Scan the QR code to view typical claims cases in 2021
New Hainan Client, Nanhai.com , Nanguo Metropolis Daily March 15th news (Reporter Ren Tong) Recently, the Hainan Insurance Industry Association and the Hainan Insurance Society announced 26 typical claims cases in Hainan's insurance industry in 2021, demonstrating the social responsibility and responsibility of Hainan's insurance industry, and at the same time it has a guiding role in improving the risk awareness, insurance awareness and production safety awareness of the whole society. At the same time, it fully reflects the industry core value concept of Hainan's insurance industry of "adhering to trust, taking risks, focusing on services, and compliance with standards", and plays an active role in disaster prevention and reduction, serving people's livelihood, helping rural revitalization, and supporting local economic and social development, providing strong support for the construction of Hainan Free Trade Port .
Service Innovation Cases
Cases 1
Underwriting Company: PICC Property Insurance Hainan Branch
Investment Insurance Types: Business interruption insurance (new coronavirus epidemic)
Compensation amount: 1 million yuan
Case summary:
On August 1, 2021, according to the press conference on the prevention and control of the new coronavirus pneumonia in Sanya City, a guest in a hotel in Sanya was diagnosed with a new coronavirus pneumonia patient, and closed control was implemented on the hotel. The hotel was forced to close for 21 days and suffered major economic losses. After the hotel was completely unblocked, PICC Property and Casualty Insurance quickly verified the case and confirmed that it met the scope of insurance liability, and the compensation amount was 1 million.
case comment:
business interruption insurance, also known as " profit loss insurance ", is a risk of losses caused by losses caused by losses caused by losses caused by material property. It is an expanded insurance that is dependent on property insurance or machine damage insurance and other insurances. Since the beginning of 2020, due to the impact of the new crown epidemic, companies have encountered difficulties in their operations. After the outbreak of the epidemic, insurance companies actively responded, introduced the insurance loss compensation function into the normalized prevention and control of the epidemic, actively assisted enterprises in resuming work and production, eliminated the concerns about resuming work of enterprises, and provided insurance protection for serving local economic development.
case 2
Underwriting company: PICC Property Insurance Hainan Branch
Investment insurance type: Hainan Average Vegetable Retail Price Insurance
Compensation Amount: 22,000
Case Summary:
On August 13, 2021, Hainan Province's first affordable vegetable retail price insurance was piloted on Ledong , providing price risk protection for 22 kinds of vegetables such as beans, tomatoes and sweet potato leaves . A retailer in the First Farmers' Market insured the insurance. On September 14, 2021, the actual sales price of vegetables was lower than the agreed sales price, causing the insured to lose the price, triggering the insurance liability. The insurance company compensated 22,000 yuan in compensation as agreed in the insurance contract.
case comment:
affordable vegetable retail insurance is based on the original greenhouse melon and vegetable price insurance in Hainan Province, and innovatively develop vegetable retail price insurance covering the retail end. Through the form of insurance protection, it absorbs more retailers into affordable vegetable stalls, achieving the goal of stabilizing prices and benefiting the people, and winning the market with win-win results. In 2021, PICC Property Insurance underwritten 2,124 orders, providing vegetable retail price risk protection to 3,987 vegetable merchants. As of the end of 2021, a total of 872 orders were paid, with a total compensation of 9.9379 million yuan. The provincial affordable vegetable supply guarantee action has been listed as one of the practical projects of the provincial party committee and the provincial government for the people in 2021.
case 3
Underwriting company: PICC Property Insurance Hainan Branch
Insured type: Inpatient Nursing Insurance (Extremely Poor Personnel)
Compensation amount: 11,500 yuan
Case summary:
Wenchang City Special Poor Personnel Mr. Y, suffering from drug-induced liver damage (infectious disease type), was hospitalized in the infectious department of a hospital in Wenchang City from July 28, 2021 to August 19, 2021. The civil affairs department evaluated his self-care ability as a disabled person and arranged one-on-one care for professional nursing staff. During the hospitalization period, a nursing fee of 11,500 yuan was incurred. After verification, it was found that it was within the scope of insurance liability. The insured Mr. Y did not need to advance the nursing fee, and the insurance company paid the nursing fee directly to the nursing institution.
