Is opening a critical illness mutual aid membership equivalent to buying insurance? Wu suffered from cancer after joining the mutual aid platform "Critical Illness Mutual Aid Sub-plan" and only received about 30% of the mutual aid fund, so he sued the platform operating company to pay the remaining mutual aid fund. The reporter learned from the Beijing No. 1 Intermediate People's Court on the 10th that the court's final judgment rejected his appeal.
Mr. Wu joined the platform's "Critical Illness Mutual Aid Sub-plan", with a subsidy amount of 300,000 yuan and a total of 186 installments of 727$18. The "Membership Convention" stipulates: accept the rules for case publicity and the rules of the jury; The mutual aid fund and management fee are shared equally by the members of the scheme; If the total amount of the contribution actually received in the current period is less than the mutual aid fund and management fee for the current period, the actual mutual aid fund for the current period shall be calculated after deducting the corresponding management fee according to the proportion of the management fee of the mutual aid plan, and the mutual aid fund shall be paid according to the proportion of the mutual aid fund in each case. The Articles of Association stipulate that this plan is not insurance and does not guarantee that you will be covered by certain risks. For Class I malignant tumors, the amount of mutual assistance is 1 3 of the maximum amount of assistance for major diseases.
After Wu suffered from cancer, he applied for mutual aid, and the loss adjustment company confirmed that the condition was true, and the upper limit of the mutual aid amount was 13330,000 yuan. The mutual aid platform operating company paid 40,000 yuan to Wu, and there were still 9The $30,000 mutual aid fund was unpaid.
After the mutual aid program was shut down. A law firm issued a "Witness Opinion": before the shutdown, the platform mutual aid was unable to raise the full amount of mutual aid; Cases that meet the requirements for mutual aid applications before the closure can still apply for mutual aid, and after the review is passed, the platform will count the balance of donations in the mutual aid account and initiate mutual aid in proportion, and the principle of proportional determination shall be determined by the platform authorized by the jury "in accordance with the principle of fairness and reasonableness". In the end, the platform decided to pay 30% of the applications before the shutdown.
Mr. Wu sued and demanded that the defendant initiate mutual assistance for critical illness in accordance with the agreement and pay 9The 30,000 yuan mutual aid fund was rejected by the court of first instance and appealed.
The Beijing No. 1 Intermediate People's Court held that the existence of a new type of network mutual aid contract between the two parties did not meet the constitutive elements of an insurance contract. According to the Mutual Aid Platform and the Articles of Association, the mutual aid plan is not insurance, and the company and the mutual aid platform do not make commitments on the amount of mutual aid obtained by the mutual aid applicant, nor are they the subject of payment. The court of first instance held that the platform executor's confirmation of the payment ratio of 30% did not violate the content of the autonomous resolution of the mutual aid platform jury, nor did it violate the prohibitive provisions of the law. The defendant had raised and paid 30% of the mutual aid fund for Wu, and the court of first instance found that it was not improper for the defendant to have completed the obligation to raise and allocate the mutual aid fund. In the end, the First Intermediate People's Court rejected the appeal and upheld the original judgment.
Wu Xuan, assistant judge of the First Intermediate People's Court, promptedMutual aid programs are different from insurance: the policyholder pays a premium to the insurer; In the mutual aid plan, the members equally share the mutual aid funds paid to other members and the management fees paid to the platform, which are gifts. Insurance companies must be established in accordance with the law and have an insurance business license; At present, there is no clear legal regulation for Internet mutual aid programs, and there is no clear business license for such platforms to operate. In the event of an accident, illness, aging, etc., the insurance company has an agreement and legal obligation to pay the insurance money; The mutual aid program does not promise the final amount of mutual aid received by the mutual aid applicant, and the mutual aid fund is subject to the actual donation amount of the member.
Before opening a Critical Illness Mutual Aid Membership, you need to carefully read the membership convention, plan charter, etc., and consult customer service if necessary. If the compensation ratio meets your expectations, you can recharge on the platform to avoid bothering to negotiate after suffering from illness.
**:Beijing**client reporter Lin Jing
Process edit: u031