In 2016, Mr. Wang, who lives in Puyang City, Henan Province, spent 120,000 yuan to buy a Taikang Life Insurance medical insurance for his wife after being introduced by an acquaintance.
The wife felt sorry for the money, but Mr. Wang was thinking of spending money to buy a peace of mind, believing that this insurance is not a loss and that it will definitely come in handy at critical moments.
Moreover, the insurance sales staff repeatedly guaranteed: "As long as a major disease is diagnosed, you can apply for a claim!" What the couple did not expect was that after two years, it was a prophecy.
Mr. Wang asked salesperson at Puyang Taikang Insurance Company
In 2018, during a physical examination, Mr. Wang's wife accidentally found suffering from three serious diseases. In one day, the sky collapsed and the burden of treating his wife was heavily pressed on Mr. Wang's shoulders, making him almost unable to breathe.
At this time, the insurance I bought two years ago became a life-saving straw. But when Mr. Wang took the insurance policy to find the insurance company to make a claim, the staff told him that the claim could not be made.
This couple was like a bolt from the blue, and Mr. Wang was on the verge of collapse for a moment.
What exactly does this health insurance write? The insurance policy stipulates that you can apply for claims if you diagnose a major disease. Why does the insurance company still refuse to pay Mr. Wang’s claim?
Mr. Wang was talking to reporters
In order to understand this matter more clearly, let us return the timeline to 2016. At this time, Mr. Wang and his wife have been married for many years. Compared to the flowers before marriage, their life after marriage is mostly about food, food, oil and salt.
The wife works hard and is a virtuous daughter-in-law praised by neighbors and neighbors.
Mr. Wang heard the praises from everyone and couldn't help but feel a little fluttering. However, when he returned home, he saw a dazzling white hair on his wife's head. He took the water cup brought by his wife, and he took the opportunity to see the thick calluses on his wife's hand again.
The wife smiled on her face, but at this time Mr. Wang's heart was filled with all kinds of .
Once upon a time, my wife also dressed up fashionablely and her skin was tender. Time dyed her hair white and life roughened her skin.
wife does housework
Mr. Wang wants to compensate his wife, but when buying flowers and jewelry, his wife feels it is wasted money and will only advise him: "It's better to save the money and leave it for the critical time."
Mr. Wang's frowning look naturally attracted the attention of his colleagues.
Colleague Lao Li quietly asked him: "Lao Wang, you have been absent-minded these two days. Has something happened at home? If you tell me, brother will help you find a solution. If you continue like this, it will not work if your work is affected."
Colleague Lao Li asked Mr. Wang
Mr. Wang and Lao Li get along well on weekdays In order to be harmonious, I also said the thoughts that had troubled him for many days: " My wife's birthday is coming soon. I wondered what surprises to give her, but she doesn't love gold and silver."
After hearing this, Lao Li teased Mr. Wang: "Lao Wang, you know that our female colleagues here all say you are a model husband."
Seeing Mr. Wang glaring at his eyes, he spoke and gave Mr. Wang an idea:
"Old Wang, my nephew works in Taikang Life Insurance . He asked me to say, you might as well buy your wife a medical insurance. The money spent is guaranteed. If you have any disease in the future, just find a claim to prevent unexpected events."
Mr. Wang and Xiao Li called
Mr. Wang was also a little moved after hearing this. After all, who can guarantee that he will not get sick: "Okay, listen to you, give me your nephew's phone number, I'll ask him carefully."
Old Li gave the phone to Mr. Wang, and Mr. Wang didn't delay and immediately decided to meet again this Saturday before the two met.
In 2016, Mr. Wang, who lives in Puyang City, Henan Province, spent 120,000 yuan to buy a Taikang Life Insurance medical insurance for his wife after being introduced by an acquaintance.
The wife felt sorry for the money, but Mr. Wang was thinking of spending money to buy a peace of mind, believing that this insurance is not a loss and that it will definitely come in handy at critical moments.
Moreover, the insurance sales staff repeatedly guaranteed: "As long as a major disease is diagnosed, you can apply for a claim!" What the couple did not expect was that after two years, it was a prophecy.