case comment:
PICC Property Insurance has actively explored and established a new model of nursing insurance during hospitalization of "government + insurance + hospital + nursing institution", and signed the "Care Insurance for Hospitalization of Special Poor People" project with Wenchang Municipal Civil Affairs Bureau. The coverage is that the nursing expenses incurred by urban and rural poor people in Wenchang City need to accompany during hospitalization shall be borne by the insurance company. Insurance companies and third-party professional nursing institutions cooperate to enable patients to receive professional nursing care, effectively alleviating the pressure on nursing expenses and rehabilitation needs of extremely poor people during hospitalization. The insurance is purchased by government departments to improve the efficiency of the use of medical resources, effectively improve the socialization level of elderly care services in the city, and promote social harmony and stability. In 2021, PICC Property Insurance provided hospital care insurance coverage for 806 extremely poor people in Wenchang City. As of the end of October 2021, the total compensation was 2.1523 million yuan, and the compensation rate exceeded 100%.
case 4
Underwriting company: Ping An Pension Hainan Branch, China Life Insurance Hainan Branch, PICC Property Insurance Hainan Branch, Pacific Life Insurance Hainan Branch, total insurance
type of insurance: "Huiqiongbao" general medical insurance
insurance fee: 59 yuan
compensation amount: 999,900
case summary:
On December 15, 2020, Ms. Ou took out the insurance "Huiqiongbao A-State" insurance. Due to "acute brainstem infarction", he was hospitalized multiple times during 2021 (local medical treatment), and the total cost was 1.5351 million yuan. The total reimbursement of social security and serious illness medical insurance is RMB 450,000 (the annual reimbursement limit has been reached), and the remaining individuals pay a total of RMB 1.085,100 [the reasonable medical expenses within the scope of basic medical insurance payment are RMB 989,400, and the self-paid expenses outside the scope of basic medical insurance payment are RMB 95,700 (including RMB 41,100 for self-paid medicines for hospitalization outside the scope of basic medical insurance payment are RMB 41,100]. After review by the insurance company, based on the Huiqiongbao terms and conditions, the compensation for liability 2 was 989,400 yuan and the compensation for liability 3 was 10,500 yuan, with a total compensation of 999,900 yuan.
case comment:
In October 2020, Hainan Province’s universal supplementary medical insurance “Huiqiongbao” was officially launched. Through the cooperation mechanism of “government guidance and commercial insurance handling”, it effectively connects the social basic medical insurance and the serious illness insurance protection system, and has the characteristics of low price, high security, and universality. In 2021, the total number of insured people in "Huiqiongbao" was more than 950,000, of which 1,909 people were compensated, involving a compensation amount of 31.2384 million yuan. The successful launch of "Huiqiongbao" effectively solves the problems of serious illnesses, high medical expenses for serious illnesses, and external medications used in the medical insurance catalog, and is an effective supplement to the basic social medical insurance system.
The client in this case spent a total of 1.5351 million yuan on hospitalized medical expenses, and basic medical insurance for urban and rural residents and large-scale medical expense subsidy for has reached the capping line (total reimbursement of 450,000 yuan). Then, through "Huiqiongbao", the actual hospitalization medical expenses borne by the individual are reduced from 1.0851 million yuan to 85,200 yuan, effectively reducing the personal financial burden.
case 5
Underwriting company: Pacific Life Insurance Hainan Branch
Insured type: Group accidental injury insurance
compensation amount: 100,000 ml
Case summary:
On October 9, 2021, affected by the typhoon "compass", the water level of Nandu River rose, and nearly 100 meters of road surface was flooded. A student in a middle school in Xinpo Town, Haikou City accidentally fell into the water and died while passing through the section of the road after school. On November 1, 2021, the beneficiary applied for a claim from the insurance company. After verification by the insurance company, it met the scope of insurance liability and paid the beneficiary 100,000 yuan in accidental death insurance to the beneficiary on November 3, 2021.
