Author | Caijing New Media Wang Boyun
Editor | Jiang Shizhou
How difficult is it to settle COVID-19-related insurance claims such as quarantine allowance?
Many users who have purchased COVID-19-related insurance services told Caijing New Media that they clearly met the claim requirements, but were repeatedly denied claims. The insurance companies gave various reasons for denying claims, including "Shanghai is not a medium- to high-risk area."
After the outbreak of the new coronavirus, a large number of related insurance products emerged in the insurance industry, such as quarantine allowances. However, most of these insurance functions do not appear alone, but are put on the shelves in the form of expanding the original accident insurance liability, and claims are financially compensated in the form of subsidies. Most of these products have short-term (within one year), low premiums, and are insured. Convenience and other features.
At the same time, this type of insurance is a national insurance. Due to the recurrence of the new coronavirus pneumonia epidemic in Shanghai and other places some time ago, there has been a concentrated demand for related insurance claims.
In November 2021, Zhang Lin from Shanghai spent 59 yuan to purchase Fosun United Aiwuyou accident insurance. In May 2022, when he applied for an insurance claim due to quarantine due to the epidemic, he was told by the insurance company that "Shanghai is not "Medium and high risk areas". In his opinion, this reason is very far-fetched. "Shanghai is not considered a medium-high risk area? There are more than 40 confirmed cases in our community, and there are two in my building." Although Zhang Lin applied for compensation with supplementary information many times, the result was still "rejection of compensation."
For a time, news about insurance claims denials related to COVID-19 continued to be hot. When a user uploaded his claim information, the insurance broker even suggested that he attach a screenshot of the news "User complained that the insurance company refused to pay for COVID-19 insurance."
According to Caijing New Media, some users who have been denied compensation have begun to initiate collective complaints to insurance companies and even formed a rights protection group. A rights protection user said, "There are hundreds of people in the group, including users from insurance institutions such as Fosun and Zhonghui, and none of them have received compensation."
A relevant person from the Shanghai Banking and Insurance Regulatory Bureau told Caijing New Media that the key points have been We are aware of this type of incident and are currently studying it.
01Complex claims tug-of-war
Many users believe that insurance companies’ claims standards are constantly changing.
Judging from the application materials for quarantine insurance, the insurance company requires users to submit an application form, proof of identity, local government quarantine order documents, and documents proving the number of days and location of quarantine. It is worth noting that some insurance companies have controversial descriptions of documents proving the number of days and places of quarantine, such as "documents proving the number of days and places of compulsory quarantine issued by the local epidemic prevention department or a medical institution recognized by the insurer."
Many users Frankly speaking, they have communicated with the insurance company more than once about the claim settlement issue, but the insurance company's claim settlement requirements have been constantly adjusted. They first said that they could settle the claim if they provided a community certificate, but after providing a community certificate, they also asked for a certificate from the epidemic prevention department.
Zhang Lin believes that she did not know there were so many claims restrictions when she bought the insurance, and the insurance company was suspected of false advertising. In fact, many insurance companies' quarantine allowance and other COVID-19 related insurances claim "diagnosis compensation", "isolation compensation" and "daily allowance", and the isolation allowance ranges from 200 yuan to 800 yuan. For example, Fosun United Aiwuyou Accident Injury Insurance attracts users with selling points such as “compensation even when you are isolated at home” and “compulsory isolation allowance with a maximum cumulative compensation of 200 yuan/day for 30 days”.
"Finance" new media investigation found that starting in April 2022, a large number of users' claims were rejected. The insurance company mainly refused compensation on the grounds that it was not a medium- to high-risk area, did not recognize close contact, and did not recognize the isolation certificate issued by the neighborhood committee.
"My colleagues who were quarantined in March were able to receive normal insurance claims, but why couldn't they be compensated when I applied in April?" Luo Hao from Wuhan asked the insurance company personnel who communicated with him. In March this year, after Luo Hao saw that his friends successfully received compensation from Fosun United Aiwuyou accident insurance, he bought one for his family. Starting from April 19, the building where Luo Hao lives has been sealed. However, to his surprise, when he requested compensation, the insurance company refused on the grounds that "the community certificate did not provide a reason for the closure." Subsequently, the insurance company never responded.
Caijing New Media tried to contact Fosun United Health, but had not received a reply as of press time.
At present, a complicated tug-of-war is gradually evolving between relevant insurance companies and users. Zhang Lin revealed that they are now very cautious in making external complaints, and almost every quarantine insurance rights protection group has "undercovers" from insurance companies. At the same time, Li Wen, an employee of the insurance company, told Caijing New Media that she was "lurking" in some isolation insurance rights protection groups to observe.
"Now, there are also some industries that specialize in helping users settle claims, and some users even provide false isolation certificates for claims." In Li Wen's view, insurance companies are now in a dilemma, and they are also waiting for the attitude of the regulatory authorities.
02 Can’t afford the compensation?
Some senior experts in the insurance industry believe that COVID-19 related insurance is a phenomenon product, and many insurance platforms initially used this product to gain customers. An important reason for the current large-scale denial of claims is that the number of claims users during this period was too large. Many industry observers believe that "insurance companies did not expect that there would be such a sudden burst of claims demands. Most of the users who purchased insurance in Shanghai were full." Claims settlement. "
Li Wen's insurance company has a large number of users of related insurance products. He said that during this period, as long as there is a concentrated outbreak of COVID-19 in a certain place, the company will receive a large number of claims requests from users. The customer service staff of Fosun United Aiwuyou Accident Insurance told users that their claims standards were relatively loose before, but now that the epidemic is serious, the company can only make the review more stringent.
However, for users who purchased COVID-19-related insurance and were denied compensation, lawyer Xu Liang of Beijing Yingke believes that the reason given by the insurance company is that Shanghai and other areas are not medium- and high-risk areas, and this reason is not valid.
Xu Liang said that judging from the purpose of signing the contract between the two parties, the policy holder takes out the "COVID-19" insurance in order to receive isolation allowances when he is unable to work normally during home isolation or centralized isolation. Although the user's location has not been classified as a medium- and high-risk area, his location has been designated as a containment area. The control measures are consistent with or even stricter than those in medium- and high-risk areas, and he has been in a state of home isolation. At the same time, medium and high risks are often classified based on the cumulative number of local confirmed cases of COVID-19. Combined with the epidemic situation in Shanghai, the number of confirmed cases of COVID-19 has far exceeded the criteria for classifying medium and high risks. In other words, the policyholder is already in a situation where compensation can be claimed as stipulated in the insurance contract and should be compensated.
In addition, Xu Liang also said that according to Article 17 of the "Insurance Law of the People's Republic of China" and the "Series of Questions and Answers of the Shanghai Higher People's Court on Legal Application Issues in Cases Involving the New Coronavirus Epidemic (IV)", when users apply for insurance, the insurance The company should expressly and emphatically remind and clearly explain the terms and conditions exempting the insurer from liability.
Currently, most insurance institutions’ quarantine allowance and other related insurance products have been removed from the shelves.
(Li Wen, Zhang Lin and Luo Hao are all pseudonyms)