Mr. Wang asked salesperson at Puyang Taikang Insurance Company
In 2018, during a physical examination, Mr. Wang's wife accidentally found suffering from three serious diseases. In one day, the sky collapsed and the burden of treating his wife was heavily pressed on Mr. Wang's shoulders, making him almost unable to breathe.
At this time, the insurance I bought two years ago became a life-saving straw. But when Mr. Wang took the insurance policy to find the insurance company to make a claim, the staff told him that the claim could not be made.
This couple was like a bolt from the blue, and Mr. Wang was on the verge of collapse for a moment.
What exactly does this health insurance write? The insurance policy stipulates that you can apply for claims if you diagnose a major disease. Why does the insurance company still refuse to pay Mr. Wang’s claim?
Mr. Wang was talking to reporters
In order to understand this matter more clearly, let us return the timeline to 2016. At this time, Mr. Wang and his wife have been married for many years. Compared to the flowers before marriage, their life after marriage is mostly about food, food, oil and salt.
The wife works hard and is a virtuous daughter-in-law praised by neighbors and neighbors.
Mr. Wang heard the praises from everyone and couldn't help but feel a little fluttering. However, when he returned home, he saw a dazzling white hair on his wife's head. He took the water cup brought by his wife, and he took the opportunity to see the thick calluses on his wife's hand again.
The wife smiled on her face, but at this time Mr. Wang's heart was filled with all kinds of .
Once upon a time, my wife also dressed up fashionablely and her skin was tender. Time dyed her hair white and life roughened her skin.
wife does housework
Mr. Wang wants to compensate his wife, but when buying flowers and jewelry, his wife feels it is wasted money and will only advise him: "It's better to save the money and leave it for the critical time."
Mr. Wang's frowning look naturally attracted the attention of his colleagues.
Colleague Lao Li quietly asked him: "Lao Wang, you have been absent-minded these two days. Has something happened at home? If you tell me, brother will help you find a solution. If you continue like this, it will not work if your work is affected."
Colleague Lao Li asked Mr. Wang
Mr. Wang and Lao Li get along well on weekdays In order to be harmonious, I also said the thoughts that had troubled him for many days: " My wife's birthday is coming soon. I wondered what surprises to give her, but she doesn't love gold and silver."
After hearing this, Lao Li teased Mr. Wang: "Lao Wang, you know that our female colleagues here all say you are a model husband."
Seeing Mr. Wang glaring at his eyes, he spoke and gave Mr. Wang an idea:
"Old Wang, my nephew works in Taikang Life Insurance . He asked me to say, you might as well buy your wife a medical insurance. The money spent is guaranteed. If you have any disease in the future, just find a claim to prevent unexpected events."
Mr. Wang and Xiao Li called
Mr. Wang was also a little moved after hearing this. After all, who can guarantee that he will not get sick: "Okay, listen to you, give me your nephew's phone number, I'll ask him carefully."
Old Li gave the phone to Mr. Wang, and Mr. Wang didn't delay and immediately decided to meet again this Saturday before the two met.
With seeing Mr. Wang in a bad mood these two days, my wife asked him with a smile: "Are you going to be promoted?"
Mr. Wang looked at his wife and smiled. He couldn't wait to see the expression on his wife's face after getting the insurance policy, so he smiled mysteriously and said : "You will know . "
Mr. Wang was waiting for Xiao Li in the cafe
HD on Saturday, Mr. Wang waited early at the agreed location. When Lao Li's nephew Xiao Li arrived, he introduced him to the types of insurance and the scope of claims, which made Mr. Wang dazzled.
He interrupted his nephew's speech and said bluntly : "You are Lao Li's nephew. I can trust you, just say it directly. I want to buy insurance for your sister-in-law. The price is not a problem. As long as I have a serious illness in the future, it's fine."
Xiao Li pushed his eyes and took out a few pieces of paper from a thick stack of information:
"Brother Wang, that is the insurance newly launched by our Taikang , the full name is "Kangyi Life Major Illness Insurance". The policy covers 42 major diseases, 10 mild diseases, the coverage is 120,000 yuan, and the annual premium is more than 3,000 yuan, which is absolutely worth the money. As long as you are diagnosed with a major disease within the scope of the policy, you can make a claim. You don't have to wait until you are discharged from the hospital. You only need to pay for it. After preparing the medical records and relevant diagnostic certificates of the hospital, you can wait for the company to review. As long as my sister-in-law has no history of disease, hospitalization, diabetes , etc., she will sign it. "
Mr. Wang looked through the insurance contract
Xiao Li strolled while the iron was hot: "I don't tell him this insurance, I bought it for my parents, because it's worth it! My uncle is also preparing to buy it. If you don't believe me, please go back and ask him."