case comment:
In September 2021, the Haikou Municipal Education Department purchased insurance for 310,000 students in public primary and secondary schools in Haikou, providing comprehensive protections on campus, accidental deaths, disease deaths, major diseases, accidental medical care, etc., with a cumulative insurance amount of 16.5 million yuan. Insurance companies actively participate in school risk management, effectively improving the ability and risk protection level of schools and parents to resist unknown risks by preventing and properly handling student accidents, protecting the legitimate rights and interests of students and schools, and having positive significance for maintaining the order of education and teaching.
case 6
Underwriting company: China Life Property Insurance Hainan Branch
Insured type: Lecheng Special Drug Insurance
Compensation amount: 108,500
Case summary:
In October 2020, Mr. W was hospitalized for treatment due to physical discomfort and was diagnosed with lung cancer after examination. He used the drug "Yingfeifan" in Lecheng Special Drug Insurance policy for treatment and enjoyed direct drug compensation service. According to the distribution and inventory of the insurance company's cooperative pharmacies, Mr. W went to the designated pharmacy to collect medicines and completed direct compensation services. The insurance company paid a total of 108,500 yuan in drug payments.
Case Review:
On August 2, 2020, my country's first provincial customized global specialty insurance product "Lecheng Specialty Insurance" was officially launched. The insurance is guided by the government and actively participated by commercial insurance companies. Combined with the integrated innovation of the construction system of Hainan Free Trade Port, it provides insured patients with 70 special anti-cancer drugs at home and abroad, and is suitable for 35 cancer diseases. It has the characteristics of low premiums, high insurance amounts, and complete protection, and patients can obtain direct drug compensation services. The successful launch of "Lecheng Special Drug Insurance" solves the problems of other drug costs other than medical insurance reimbursement, and to a certain extent alleviates the problems of high domestic drug costs for malignant tumors and difficult foreign special drug use.
Property insurance case
1. liability insurance articles
cases 7
Underwriting company: PICC Property Insurance Hainan Branch
Investment insurance type: Electric bicycle third-party liability insurance
compensation amount: 1,150 yuan
Case summary:
In August 2021, Mr. Y took out the insurance " electric bicycle third-party liability insurance ", with a premium of 90 yuan. On November 12, 2021, Mr. Y scratched a car while driving, causing damage to the door on the right side of the other party's vehicle. The traffic police department determined that Mr. Y was fully responsible. After review by the insurance company, the accident falls within the scope of insurance liability and the repair cost of damaged vehicles is 1,150 yuan.
Case comment:
In recent years, Hainan Province has shown a large number of electric bicycles and is increasing year by year. As an important tool for transportation for the masses, electric bicycles are not only convenient for the production and life of the masses, but also have many safety hazards in terms of sales, traffic and safety management, threatening the safety of people's lives and property. According to statistics from relevant departments, the proportion of electric bicycles involved in road traffic accidents in Hainan is as high as 90%. The third-party liability insurance for electric bicycles can effectively protect the people's driving and travel safety, reduce losses, and maintain social stability. It is recommended that electric bicycle owners actively take out third-party liability insurance for electric bicycles in order to ensure the safety of their own and others' lives and property.
case 8
Underwriting company: Pacific Property Insurance Hainan Branch
Investment type: Medical Institution Practice Liability Insurance
Compensation Amount: 600,000
Case Summary:
On September 16, 2020, patient Y went to a hospital in Hainan for heart bypass surgery , and died after rescue failed, and a dispute arises between the doctor and the patient. After evaluation by the expert group of the Hainan Provincial Medical Measurement Commission, it was believed that the medical prescription had faults in diagnosis and treatment, and it was recommended that the medical prescription bear the corresponding compensation liability according to the secondary responsibility. The insurance company will compensate the deceased's family 600,000 yuan in insurance compensation on July 9, 2021 in accordance with the insurance contract.
