"As long as the hospital is diagnosed with the major disease mentioned in the contract, the insurance company will immediately compensate you XX million."
Friends who have bought critical illness insurance must be familiar with this sentence.
Many agents introduce this, and many people firmly believe in it.
But is critical illness insurance really "payment upon confirmation"?
is correct, but it is not completely correct.
So, what are the standards for critical illness insurance claims? Let’s take a look together.
- What is "reimbursement when confirmed"
- 25 common critical illness claims standards
- daddy summary
What is "reimbursement when confirmed"?
First, let’s take a look at a real case:
In May 2014, Mr. A took out a universal life insurance policy (including critical illness protection liability).
In July of this year, Mr. A was diagnosed with cerebral hemorrhage and cerebral infarction.
Then in September of that year, Mr. A was diagnosed with cerebral hemorrhage and sequelae of cerebral hemorrhage. After treatment, he was discharged from the hospital in October.
Results Mr. A was rejected by the insurance company when applying for critical illness claims.
Reason is that Mr. A's condition did not meet the standard requirements for "meet permanent dysfunction" in the insurance contract terms for the sequelae of stroke . Mr.
A then sued the insurance company, but his lawsuit was still rejected.
It can be seen that Mr. A is indeed suffering from a serious illness. But why can't Mr. A, who bought insurance, get compensation for critical illness? Doesn’t
say “reimbursement as soon as you confirm”? Why not pay?
First of all, the insurance industry uniformly stipulates 25 definitions of critical illness in the "Specifications for the Definition of Diseases of Major Illness Insurance". The definitions of disease in critical illness insurance products of each insurance company must comply with the "Specifications".
In other words, no matter what types of critical illnesses are protected by a specific product of an insurance company, there are 25 types of critical illnesses that must be included and the definitions are the same.
Although there are only 25 types of critical illnesses, in fact, they have accounted for about 95% of the current critical illness insurance claims, and can be said to be the core of critical illness insurance.
These 25 types of serious diseases can be divided into the following three categories:
Legal definition and classification of 25 types of serious diseases
25 types of serious diseases claims conditions are matched with their types.
According to this, there are three types of compensation for critical illness insurance:
- can be compensated if the diagnosis is confirmed
- performed the agreed surgery
- reached the disease agreement state
- , so the statement of "reimbursement as soon as the diagnosis is confirmed" is not rigorous, so what are the above conditions for critical illness claims?
25 common critical illness claims standards
Specific claims conditions for different diseases can be found in this picture.
statutory claims for 25 critical illnesses
Here are a few excerpts from the original text from the insurance terms, which is convenient for everyone to understand intuitively.
1. You can make a claim if you are diagnosed.
Excerpt from a certain critical illness insurance clause
Malignant tumors are typical diseases that can make a claim if you are diagnosed.
It should be noted that it must be clearly diagnosed by pathological examination results and does not belong to the listed disease type that is not covered by the liability protection for this disease. Only by meeting these two conditions can you obtain a claim.
2. The agreed operation was performed:
Excerpt from a certain critical illness insurance clause
This is usually the most intuitive. This critical illness will be clearly stated in the terms. Any surgery that needs to be actually performed and what surgery is not covered. Anyone who meets the conditions can be compensated.
3. Reaching the disease agreement status
Excerpt from a certain critical illness insurance clause
In fact, this type of dispute arising from is at most due to the diagnosis of critical illness. This is the case with Mr. A at the beginning of the article.
Generally speaking, the insurance terms will specify such serious illnesses and what status they need to reach to be compensated. For consumers, this is also what we need to pay attention to the most.
especially needs to pay attention to time limits, status limits, etc. For example, the terms of this critical illness insurance clearly state that the sequelae of stroke need to be confirmed 180 days after the diagnosis, and at least one of the following obstacles remains.
1011111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111
Daddy Summary
Due to the complexity of the insurance contract, it is indeed difficult to fully and accurately convey the claims standards for critical illness insurance, such as "confirmation and compensation".
and are more than 70% of critical illness insurances that are caused by malignant tumors and need to be compensated, which has aggravated people's misunderstanding of "payment upon diagnosis" for critical illness insurance.
Therefore, when we buy critical illness insurance, we need to carefully browse the terms of critical illness insurance to avoid buying critical illness insurance that seems to be sufficient and has many actual restrictions and cannot effectively protect our critical illness insurance.
For more questions about insurance, please click
in the upper left corner of the screen