Mr. Wang hesitated for a moment. After all, it's a large amount of money. It's better to be cautious. But due to favors, he didn't know how to say it clearly. He just said that he wanted to go to the bathroom and called Lao Li.
Lao Li promised: "You said that insurance, I bought it, you inspired me that day, and I plan to buy one for my wife."
Mr. Wang heard that Lao Li bought it, so he gritted his teeth: "Give me the contract, I'll let my wife sign it."
Xiao Li persuaded again: "You buy one for yourself too."
Mr. Wang was stunned. He thought of the mortgage on his shoulder, and thought of his son who was studying. He shook his head: "No, just invest for my wife."
Mr. Wang was stunned. He thought of the mortgage on his shoulder, and thought of his son who was studying. He shook his head: "No, just apply for my wife."
Mr. Wang took the insurance contract and went home
Mr. Wang's wife heard his plan and saw the contract in her hand. She was moved to tears, but she refused again: "You save the money and spend it for your children to study."
Mr. Wang held his wife's hand and said earnestly : "Since you followed me, you have not had a few good days. I want to buy this insurance for you, because I am afraid that I will be ahead of you in the future. If you have this insurance, you can have a support."
Mr. Wang's tears couldn't stop listening to Mr. Wang's heartfelt confession. After Mr. Wang's repeated requests, his wife finally agreed to sign the contract.
wife was moved and cried
They thought that Disease insurance must have come in handy decades later, but they didn't expect that when the Spring Festival approached 2018, the bad news came suddenly.
Mr. Wang's wife will be dizzy from time to time, and there is a large erythema rash on her body. When he asked, his wife waved her hand and said: "It's okay, maybe I'm too tired. Our unit will have a physical examination in a few days. Let's see it later."
When he heard his wife say this, Mr. Wang also felt relieved, but he didn't think this was a sign of bad luck.
My wife has erythema
One afternoon, Mr. Wang received a call from his wife. His wife's voice was heavy and mixed with panic sobs: "Husband, I have three serious illnesses in my physical examination. The doctor suggested that I be hospitalized immediately, saying that if I delay it, it would endanger my life."
Mr. Wang rushed to the hospital. His wife sat on a chair in the hospital hall, her face paler than the wall. Mr. Wang never thought that why his wife, who had always been healthy, suddenly became ill?
He accompanied his wife to the relevant department for treatment and finally calmed his wife's emotions, but Mr. Wang was embarrassed when he looked at the long list.
Mr. Wang accompanied his wife to see a doctor in the hospital
What should I do? The diseases the doctor said are difficult to understand, systemic lupus erythematosus , pulmonary hypertension and scleroderma, these diseases that I have never heard of before are all added to my wife, and are life-threatening.
Medical expenses, wife's care, son's schooling, and work, several real mountains crowded towards Mr. Wang, Almost wanted to crush him. But Mr. Wang could not collapse. He was the only pillar in the family.
Mr. Wang suddenly remembered the medical insurance he bought two years ago. He hurriedly went home to find the insurance policy. The contract was black and white. His wife was sick and was within the scope of the claim!
Mr. Wang cried sadly and
Mr. 0With his wife was saved, Wang Xian The child cried with joy and called his colleague Lao Li's nephew with anticipation.
Mr. Wang licked his chapped lips:
"Xiao Li, I am your brother Wang, your uncle's colleague, do you still remember me, I bought an insurance from your place two years ago, and you said that as long as you are within the policy, you can report it. Your sister-in-law's disease is systemic lupus erythematosus, pulmonary hypertension and scleroderma. Can you take a look at this claim? "
Xiao Li paused for a few minutes and told Mr. Wang with certainty: "These three diseases can be claimed, but because the Spring Festival is coming, our company is about to have a holiday. Let's do this, Brother Wang, I will call you when I go to work after the holiday. Don't worry, wait patiently. "
Mr. Wang's heart that had been falling in the air was finally let go.