case comment:
insurance company actively fulfilled its compensation liability and provided financial compensation to the patients' families, effectively alleviating the economic pressure of the patients' families, and fully playing the important role of medical liability insurance in preventing and resolving medical disputes and protecting the legitimate rights and interests of both doctors and patients.
case 9
Underwriting company: Hainan Property Insurance Company has insurance totally insured
insurance types: Construction safety production liability insurance
compensation amount: 872,600 yuan
case summary:
On August 23, 2021, a worker X, a certain engineering company, accidentally fell from the third floor to the second floor while demolishing the mold at a commercial building project site, fell from the third floor to the second floor and died after ineffective treatment. The joint insurance company compensated the medical expenses and death compensation totaling 872,600 yuan in accordance with the insurance contract.
Case Comment:
In 2021, Hainan Insurance Industry signed a total of 2009 "Jianshi An Liability Insurance" policies, providing 47.58 billion yuan in risk protection and paying 55.5041 million yuan in compensation."Cultivation and Safety Liability Insurance" is a practical need to ensure the smooth progress of emergency rescue and after-treatment of construction work safety accidents. It is to introduce the professional risk control and social security functions of commercial insurance into the production safety supervision system, which plays an important role and significance in promoting the further stable improvement of the production safety form in Hainan Province and the innovation of the safety supervision model.
2. car insurance articles
cases ten
underwriting company: Ping An Property Insurance Hainan Branch
insurance types: Compulsory motor vehicle insurance, commercial insurance
compensation amount: 10,300 yuan
case summary:
Insured person drove a vehicle and an electric bicycle, causing vehicle damage and traffic accidents in which the three were injured. During the emergency observation in the hospital, the injured was diagnosed with a rib fracture, multiple contusions throughout the body, and left lung nodules, and was hospitalized due to "pulmonary space-occupying lesions". The examinations, surgery and medication performed during the hospital were basically treated based on his lung disease (later confirmed to be adenocarcinoma of the left lung).
The injured person believes that the cost during the hospitalization period was caused by a traffic accident and asked the insurance company to compensate for all medical expenses. The insurance company applied for mediation from the Haikou Traffic Accident Mediation Center. The mediator of the Hainan Insurance Industry Association organized the mediation. According to the principle of insurance recent causes, the medical expenses caused by the injury caused by the traffic accident are distinguished from the medical expenses of their own diseases. The injured person finally accepted the mediation plan, and the insurance company paid 10,300 yuan for the accidental injury of the injured person. The two parties signed a mediation agreement and conducted judicial confirmation.
Case comment:
In response to the pain points of "the road is busy, there are many disputes, and the people are upset", The Supreme People's Court, Ministry of Public Security, Ministry of Justice, China Banking and Insurance Regulatory Commission jointly issued a document to create a "dao and communication integrated platform" to fully serve social governance. The "Daojie Integrated Platform" has innovatively played an important role in insurance participation in social governance, forming a good situation where customers, people's courts, and insurance companies benefit together, and has effectively served the modernization of the national governance system and governance capabilities. Relying on the road traffic disputes handled by the platform, the mediation success rate has been significantly improved, which not only shortens the customer's compensation cycle, but also reduces the burden of litigation, greatly improves customer satisfaction, and achieves "let data run more and let the public run less errands." The number of court litigation cases has also been greatly reduced, effectively alleviating the contradiction of "many cases and fewer people" and optimizing the allocation of judicial resources.
III. Agricultural Insurance
Case 11
Underwriting Company: Pacific Property Insurance Hainan Branch
Investment Insurance Type: Hainan Provincial Local Finance Dragon Fruit Planting Insurance
Compensation Amount: 315,300
Case Summary:
Affected by the strong wind on October 17, 2021 (level 8 or above), some dragon fruit plants planted by the insured agricultural company suffered damages such as fruits and flower spikes. After on-site investigation and damage determination, the damage area of 154 mu of dragon fruit was finally approved, with a compensation amount of 315,300 yuan.
