year accident insurance, long-term accident insurance and very short-term accident insurance.
To put it simply, if you pay for one year and pay the premium for the second year, you will not be protected for one year, which is a one-year accident insurance. The premium of one-year accident insurance is not expensive, two or three hundred yuan a year can buy hundreds of thousands of yuan of death and disability insurance, for the policyholder, the premium pressure is less, and it is indeed "spending a small amount of money to drive away big worries", which is a necessary insurance for everyone, especially the family pillar. Generally speaking, if you purchase a one-year accident insurance, the premium will not be refunded if no insured event occurs within one year.
The insurance period is long-term, such as 20 years, 30 years, or 70 years old, 75 years old, or even lifelong accident insurance, which is long-term accident insurance, and the payment period is subject to the contract. In recent years, a number of insurance companies have launched a return-type long-term accident insurance, that is, if there is no accident resulting in compensation, when the insurance period expires, the insurance company will return all the premiums paid by the policyholder, which is equivalent to "there is an accident to compensate for the accident, and there is no accident to return the premium", the premium funds will not be lost, and the one-year accident insurance will be exempted from the trouble of paying for insurance every year. And because of this,Compared with one-year accident insurance, the annual premium of long-term accident insurance will be relatively higher, and you can freely choose according to your own premium budget.
In addition to one-year accident insurance and long-term accident insurance, there is also a very short-term accident insurance, that is, accident insurance with an insurance period of less than one year, often only a few days, a few hours or even a shorter period of time. Accident insurance for ropeway tourists, personal accident insurance for swimming pools, etc., are all very short-term accident insurance.
(2) What is the appropriate amount of accident insurance
The sum insured of accident insurance is 3.5 million yuan, and there are millions of yuan or even more, and the size of the insured amount is mainly related to the individual's family responsibility and willingness to pay.
Generally speaking, I recommend that two adults in the family, especially the breadwinner of the family, be sure to have an adequate amount of accident insurance. After all, the premium of accident insurance is low, and the death insurance amount of 1 million yuan for ordinary occupations is only about a few hundred yuan for one-year accident insurance. Risks are everywhere, and with insurance, if an accident happens to the breadwinner of the family, at least a large amount of insurance money can be left to the family to protect their lives.
When purchasing accident insurance for your child, it is recommended to focus on accidental medical liability. Because children are playful and active, the probability of collision is higher, and accidental medical insurance can be used for medical expense reimbursement in this case. In 2015, the China Insurance Regulatory Commission[2] issued the Notice on Issues Concerning the Death of Parents Insuring Life Insurance for Their Minor Children (Bao Jian Fa 2015 No. 90), which stipulates that the total amount of death insurance insured by parents for their minor children shall not exceed 200,000 yuan if they are under the age of 10; Those who have reached the age of 10 but are under the age of 18 shall not exceed 500,000 yuan, except for aviation accidents and major natural disaster accidents.
For the elderly in the family, because they are no longer the main family income, the family responsibility is small, and due to the aging of physical functions, the probability of bumps and injuries has become greater, so it is also recommended to focus on them when choosing accident insurance for the elderly.
Medical coverage liability, death benefit liability is no longer the primary consideration. Based on this idea, some insurance companies have launched accident insurance products specifically for middle-aged and elderly people, which can also be considered when applying for insurance.
(3) Does the occupation you are engaged in have an impact on the purchase of accident insurance?
Accident insurance has a lot to do with occupation. Readers who have been insured may know that when purchasing accident insurance, the insurance company will ask the customer to confirm what kind of occupation or type of occupation they are engaged in. This is the classification of the insured person's occupation according to the degree of danger according to the previous risk incidence. At present, there is no unified occupational classification table in the domestic insurance industry, and each insurance company has compiled its own occupational ** and classification table. The common classification method is to divide into 6 types of occupations according to the risk level, plus the occupations that refuse insurance, a total of 7 levels, each type of occupation contains a variety of specific occupations with similar risks in various industries. The occupational risk level is increased from Category 1 to 6, of which Category 1 and 3 are low-risk occupations and most of the accident insurance can be covered, Category 4 is medium-risk occupations, and Category 5 and 6 are high-risk occupations.
In order to avoid claims disputes, it is recommended that consumers truthfully inform their occupations when applying for insurance, and the insurance company will make underwriting conclusions based on the consumer's occupation.
As for the type of occupation you are engaged in, you can check the occupational category provided by the insurance company. If you can't find your occupation in the list of occupation categories, you can choose an occupation that is similar to your job description, or consult the sales staff or customer service of your insurance company.
Most of the accident insurance products of insurance companies will indicate the type of occupation that can be insured in the insurance instructions. Generally speaking, Category 1 and 3 occupations can be insured with general accident insurance, while Category 4 and 6 high-risk occupations often do not meet the insurance requirements of ordinary accident insurance. In view of this, some insurance companies have launched targeted accident insurance products for medium and high-risk occupational groups.
(4) If I have purchased accident insurance, do I need to tell the insurance company after the job change?
Whether or not to inform the insurance company depends on whether the degree of danger of the occupation increases after the change.
If the insured is an office employee when the insured purchases accident insurance, and later the insured changes to another company, and the nature of the work remains basically unchanged, this means that the degree of occupational danger has not increased, and such changes do not need to be notified to the insurance company. If you are not sure whether the degree of occupational danger will increase after the change, you can consult the customer service of the insurance company.
If the job is from the office staffReplaced by food delivery riders, taxi drivers, and other occupations with significantly increased levels of riskMost insurance companies stipulate in the terms of the contract that the insurance company needs to be notified of the change of occupation in this case, and the insurance company will decide whether to continue the coverage with a premium or terminate the contract according to the changed occupation.
If the level of occupational danger increases without informing the insurance company, and then an accident occurs, the insurance company will reduce the amount of compensation or refuse to pay. Therefore, in order to ensure that their accident insurance coverage is sufficient and avoid claims disputes, it is recommended that insurance consumers notify the insurance company in a timely manner after the change of occupation in accordance with the contract.
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