Mr. Wang looked through the medical record.
Mr. Wang felt very distressed. The Spring Festival was originally a good day for family reunion, but when he arrived, he kept his feet running and was rushing forward and backward. Fortunately, his son was sensible and took the initiative to help, which made Mr. Wang feel relieved.
Mr. The son was in the rebellious period, and originally made Mr. Wang worried about his eating problems, but his son took the initiative to say: "Dad, you won't have to cook for me in the future. I will prepare the next day's meal after school in the evening, and you will take one to the hospital and eat one by yourself. "
Even though he was exhausted physically and mentally, Mr. Wang still felt hopeful.
Mr. Wang's son was doing housework
Time froze, and the Spring Festival holiday came to an end soon.
Mr. Wang is about to start work, and he began to worry again. Seeing that Xiao Li did not reply, Mr. Wang took the initiative to call Xiao Li several times, but every time Xiao Li responded: "Brother Wang, our staff are reviewing, you wait a little longer. "
is looking forward to the stars and the moon, and finally I waited for the insurance company's call, but it was not called by Xiao Li. The other end of the phone said: "I'm very sorry, your lover's symptoms are too mild and cannot meet our company's claims standards. "
Mr. Wang was confused. Xiao Li clearly said that he could make a claim, but why did he go back on his word now?
Mr. Wang was calling Xiao Li
Mr. Wang felt that he had been deceived. His previous gratitude to Xiao Li turned into anger: "Xiao Li, what's going on? You clearly said you could make a claim, but when you were about to come, you made this happen again. Are you playing tricks on me? "
When he heard Mr. Wang say this, Xiao Li asked for good things, but he didn't agree. The contract was clearly written. This person didn't look at the contract, but he was stubbornly stumbling towards him. Just let Mr. Wang say that compensation is absolutely impossible:
"Brother Wang, I know your current mood, but this is really not me coaxing you. My parents also bought this insurance, but my sister-in-law's situation really cannot pass the review, and the contract is clearly written. Brother Wang, you can go and see it yourself."
Mr. Wang looked through the contract while calling
Mr. Wang was furious. The insurance he bought for 120,000 yuan was in use and it was useless. It was simply ridiculous. So what was he spending money for? Is it providing performance to the insurance company?
Mr. Wang immediately found out the reason for his wife's diagnosis case and contract-related diseases. Compensation conditions and repeated comparisons were made.
He found that the contract's provisions on severe primary pulmonary hypertension clearly required that the average pressure of the pulmonary artery in the resting state should exceed 30mmHg, while the average pressure of his wife's pulmonary artery has reached more than 90mmHg.
And although systemic lupus erythematosus does not meet the provisions, the last item regarding the endogenous creatinine clearance rate of 4 The agreement is less than 30ml per minute, but it meets the claims conditions for the first two items.
The third severe systemic scleroderma obtained by his wife, and the content of the hospital diagnosis certificate and the claims conditions are also completely consistent.
He called Xiao Li again, but Xiao Li bit the contract provisions and did not let go.
Mr. Wang was repeating Verifying cases and contracts
Mr. Wang went to ask Lao Li to say good things to his nephew again, but Lao Li pushed his nephew to Lao Wang two years ago in order to improve Xiao Li's bottom performance. Now something happened, he just wanted to persuade Mr. Wang to calm down.
0,000 will make a big deal, and Xiao Li will be in trouble if he doesn't have a job. Thinking about this, Lao Li advised Mr. Wang to accept his fate: "We are just ordinary citizens, how can we twist our thighs? This kind of thing can only be a loss. "
is a dumb loss? To put it lightly. In the end, the huge medical expenses are still paid by yourself. Now that the insurance is cancelled, the money paid in the past two years has been wasted.
Mr. Wang once paid money to the insurance company
When he was at a loss, Mr. Wang thought of finding a reporter and simply exposed the matter. Even if His problem cannot be solved, and it can also wake others up.