Case comment:
In recent years, dragon fruit cultivation has become an emerging tropical fruit industry in Hainan, with huge development potential. The insurance company actively implements the central government's work requirements on "improving standards, expanding scope, and increasing product" in agricultural insurance, and provides risk protection for Hainan farmers to plant dragon fruit throughout the entire process, that is, it covers the losses of dragon fruit plants, branches, flowers, fruits, etc. due to tropical cyclone and tornadoes above level 8. The successful implementation of dragon fruit planting insurance has eliminated worries for the majority of fruit farmers and protected the rapid development of the dragon fruit planting industry in Hainan Province.
cases twelve
Underwriting company: PICC Property Insurance Hainan Branch
Investment insurance type: Central fiscal subsidized rubber tree wind disaster insurance
compensation amount: 18,700 yuan
Case summary:
In June 2021, 108 farmers in Boshan Village, Wanquan Town, Qionghai City took out the "Central fiscal subsidized rubber tree wind disaster insurance". On October 13, 2021, due to the "Compass" typhoon, rubber tree was damaged in large areas. When the disaster occurred, data from the Provincial Meteorological Service Center showed that Qionghai reached the level of level 9 harsh wind and heavy rain.On the morning of October 14, 2021, the insurance company received a report and immediately arranged for claims to rush to the damaged site to investigate and determine the damage. After verification, it was found that it was within the scope of insurance liability. In just 4 hours, the insurance company paid the compensation of 18,700 yuan to the farmers.
Case comment:
Hainan has a tropical marine monsoon climate and is greatly affected by typhoons. As one of Hainan's most representative tropical characteristic economic crop "Three Trees" industries, rubber trees are extremely vulnerable to storms. Rubber tree wind disaster insurance can ensure that rubber farmers resume work and production as soon as possible, increase rubber farmers' enthusiasm for planting rubber, drive the development of industries, and is of great significance to promoting Hainan's economic development, rural revitalization and consolidating the results of poverty alleviation.
IV. Property Insurance
Case Thirteen
Underwriting Company: Pacific Property Insurance Hainan Branch
Investment Insurance Type: Aircraft Comprehensive Insurance
Compensation Amount: 1.0888 million
Case Summary:
On May 20, 2021, the insured piloted an aircraft to conduct solo water flight training over a reservoir in Danzhou City, Hainan Province, and fell into the reservoir due to a landing gear failure. The insurance company went to the site as soon as possible and entrusted the salvage company to formulate a salvage plan to ensure that there is no large amount of fuel leakage. In addition, in order to ensure the safety of water quality, a third-party agency was entrusted to arrange 12 points to test the water quality. The aircraft was finally treated with the total loss of according to . The water quality inspection accident did not cause water quality pollution. On August 10, 2021, the insurance company paid the insured 1 million yuan in total damage compensation for the aircraft, 88,800 yuan in salvage and water quality inspection fees, and a total compensation of 1.0888 million yuan.
case comment: The insurance liability of
aircraft comprehensive insurance includes three parts: loss or damage to the aircraft fuselage, third-party liability and on-board personnel liability. This type of insurance can effectively alleviate the financial pressure of insured enterprises and play a role in protecting the development of enterprises. The reservoir of the accident in this case is the only reservoir used by local residents in their lives. The consequences are improperly handled and the consequences are unimaginable. As an important part of the social stability system, the insurance company cooperates with the government functional departments to actively fulfill the responsibilities of the insurance company.
case 14
Underwriting company: Ping An Property Insurance Hainan Branch
Investment insurance type: Property and All Insurance
Compensation Amount: 7 million yuan
Case Summary:
On February 8, 2021, a laboratory in the insured factory caught fire during operation, and many key equipment in the laboratory were completely damaged. On August 13, 2021, the insurance company compensated a total of 7 million yuan in losses in accordance with the policy agreement.
