Regarding the "two-year non-defense" clause, some friends' interpretations are amazing: "Even if you are insured with illness, as long as you survive two years, the insurance company will have to compensate if it doesn't compensate!"
Before we discussed the case of insurance with illness and being refused compensation within two years, many friends also wanted to know, if the claim occurs two years later, will the insurance company not be able to refuse compensation?
We have reviewed dozens of documents. Today, based on real cases, we will talk to you about the application of "two-year non-defense". The main content is as follows:
- How to correctly understand the "two-year non-defense" clause?
- is insured with illness. Will you be compensated in two years? (Real case analysis)
- has been insured with illness, what should I do if I didn’t tell you truthfully?
How to correctly understand the "two-year non-defense" clause? The reason why
"two years of non-defense" has attracted much attention is that it has solved the trust crisis of insurance companies to a certain extent and gave policyholders confidence. But there are many misunderstandings from this. Let’s first interpret this regulation from two aspects.
1. "It doesn't matter if you are sick, you will lose money after two years"?
Most friends understand the two-year non-defense clause as follows:
If Lao Wang concealed the history of diabetes and successfully acquired insurance, within two years, the insurance company did not know about this and did not terminate the contract. Two years later, Lao Wang got the serious illness in the insurance contract, and the insurance company had to compensate.
The basis for this interpretation is mainly Article 1 to 3 of Article 16 of the Insurance Law:
For everyone, translate it in a popular way:
- The insured is obliged to truthfully inform yourself of your health.
- The policyholder has the right to terminate the contract and refuse compensation if he intentionally or negligently fails to inform the insured person.
- 42 years after the contract was established, the insurance company shall not terminate the contract without truthful notification or refuse compensation.
At first glance, it seems that "if you have to survive two years, you don't have to worry about psychological compensation at all", but in fact, this interpretation is not comprehensive enough.
2. Is "two years of non-defense" really a universal clause?
"two-year non-defense" clause is not a weapon for insured with illness, and it is not that everything will be fine as long as you survive 2 years. Article 16, paragraphs 4 and 5 of the Insurance Law also stipulate:
That is to say, Whether within two years or two years, if the insured commits "intentionally not informing truthfully" or "failure to inform truthfully due to gross negligence" can affect the policy underwriting results, once the insurance company discovers and gives evidence, it may be terminated and the compensation is refused, and the premium is not even refunded.
Don’t think that the insurance company does not know that it is insured with illness and cannot provide evidence. The insurance company has the right to investigate most of the insured's information, and there are many investigation channels and means. The original intention of establishing the two-year non-defense clause is to protect consumers in case of dispute. But the law will not have any partiality, and the "two-year undefensible" is by no means a "sword of Shangfang" that maliciously defrauds insurance.
We have checked relevant claims documents on the China Judgment Documents website. Below we will analyze the real judgment cases to let everyone understand this example more deeply.
is insured with illness. Will you be compensated in two years?
real cases are much more complex and the judgment results are different.Let’s first look at two cases where insurance is insured with illness. If you have not told me truthfully, you have been rejected after taking out the insurance for more than two years:
Case 1: If you have an accident within two years, you will apply for a claim after two years
Let’s look at this Case:
was diagnosed shortly after a son was born, " pathological jaundice ". Severe jaundice can cause an increase in bilirubin, and excessively high bilirubin will cause brain cell potential balance imbalance, induce epilepsy, which can directly affect the insurance company's decision on whether to underwrite it.
, but Yu did not tell the truth when he was insured. In less than a month of insurance, Yu's son was diagnosed with "severe epilepsy". After two years of the contract was established, Yu applied for a claim. The insurance company refused to pay the first time that it was confirmed that "epilepsy" was in a 180-day waiting period.
Subsequently, the insurance company received Yu's lawsuit materials and learned that the insured had suffered from "pathological jaundice" before taking out insurance, so it issued a "termination notice" within 30 days.
The court held that the insurance company legally drove the contract termination right . Although Yu had applied for the claim for more than two years, When a son diagnosed "epilepsy", it was within two years of the contract establishment, and the "two-year non-defense" regulations did not apply.
From deliberately taking out insurance with illness to delaying two years to apply for a claim, Yu always held a "lucky" to the point where "two years of indefense" is not an omnipotent basis for claims, and the law cannot take advantage of loopholes.
Case 2: Intentionally not informing truthfully, two years later
In this case, Zhou was qualified to be an agent for insurance sales. When he had a brain tumor resection in 2012, he received a critical illness claim for Ping An Life . He was insured again in 2014, but did not truthfully inform the medical history. The subjective malice was very obvious.
Although it was in danger for 5 years since the contract was established, "brain malignant tumors" are a disease that existed before the contract was established . The law will never favor this kind of evil deed of deliberately taking out insurance with illness.