Mr. Wang contacted the staff and told the staff about what happened recently. When he was sad, he couldn't help but wipe his tears and said in anger:
"When I bought this, I would say anything. When it was time to settle the claim, I would first ask me to wait. Then I told me that it would not work after a month and it would not meet the requirements. Why can't it be achieved? Isn’t this bullying? I just want justice! My wife is still lying in the hospital, waiting for the life-saving money! What's wrong with a big company? Can you bully the people if you are big? "
Seeing that Mr. Wang was out of control, the staff quickly comforted his emotions and comforted him : "Uncle, we will find a way for you. ”
Mr. Wang found the reporter
Accompanied by the staff, Mr. Wang went to the local Qingfeng County Taikang Life Insurance Company to ask clearly.
But the insurance company's personnel in charge of reception refused repeatedly: "You can't do this either. We all act according to the contract, and your conditions have indeed failed to pass the review. "
Mr. Wang was also angry, but his repeated running around in recent days made him very upset. The reception staff's words added fuel to the fire. Mr. Wang was so angry that he trembled with his hands and feet. OK, when he bought insurance, he treated it as his grandfather, and now he was like this!
He immediately threw the things in his hand : "If your company can't give me an explanation, I won't leave! Call your leaders! In the world, is there even the king's law gone? I want to sue your company! "
Mr. Wang asked the insurance company to argue
The reception staff felt frightened when they saw Mr. Wang getting angry. Mr. Wang was on the verge of collapse at this moment. If he angered him, the consequences would be unpredictable.
She immediately changed into a kind expression and said kindly: "It's useless for you to come here. The claims specialist and relevant leaders went to another place for a meeting this week. You might as well go to our superior branch. I understand your mood and please understand our work. ”
Mr. Wang left the insurance company's door and couldn't help but sit on the steps and cried.There are people coming and going outside, and there are traffic, but his life is in a desperate situation. When will this end?
Mr. Wang looked at the street and cried bitterly
Originally bought insurance to get insurance, but now he is involved in bigger trouble. It was this kind of rhetoric again. Mr. Wang knew that they were playing past the ball again, but he was at a loss.
The staff member felt compassion when they saw Mr. Wang's appearance and sighed: " Uncle, it has always been difficult to seek justice. It has reached this point. Let's figure out this matter. No matter what, there must be an explanation."
After hearing the staff's words, Mr. Wang remembered the hardships of the past few months. Yes, I have survived the most difficult time. Now the dawn is ahead. Do you have to give up?
Mr. Wang was comforted by others
He wiped away his tears, thanked the staff, and took the bus to Taikang Life Insurance Co., Ltd., Henan Puyang Central Branch, located in the honor office building.
This time, the relevant staff finally explained to Mr. Wang:
"First of all, pulmonary arterial hypertension must be primary. The primary means that it is not caused by other diseases, or it is caused by unknown reasons;
Your wife's pulmonary arterial hypertension is caused by this systemic lupus erythematosus, so this cannot It comes from primary pulmonary hypertension. You mentioned that your wife's endogenous creatinine clearance rate is higher than 90ml, but in fact, the endogenous creatinine clearance rate reflects a degree of kidney organ lesions.
Generally speaking, endogenous creatinine clearance rate is less than 30ml of kidney organ function damage. Your wife's condition obviously does not comply with the contract. As for systemic scleroderma, it is also based on the same reason. The most likely one side of your wife's kidney is that there is a problem or that it has not reached the state of "uremia", so it does not meet the requirements for the disease's claims."
Mr. Wang went to Puyang Central Branch
Mr. Wang got the answer he wanted, but became more and more confused, but the dissatisfaction he had accumulated in his heart gradually became a small hill. When Xiao Li advised him to take out insurance, he did not give any relevant explanations to him.
He didn't know that so many conditions had to be met, and he just thought that he could get compensation as long as he confirmed the relevant diseases agreed in the contract. Moreover, at that time, Xiao Li knew that he had only a little idea, but he did not interpret the relevant terms in detail, and the whole process was confused.
, insurance companies claim that they can pay as long as they are diagnosed with related diseases, but now they keep the words in hand. Didn’t their behavior deliberately deceive consumers? Do you have to pay any price to trample on consumers’ trust?
Relevant personnel explain to Mr. Wang
In fact, it is entirely possible for Mr. Wang to obtain compensation for this situation.