case comment: The laboratory involved in
is built by a German manufacturer. If it is reset and repaired by the original manufacturer, not only will the construction period be as long as 2 years, but the price of reset is much higher than the original cost, seriously affecting the production and operation of the insured. Insurance companies actively help find domestic alternative repair manufacturers through various channels. After the insured confirms the alternative reset plan, they immediately pay insurance compensation, which greatly reduces the financial pressure of the insured and strongly supports the resumption of work and production of enterprises.
case fifteen
Underwriting company: China Life Property Insurance Hainan Branch
Investment insurance type: Family property insurance
Payment amount: 3120 yuan
Case summary:
On July 11, 2021, the insured Mr. Z's house smoker caught fire and spread and burned ceiling . After on-site inspection by the insurance company, there was a smoker with a ceiling of 2 square meters. According to the purchase documents provided by the insured and the market understanding, the final property damage amount was 3,120 yuan, and the insurance company paid the compensation the next day.
case comment:
family property insurance is an insurance that provides economic compensation for property losses suffered by residents or families. It has low premiums and a wide coverage range. It can be purchased offline and online. It is one of the most important insurance types for individuals and families to insure, and plays a positive insurance role in ensuring residents' stable life and social stability.
5. Yi Health Insurance
Case 16
Underwriting Company: Tianan Property Insurance Hainan Branch
Insured Type: Surgical Accidental Injury Insurance
Compensation Amount: 100,000
Case Summary:
On November 17, 2021, M's "pancreatic space-occupying lesions" was hospitalized in a hospital and underwent tumor resection. His condition was critical after the operation and his prognosis was extremely poor. He died at home on the day of discharge on November 20, 2021. After verification, it falls within the scope of insurance liability and the insurance company pays 100,000 yuan in insurance.
case review:
surgical accident insurance refers to the insurance company paying the insurance premiums for death, disability and complications caused by medical accidents (such as surgical accidents, anesthesia accidents) during the surgical diagnosis and treatment. Surgical accident insurance fills the gap in protection of ordinary accident insurance products, turns medical safety incidents from post-disposal to active prevention and control beforehand, build an effective communication platform for both doctors and patients, and at the same time, play the role of insurance mechanisms in third-party compensation and social sharing of medical risks in medical dispute handling, which is conducive to building a comprehensive health construction system for Hainan Free Trade Port .
case 17
Underwriting company: PICC Property Insurance Hainan Branch
Insured type: "Everyone Ankang" million medical insurance
compensation amount: 647,600
Case summary:
On June 2, 2020, W was suffering from acute lymphoblastic leukemia and was admitted to the hospital for treatment. After review by the insurance company, it meets the insurance liability for major diseases. The payment ratio of medical expenses for malignant tumors is 100%, and the "advance payment service" process can be initiated. Compensation is paid to the insured/treatment institution for a total of 6 times, and a total of 647,600 yuan in compensation is paid. The case was closed on April 12, 2021.
case comment:
million medical insurance is a low-income and high-insurance medical insurance. The liability for malignant tumor medical insurance is not limited to social security and medication, and it can be renewed after performing advance payment and claims, and it can be renewed up to 80 years old. The insurance protection role has been fully utilized to meet the medical insurance of normal families, so that the insured will not become poor due to illness, and promote the stability of social order.
Personal insurance case
1. Health insurance article
case 18
Underwriting company: Taiping Life Hainan Branch
Insured type: critical illness insurance, cancer prevention insurance
compensation amount: 2.3 million yuan
Case summary:
In October 2021, the insured Ms. L accidentally found a mass between her neck in her hometown of Harbin. In order to obtain an accurate diagnosis and a better treatment plan, she went to Zhejiang Provincial First People's Hospital for medical treatment and diagnosed with thyroid cancer . After being discharged from the hospital, Ms. L chose to undergo recuperation in Hainan and submitted a claim application to Taiping Life Insurance in Hainan. After review, the company paid 2.3 million yuan in compensation.
