Hello everyone, I am a bean paste that specializes in insurance evaluation~
Today we will talk about a controversial case: A serious illness that was diagnosed after waiting period, why doesn’t the insurance company compensate?
A user consulted: I bought a critical illness insurance , and during the waiting period, I was diagnosed as "the nature of the tumor is not determined" (suspected tumor symptoms), and finally diagnosed as "malignant germ cell tumor" just past the waiting period, and the insurance company refused to pay.
This issue is quite complicated. Different contract terms and claims results will also vary. Today I will use this case to talk about the "waiting period" with you. The content of the article is as follows:
1. Is the waiting period important? What impact will it have on us?
2. What should the insurance company deal with getting sick during the waiting period?
3. I got sick during the waiting period and was diagnosed after the waiting period. Should I pay for it?
1. Waiting period knowledge that must be known for buying insurance
Waiting period: means that even if an insurance accident occurs within a period of time from the effective date of the contract, cannot be compensated (the harm caused by accidents is not restricted).
The reason why the waiting period is set is to prevent from "reverse selection" , that is, to prevent the insured from immediately making a profit by knowing that an accident will occur.
waiting periods for life insurance and critical illness insurance are mostly 0~180 days . There is no waiting period for accident insurance, but some accident insurances are subject to accident medical liability usually have a 30-day waiting period.
When we choose an insurance product, must be the shorter the waiting period, the better .
There will also be differences in the waiting period in the specific protection responsibilities. For example, the following multiple compensation critical illness insurance, the waiting period for the first critical illness compensation is 90 days, and the interval between the second compensation and the first compensation "must be 180 days after the expiration."
Multiple compensation for critical illness insurance waiting period instructions
Note: Insurance liability due to accidents is not subject to waiting period . For example, if you are waiting for accidental blindness, you can pay for it according to the specific condition.
2. How to compensate for illness during the waiting period?
First look at the insurance company's compensation method for illness during the waiting period and accidents, as shown in the figure below:
A certain critical illness insurance treatment method for accidents during the waiting period
You can know that there are mild symptoms or serious illnesses during the waiting period of critical illness insurance. Generally, refund the premium . If it is a mild illness, some will not pay, and the contract will not be terminated. The most tricky one is some products from *An (mild symptoms or serious illness during the waiting period, cashback value, but the cash value in the first year is extremely low).
Medical insurance Waiting period generally does not pay compensation, and the contract will continue to be valid ; if there is a danger during the life insurance , generally directly refunds the premium .
Take critical illness insurance as an example and list 3 common cases to see the impact of illness during the waiting period on us:
) Unfortunately infected with the disease during the waiting period
For example, after the front foot was insured, the back foot was unfortunately infected with hepatitis B virus. In principle, as long as you meet the "Health Notification" when you take out the insurance, it will not affect the critical illness insurance you purchased.
After all, you cannot get sick just because you have bought a critical illness insurance. However, it is conservative to recommend that you still report this situation to the insurance company to avoid quarrels during claims.
) The mild symptoms were diagnosed during the waiting period
If the mild symptoms were diagnosed during the waiting period, you would definitely not pay the compensation. There are two ways to deal with this situation according to the contractual differences:
- returns the premium and the contract is terminated;
- does not pay or return the premium, the contract does not terminate, and the critical illness insurance liability is valid.
) Waiting for a critical illness during the waiting period
This situation generally means that the premium is returned and the contract is terminated.
There are also situations where some critical illness insurances also have death protection, and a waiting period will be set for death liability. During this period, deaths caused by non-accidental injuries are the common way to deal with the premium paid and the contract is terminated.
Destination handling method
But there are also some products do not have a waiting period for death liability, and the insurance amount is paid, and the protection liability is terminated.
3. Can I compensate for the diagnosis after the waiting period?
Disease abnormalities are found from , and it takes a long time to diagnose when you visit and check, and finally confirm , so this kind of "sickness during the waiting period and diagnosis after the waiting period" occurs. In this case,
cannot be absolutely said whether you can compensate or not, it depends on the contract. contract will be compensated as soon as you say it. If you can't compensate, you can't force it.
An important critical illness insurance contract explains this situation
or above critical illness insurance. The contract clearly states that the disease, symptoms or pathological changes occur during the waiting period and continues to the waiting period and suffer from one or more major diseases agreed in this contract. No compensation will be paid, and the premium has been paid without interest.
I checked several critical illness insurance contracts, and they were basically the same as the above treatment method. They did not pay compensation and returned the premiums, but it cannot be said that this is the case in all cases.
I found a case of insurance claims lawsuits for 13 years:
Claims case
This is just an individual case and is not universal. Moreover, there will be certain differences in judges in different places when judging the case, so the way to deal with the situation "will be confirmed after the waiting period? Can you pay compensation?" is basically to return the premium paid.
4, summary
Today I have explained all the issues related to the waiting period. Many people are worried that they will find faults when seeking medical treatment during the waiting period, and the insurance company will not file a claim, so they will delay going to the hospital for treatment after the waiting period.
I personally disagree with this behavior. I have also written about the previous article: Some serious illnesses are often delayed. They are a little problem, and they always ignore it. In the end, they will form serious illnesses (such as early cancer cells), which will not be worth the effort.
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