Although Mr. Wang's wife's case statement and diagnosis certificate did not pass the review of the claim requirements, based on the actual situation at that time, when Xiao Li promoted the business to Mr. Wang, he was vague and did not introduce and explain the obligations of the insurance policy purchased by Mr. Wang, which led to him misunderstanding.
According to the law, if the two parties enter into an insurance contract, if the standard terms provided by the insurer are adopted, then in this case, the insurer shall explain the content of the contract for the insured.
Insurance method
So Xiao Li obviously has the suspicion of dereliction of duty. If he explained to Mr. Wang in detail the conditions that need to be met for the claim, then the consequences of Mr. Wang's failure to make a claim after signing will have nothing to do with Xiao Li.
Therefore, Mr. Wang can fight for his legitimate rights and interests through legal litigation.
just needs a "acquaintance" to testify to prove that what Mr. Wang said is not false, but that his colleague Lao Li is Xiao Li's uncle, and whether he is willing to testify is another matter. The only thing that can be blamed for Mr. Wang for believing in the wrong person.
This also warns us that when purchasing insurance, we must keep our eyes open and be careful. We cannot blindly believe in the salesperson's "fooling". After all, things involving money cannot be careless, otherwise we can only taste the bitter fruit by ourselves.
"Mr. Wang rushed to the hospital. His wife sat on a chair in the hospital hall, her face paler than the wall. Mr. Wang never thought that why his wife, who had always been healthy, suddenly became ill?
He accompanied his wife to the relevant department for treatment and finally calmed his wife's emotions, but Mr. Wang was embarrassed when he looked at the long list.
Mr. Wang accompanied his wife to see a doctor in the hospital
What should I do? The diseases the doctor said are difficult to understand, systemic lupus erythematosus , pulmonary hypertension and scleroderma, these diseases that I have never heard of before are all added to my wife, and are life-threatening.
Medical expenses, wife's care, son's schooling, and work, several real mountains crowded towards Mr. Wang, Almost wanted to crush him. But Mr. Wang could not collapse. He was the only pillar in the family.
Mr. Wang suddenly remembered the medical insurance he bought two years ago. He hurriedly went home to find the insurance policy. The contract was black and white. His wife was sick and was within the scope of the claim!
Mr. Wang cried sadly and
Mr. 0With his wife was saved, Wang Xian The child cried with joy and called his colleague Lao Li's nephew with anticipation.
Mr. Wang licked his chapped lips:
"Xiao Li, I am your brother Wang, your uncle's colleague, do you still remember me, I bought an insurance from your place two years ago, and you said that as long as you are within the policy, you can report it. Your sister-in-law's disease is systemic lupus erythematosus, pulmonary hypertension and scleroderma. Can you take a look at this claim? "
Xiao Li paused for a few minutes and told Mr. Wang with certainty: "These three diseases can be claimed, but because the Spring Festival is coming, our company is about to have a holiday. Let's do this, Brother Wang, I will call you when I go to work after the holiday. Don't worry, wait patiently. "
Mr. Wang's heart that had been falling in the air was finally let go.
Mr. Wang looked through the medical record.
Mr. Wang felt very distressed. The Spring Festival was originally a good day for family reunion, but when he arrived, he kept his feet running and was rushing forward and backward. Fortunately, his son was sensible and took the initiative to help, which made Mr. Wang feel relieved.
Mr. The son was in the rebellious period, and originally made Mr. Wang worried about his eating problems, but his son took the initiative to say: "Dad, you won't have to cook for me in the future. I will prepare the next day's meal after school in the evening, and you will take one to the hospital and eat one by yourself. "
Even though he was exhausted physically and mentally, Mr. Wang still felt hopeful.
Mr. Wang's son was doing housework
Time froze, and the Spring Festival holiday came to an end soon.
Mr. Wang is about to start work, and he began to worry again. Seeing that Xiao Li did not reply, Mr. Wang took the initiative to call Xiao Li several times, but every time Xiao Li responded: "Brother Wang, our staff are reviewing, you wait a little longer. "
is looking forward to the stars and the moon, and finally I waited for the insurance company's call, but it was not called by Xiao Li. The other end of the phone said: "I'm very sorry, your lover's symptoms are too mild and cannot meet our company's claims standards. "
Mr. Wang was confused. Xiao Li clearly said that he could make a claim, but why did he go back on his word now?