case comment:
nationwide compensation, three places are linked. After the customer is in danger, he or his beneficiary may submit materials to apply for claims at any branch of the insured insurance company according to his own convenience, and the insurance company may accept it. In this case, the three branches of Taiping Life Insurance cooperated to provide customers with disparate claims services, fully reflecting the insurance company's convenient claims settlement methods.
case 19
Underwriting company: Ping An Life Hainan Branch
Insurance type: Critical Illness Insurance
Compensation amount: 2.1 million yuan
Case summary: In July 2021, Ms. L found thyroid nodules in physical examination, and was diagnosed with thyroid cancer after further examination in hospital. After review by the insurance company, it is in line with the responsibility for major disease insurance. In August 2021, Ping An Life paid Ms. L a major disease insurance premium of 2.1 million yuan and hospitalization subsidy of 8,500 yuan, and at the same time, it exempted the premium of 369,200 yuan.
Case comment:
Major diseases are unpredictable, life is priceless, treatment costs are sky-high, and full protection is a necessity. Taking unknown health risks into consideration in advance and using insurance to reasonably transfer risks to avoid losses is an indispensable risk management method for every family.
case twenty
underwriting company: Xinhua Insurance Hainan Branch
investment insurance types: critical illness insurance, medical insurance
compensation amount: 1.029 million yuan
case summary:
insured, 5 years old, unfortunately diagnosed with malignant brain tumor at Beijing Tiantan Hospital on September 30, 2020. His guardian submitted a claim application to the insurance company. The review of the insurance company is true, and the insurance company paid 1.029 million yuan in insurance.
Case Comment:
In recent years, the incidence of brain tumors has been on the rise. According to statistics, brain tumors account for about 5% of systemic tumors and 70% of childhood tumors. With the widespread application of new medical technologies, some brain tumor patients have better treatment effects, but some patients also give up treatment because they cannot afford the expensive medical expenses. In this case, the insured has a high awareness of insurance. After the child is born, he reasonably combines insurance with multiple insurance types to improve his ability to resist risks, establish comprehensive risk protection for the child, and when the risk comes, he provides a stable economic foundation for the child's survival and treatment.
case 21
Underwriting company: PICC Life Insurance Hainan Branch
Insured type: Million Medical Insurance
Compensation amount: 150,000
Case summary:
On August 25, 2021, the insured was hospitalized for treatment due to aortic dissection inter-wall hematoma, and the medical expenses were as high as 350,000 yuan. After the medical insurance was settled, the self-paid part would be borne by 170,000 yuan. The insured applied for insurance claims from the insurance company in November 2021, and the insurance company paid 150,000 yuan in medical insurance after verification.
case comment:
commercial medical insurance is a cost-type medical insurance , which follows the principle of loss compensation , that is, the actual medical expenses incurred by the insured person shall not exceed the actual medical expenses. For insured persons with social insurance, commercial insurance compensation can be made on the basis of social insurance reimbursement. In this case, the million-dollar medical insurance provides customers with high medical expense risk protection and low insurance premiums, which greatly solves the family's financial burden problem and makes up for the vacancies that cannot be fully reimbursed for medical insurance.
2. life insurance articles
cases 22
Underwriting company: Ping An Life Hainan Branch
insurance types: lifetime life insurance, critical illness insurance , medical insurance and other multiple insurance types
compensation amount: 3.5489 million
case summary:
In June 2021, client Ms. L died of a sudden respiratory arrest due to heartbeat and breathing. The beneficiary applies for a claim from the insurance company. After review by the insurance company, it falls within the scope of insurance liability and pays 3.5489 million yuan of insurance premiums to the beneficiary in July 2021.
case comment:
life is fragile, and family protection plans should be made in advance to avoid financial risks that families may not be able to bear in the future through insurance. The combination of multiple insurance types can effectively expand the scope of risk protection, increase the risk protection quota, and achieve all-round protection without regression in the economy.