From these two cases of refusal, it can be seen that the " cannot defend against two years" regulations are not so magical. Next, we analyze two cases where was sentenced to compensate two years later to see if their judgment basis is "not to be defended for two years".
Case 3: The salesperson knew that the policyholder was sick and still agreed to take out insurance with illness
In this case, Zhou was refused compensation by the insurance company for taking out insurance with illness, and then filed a lawsuit based on the fact that the contract has been established for more than 2 years, but the key to his compensation is not the two-year non-defense regulations.
It turned out that when was insured, Zhou truthfully told him that he had been hospitalized for " coronary heart disease ", but the salesperson still asked him to fill in "No" when he asked "whether he suffers from coronary heart disease and other cardiovascular diseases", and the insurance company also agreed to insure .
Regarding this situation, Zhou also submitted a written instruction from the salesperson to the court, confirming that he had truthfully informed the salesperson that he had done cardiac stent surgery .
According to Article 16 of the Insurance Law, Article 6:
If the insurer knows that the insured has not informed the truthfully at the time of the contract, the insurer shall not terminate the contract; if an insurance accident occurs, the insurer shall bear the liability for compensation or payment of the insurance premium.
That is to say, when is insured, if the insurance company already knows that the insured is sick and still agrees to take out the insurance with illness, it will not have the right to remove the contract. After the accident occurs, should be compensated.Whether it is an insurance company or a policyholder, the law will not allow any party to intentionally harm the other party's interests for its own interests. The boundary of black and white text is there, and any temptation or overstep may be paid.
Case 4: After the insurance company knew the reason for the accident, it did not actively exercise the contract termination right
This case is relatively complicated. Although the judgment results of the first instance, second instance and final instance are all "reimbursed", the basis for the judgment is not completely consistent:
- The first instance and second instance believe that although Chen was insured with illness, it has been more than two years since the insurance was insured, so the insurance company can no longer terminate the contract.
- final review believes that Chen violated the obligation to truthfully inform , and the so-called "the contract cannot be terminated after more than two years" does not apply. However, when the insurance company decided to terminate the contract, the notice was not handed over to Chen's family in time, but was left in the company's case file , so the contract termination right could no longer be exercised.
In other words, final review believes that the insurance company can terminate the contract, but the insurance company did not successfully give the termination letter to the applicant within 30 days stipulated by the law.
has provisions in the "Interpretation of the Supreme People's Court on the Application of the Insurance Law": Article 16, paragraphs 4 and 5 of , 5 of , 5 of , 5 of , citing the policy underwriting results, or if the policyholder has deceiving acts of "intentionally failing to truthfully inform" or "failing to truthfully inform the policy due to gross negligence" can affect the insurance policy underwriting results, the insurance company may refuse to pay.
In this way, the insurance company cannot directly refuse to pay the insurance premium without successfully exercising the right to terminate the contract. This case undoubtedly shows that: law will not protect people who lie on their rights . If they fail to exercise their rights, the rights will also expire.
The insurance company did not lose to Chen's "speculative" behavior, but to the time limit, paying the price for omissions in work. The four real cases of
are typical cases we selected and analyzed after reviewing dozens of documents. During the process of review, we truly feel that may be difficult for the law to change people's misunderstandings, but the law cannot serve misunderstandings .
We hope that this article will give everyone a more correct understanding of the "two-year non-defense" clause and pay more attention to the truthful notification when taking out insurance.
already has insurance with illness?
Everyone is subject to the law. Instead of engaging in "lucky", it is better to pay attention to it when taking out insurance and eliminate the claims dispute from the source. So what should I do if I have already taken out insurance with illness? We have sorted out the following two situations for you:
- has a truthful message: Insurance company knows its physical condition and is willing to underwrite it normally, so there is no need to worry, it will not affect the claim settlement.
- did not inform the truth: needs to actively contact the insurance company to supplement health notice.
Generally speaking, if it is a disease that has not been asked about health notification, such as common colds and fevers, it does not affect the coverage, and it does not mean that there is no truthful notification.
If the disease you have not informed truthfully involves health notification, such as nodules , hypertension and other diseases, the additional notification may be excluded, surcharges, or even terminated the contract.
can underwrite other products before supplementary notification, truthfully inform you of your physical condition. If you have the opportunity to be covered by other products normally, you can buy products that can be covered normally first, and wait until the waiting period is over before returning the products that have not been told truthfully before.
written at the end
Once the is used, it means that there is a claim dispute with the insurance company that cannot be mediated.
And the court game can be as short as several months and as long as several years. As an ordinary person, when he encounters danger due to misfortune, he still has to spend time and effort and exhaust both physically and mentally for an uncertain result. Who will suffer greater losses from us or insurance companies?
As an insurance evaluation agency, I sincerely hope that everyone can make it clear: insurance is to resist unknown risks, not to make people take risks .
wishes health and smooth:)
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