Mr. Wang was calling Xiao Li
Mr. Wang felt that he had been deceived. His previous gratitude to Xiao Li turned into anger: "Xiao Li, what's going on? You clearly said you could make a claim, but when you were about to come, you made this happen again. Are you playing tricks on me? "
When he heard Mr. Wang say this, Xiao Li asked for good things, but he didn't agree. The contract was clearly written. This person didn't look at the contract, but he was stubbornly stumbling towards him. Just let Mr. Wang say that compensation is absolutely impossible:
"Brother Wang, I know your current mood, but this is really not me coaxing you. My parents also bought this insurance, but my sister-in-law's situation really cannot pass the review, and the contract is clearly written. Brother Wang, you can go and see it yourself."
Mr. Wang looked through the contract while calling
Mr. Wang was furious. The insurance he bought for 120,000 yuan was in use and it was useless. It was simply ridiculous. So what was he spending money for? Is it providing performance to the insurance company?
Mr. Wang immediately found out the reason for his wife's diagnosis case and contract-related diseases. Compensation conditions and repeated comparisons were made.
He found that the contract's provisions on severe primary pulmonary hypertension clearly required that the average pressure of the pulmonary artery in the resting state should exceed 30mmHg, while the average pressure of his wife's pulmonary artery has reached more than 90mmHg.
And although systemic lupus erythematosus does not meet the provisions, the last item regarding the endogenous creatinine clearance rate of 4 The agreement is less than 30ml per minute, but it meets the claims conditions for the first two items.
The third severe systemic scleroderma obtained by his wife, and the content of the hospital diagnosis certificate and the claims conditions are also completely consistent.
He called Xiao Li again, but Xiao Li bit the contract provisions and did not let go.
Mr. Wang was repeating Verifying cases and contracts
Mr. Wang went to ask Lao Li to say good things to his nephew again, but Lao Li pushed his nephew to Lao Wang two years ago in order to improve Xiao Li's bottom performance. Now something happened, he just wanted to persuade Mr. Wang to calm down.
0,000 will make a big deal, and Xiao Li will be in trouble if he doesn't have a job. Thinking about this, Lao Li advised Mr. Wang to accept his fate: "We are just ordinary citizens, how can we twist our thighs? This kind of thing can only be a loss. "
is a dumb loss? To put it lightly. In the end, the huge medical expenses are still paid by yourself. Now that the insurance is cancelled, the money paid in the past two years has been wasted.
Mr. Wang once paid money to the insurance company
When he was at a loss, Mr. Wang thought of finding a reporter and simply exposed the matter. Even if His problem cannot be solved, and it can also wake others up.
Mr. Wang contacted the staff and told the staff about what happened recently. When he was sad, he couldn't help but wipe his tears and said in anger:
"When I bought this, I would say anything. When it was time to settle the claim, I would first ask me to wait. Then I told me that it would not work after a month and it would not meet the requirements. Why can't it be achieved? Isn’t this bullying? I just want justice! My wife is still lying in the hospital, waiting for the life-saving money! What's wrong with a big company? Can you bully the people if you are big? "
Seeing that Mr. Wang was out of control, the staff quickly comforted his emotions and comforted him : "Uncle, we will find a way for you. ”
Mr. Wang found the reporter
Accompanied by the staff, Mr. Wang went to the local Qingfeng County Taikang Life Insurance Company to ask clearly.
But the insurance company's personnel in charge of reception refused repeatedly: "You can't do this either. We all act according to the contract, and your conditions have indeed failed to pass the review. "
Mr. Wang was also angry, but his repeated running around in recent days made him very upset. The reception staff's words added fuel to the fire. Mr. Wang was so angry that he trembled with his hands and feet. OK, when he bought insurance, he treated it as his grandfather, and now he was like this!
He immediately threw the things in his hand : "If your company can't give me an explanation, I won't leave! Call your leaders! In the world, is there even the king's law gone? I want to sue your company! "
Mr. Wang asked the insurance company to argue
The reception staff felt frightened when they saw Mr. Wang getting angry. Mr. Wang was on the verge of collapse at this moment. If he angered him, the consequences would be unpredictable.