case 23
Underwriting company: Ping An Pension Insurance Hainan Branch
Investment type: Group term life insurance
compensation amount: 500,000
Case summary:
On September 3, 2020, the insured Fu died of an accident due to an accident while riding a vehicle. The beneficiary submitted a claim application on January 13, 2021. After review by the insurance company, it falls within the scope of insurance liability. On January 19, 2021, the beneficiary was paid 500,000 yuan in death insurance to the beneficiary.
case comment:
On June 14, 2020, a government department in Haikou City purchased insurance uniformly for 13,000 people (0-18 years old) in Haikou City who hold only child certificates. The insurance liability covers death, hospitalization and hospitalization subsidies, etc., and establishes a multi-level insurance protection plan for only child families. The person who died in this case was a minor only child. The insurance company compensated the death of the only child family who had suffered misfortune and increased medical expenses to help the family members who lost their only child get out of the pain as soon as possible. At the same time, it also reminded the parents of students to strengthen traffic safety awareness education for their children and do a good job in traffic safety prevention.
III. Accident insurance
Case 24
Underwriting company: China Life Hainan Branch
Insurance type: Group accident insurance
Payment amount: 500,000
Case summary:
On May 29, 2021, Mr. L, an employee of an engineering company in Hainan, accidentally injured his head by an object at a construction site, and died on the way to the hospital for rescue. In August 2021, the insurance company's claims staff assisted the beneficiary in applying for claims through the mobile claim channel "China Life e Store", and the beneficiary was compensated for 500,000 yuan in death insurance.
case comment:
enterprises purchase commercial insurance for employees and establish a sound and complete accident compensation mechanism to enable employees to receive more sufficient and comprehensive compensation after an accident. This can not only improve employees' safety guarantees, effectively prevent and resolve accident risks and contradictions, but also resolve conflicts between enterprises and employees, reasonably transfer the business risks of enterprises, alleviate and eliminate the adverse impacts brought to employees' families and society by accidents.
case 25
Underwriting company: Xinhua Insurance Hainan Branch
Insurance type: Group accident insurance (public welfare insurance)
compensation amount: 100,000
Case summary:
On October 18, 2021, Zeng, a sanitation worker in Sanya City, Hainan Province accidentally fell and injured his head, and died after the hospital's rescue was ineffective. After the accident, Xinhua Insurance Hainan Branch opened a green claim settlement channel and paid 100,000 yuan in insurance to Zeng's family.
case comment:
In 2021, Xinhua Life Insurance gave 8816 million yuan of exclusive insurance coverage to 8816 sanitation workers in Haikou, Sanya and Danzhou . In four years, a total of 43,713 sanitation workers in Hainan Province have given exclusive insurance coverage of 4.3713 sanitation workers in Hainan Province. This case is the first case of accidental casualty claims for sanitation workers completed by Xinhua Insurance Hainan Branch since the Hainan Branch held a large-scale public welfare campaign for caring for sanitation workers across the country. It fully reflects that the insurance company practices corporate social responsibility with practical actions and conveys positive energy to the society.
case 26
Underwriting company: Pacific Life Insurance Hainan Branch
Insured type: Student Ping An Insurance
Compensation amount: 50,000
Case summary:
In February 2021, student W went to the hospital for treatment due to fatigue and neck discomfort and was finally diagnosed with spinal glioblastoma. His guardian reported the case to the insurance company to apply for compensation. After being reviewed by the insurance company, it is within the scope of insurance liability. On March 23, 2021, it was paid 40,000 yuan in insurance premiums for specific diseases and 10,000 yuan in hospitalization medical premiums, totaling 50,000 yuan in insurance premiums.
Case Review:
Student Ping An Insurance is an insurance designed for students over 3 years old. It has the characteristics of low premiums and complete protection. Parents of students can choose to take out voluntarily. When students experience unpredictable risks such as accidents and diseases during their growth, the insurance provides students with comprehensive risk insurance protection, effectively improving their ability to resist unknown risks, and escort their children's healthy growth.