She immediately changed into a kind expression and said kindly: "It's useless for you to come here. The claims specialist and relevant leaders went to another place for a meeting this week. You might as well go to our superior branch. I understand your mood and please understand our work. ”
Mr. Wang left the insurance company's door and couldn't help but sit on the steps and cried.There are people coming and going outside, and there are traffic, but his life is in a desperate situation. When will this end?
Mr. Wang looked at the street and cried bitterly
Originally bought insurance to get insurance, but now he is involved in bigger trouble. It was this kind of rhetoric again. Mr. Wang knew that they were playing past the ball again, but he was at a loss.
The staff member felt compassion when they saw Mr. Wang's appearance and sighed: " Uncle, it has always been difficult to seek justice. It has reached this point. Let's figure out this matter. No matter what, there must be an explanation."
After hearing the staff's words, Mr. Wang remembered the hardships of the past few months. Yes, I have survived the most difficult time. Now the dawn is ahead. Do you have to give up?
Mr. Wang was comforted by others
He wiped away his tears, thanked the staff, and took the bus to Taikang Life Insurance Co., Ltd., Henan Puyang Central Branch, located in the honor office building.
This time, the relevant staff finally explained to Mr. Wang:
"First of all, pulmonary arterial hypertension must be primary. The primary means that it is not caused by other diseases, or it is caused by unknown reasons;
Your wife's pulmonary arterial hypertension is caused by this systemic lupus erythematosus, so this cannot It comes from primary pulmonary hypertension. You mentioned that your wife's endogenous creatinine clearance rate is higher than 90ml, but in fact, the endogenous creatinine clearance rate reflects a degree of kidney organ lesions.
Generally speaking, endogenous creatinine clearance rate is less than 30ml of kidney organ function damage. Your wife's condition obviously does not comply with the contract. As for systemic scleroderma, it is also based on the same reason. The most likely one side of your wife's kidney is that there is a problem or that it has not reached the state of "uremia", so it does not meet the requirements for the disease's claims."
Mr. Wang went to Puyang Central Branch
Mr. Wang got the answer he wanted, but became more and more confused, but the dissatisfaction he had accumulated in his heart gradually became a small hill. When Xiao Li advised him to take out insurance, he did not give any relevant explanations to him.
He didn't know that so many conditions had to be met, and he just thought that he could get compensation as long as he confirmed the relevant diseases agreed in the contract. Moreover, at that time, Xiao Li knew that he had only a little idea, but he did not interpret the relevant terms in detail, and the whole process was confused.
, insurance companies claim that they can pay as long as they are diagnosed with related diseases, but now they keep the words in hand. Didn’t their behavior deliberately deceive consumers? Do you have to pay any price to trample on consumers’ trust?
Relevant personnel explain to Mr. Wang
In fact, it is entirely possible for Mr. Wang to obtain compensation for this situation.
Although Mr. Wang's wife's case statement and diagnosis certificate did not pass the review of the claim requirements, based on the actual situation at that time, when Xiao Li promoted the business to Mr. Wang, he was vague and did not introduce and explain the obligations of the insurance policy purchased by Mr. Wang, which led to him misunderstanding.
According to the law, if the two parties enter into an insurance contract, if the standard terms provided by the insurer are adopted, then in this case, the insurer shall explain the content of the contract for the insured.
Insurance method
So Xiao Li obviously has the suspicion of dereliction of duty. If he explained to Mr. Wang in detail the conditions that need to be met for the claim, then the consequences of Mr. Wang's failure to make a claim after signing will have nothing to do with Xiao Li.
Therefore, Mr. Wang can fight for his legitimate rights and interests through legal litigation.
just needs a "acquaintance" to testify to prove that what Mr. Wang said is not false, but that his colleague Lao Li is Xiao Li's uncle, and whether he is willing to testify is another matter. The only thing that can be blamed for Mr. Wang for believing in the wrong person.
This also warns us that when purchasing insurance, we must keep our eyes open and be careful. We cannot blindly believe in the salesperson's "fooling". After all, things involving money cannot be careless, otherwise we can only taste the bitter fruit by ourselves.
