CFIC introduction
Since conflicts and disputes occur frequently during the epidemic, should the relevant compensation process be standardized?
After the outbreak of the epidemic,
More than one insurance company took advantage of the situation to launch "quarantine insurance"
, but in actual compensation, they encountered difficulties
Previously,
The editor had reported that
Ms. Shen in Shanghai applied for quarantine allowance
1 Insurance company repeatedly refused to pay , the reason was that
"During this period, Shanghai did not have medium and high-risk areas"
There is also a Ms. Wang
has a "quarantine order" but the claim was still rejected
What is the reason? After receiving the "release order for
", Ms. Wang (pseudonym) sorted out the relevant materials and submitted an application to the insurance company on April 28, requiring compensation in accordance with the relevant standards of the "new crown quarantine insurance" she purchased. But unexpectedly, this appeal was rejected by the insurance company.
"The insurance company said that the 'nucleic acid abnormality' is stated on the release of the isolation form, and it can be determined that I am a confirmed case and do not meet the claims conditions for the 'isolation insurance'. It must follow the 'medical insurance' claim process and provide medical treatment certificates and other documents." However, Ms. Wang is an asymptomatic infected person. She has been "observing" at the quarantine point for more than ten days. When she left the cabin, she did not have the so-called "medical treatment certificate" , and the compensation process has been stagnant for a long time.
During this period,
similar to buying "new crown" insurance
There are many disputes about repeatedly rejecting claims
Among them, some are because
it is difficult to issue the required proof documents
Some are
Insurance companies and policyholders
Different perceptions of "isolation", "symptoms", etc.
This makes consumers feel that
encountered "layers of increase" in the process of claim
Insurance companies are playing text games
but on the other hand
Insurance companies are also very aggrieved
claim that there are indeed various problems in claims practice
As a practitioner in the legal-related industry
Jin Ming has recently received help from many friends around him
In the process of answering friends' questions
A "golden idea" was born in his mind
Since conflicts and disputes frequently occur during the epidemic
Should the relevant compensation process be regulated?
How difficult is it to settle claims for "just a cup of milk tea" and "quarantine insurance"?
Since the epidemic in 2020, more and more insurance products related to the epidemic have entered the public's vision. Some can get a quarantine allowance of several hundred yuan per day as long as the price of "a cup of milk tea". However, due to the unclear detailed compensation standards for the "quarantine insurance", many disputes have arisen. For this reason, the Shanghai Banking and Insurance Regulatory Bureau has reminded consumers to carefully read the relevant terms of in the contract terms of "what to protect" and "what to protect" , clarify the "definition of isolation" and scope of responsibility, and be cautious insured.
After this round of epidemic in Shanghai, some new problems emerged. Some citizens purchase medical insurance for "new coronavirus" infection by themselves or the unit has purchased medical insurance for "new coronavirus" infection. According to the insurance company's publicity content and contract agreement, once the insured is diagnosed with new coronavirus, the insurance company will bear the liability for compensation, such as 30%-60% of the insurance amount for "mild symptoms" and 100% of the insurance amount for "severe diseases". This requires that the insured must obtain effective certificates, such as symptom type, discharge summary and other materials, to prove his symptoms and treatment methods after being infected with the virus before applying for a claim.
However, according to the current relevant regulations of this city, those who have been released from isolation can obtain paper "dissociation certificate" issued by designated hospitals and temporary hospitals, or apply for an electronic "dissociation medical certificate" on the "SuiShenban". However, no matter which kind of certificate it is, it mostly says "Complied with the National Health Commission's "Diagnosis and Treatment Plan for the New Coronavirus Pneumonia (Ninth Edition)" to lift the isolation management standards and allowed to lift centralized isolation". None of them indicate the types of symptoms such as asymptomatic, mild, severe, etc., and some certificates do not reflect the quarantine time, which brings certain difficulty to applying for claims. In addition, some medical insurances also make it clear that they will not compensate for "asymptomatic infection".For insurance companies, according to the contract, it is indeed impossible to operate without the corresponding disease diagnosis certificate. There is more than one instance of
"cannot operate". A friend around Jin Ming once bought a "quarantine and worry-free insurance". According to the contract, if the insured becomes a close contact with a new crown patient, or is in a medium- and high-risk area, or is centralized or home quarantine, he can get a claim. But when it was time for it to apply for a claim, the insurance company said that there were no medium- and high-risk areas in Shanghai some time ago, and the lockdown period was not centralized or home quarantine, so the claims could not be settled. Some time ago, some media paid attention to such incidents. Relevant insurance companies also refused to pay compensation on the grounds that the city's "three districts" division management policies, silent management policies, etc. cannot be directly related to "medium- and high-risk areas" or "centralized or home isolation".
The epidemic has improved, and many people have begun to apply for claims and compensation procedures to be standardized. After inquiring about
, Jin Ming learned that there are many similar situations and the number of related complaints continues to rise. Is there a good way to solve the dilemma of both sides? A "Related Suggestions on Solving the Difficulty of Compensation for the "New Coronavirus" Insurance Claims in the City" was born.
For the "symptom type" or the admission and discharge time of medical insurance and critical illness insurance claims requirements, Jin Ming suggested that big data center, municipal health committee and other departments may consider setting up channels for issuing relevant certificates to provide convenience for citizens in need; or, consider opening inquiry permissions to insurance companies or providing relevant data according to actual needs, establishing a fast claim settlement channel to reduce the insured's running around.
As for the identification of risky areas, Jin Ming believes that has different names for the management of "medium and high-risk areas" under normalized prevention and control and the "three zones" under the blocked state, but its connotation and essence are the same. Regulatory departments and industry associations can jointly conduct special research with relevant insurance companies, form a consensus around relevant policy recognition, and issue corresponding guiding documents to guide insurance companies to handle claims in an orderly manner.
"As the epidemic situation improves, many people have begun to take the claim settlement process, and these contradictions should be faced with them." Jin Ming suggested that regulatory departments and industry associations can better play the role of supervision, coordination and organization. On the one hand, actively promotes consultations with insurance institutions, guides them to properly handle insurance disputes related to the epidemic, safeguard the legitimate rights and interests of consumers, and avoids arousing confrontation among citizens; on the other hand, , strengthens the risk management of insurance institutions, and does a good job of risk simulation based on the insurance situation, formulates response plans in advance, reasonably determines the recognition standards for claims conditions, and make insurance "claim rate in line with expectations" as much as possible, and escorts the healthy development of the insurance industry.
At the same time, the reporter also learned that in early June, Ms. Wang received a call from the insurance company and the relevant compensation matters are being coordinated and resolved.
This matter also reminds consumers of
Do not impulsive when purchasing insurance products related to the epidemic
Be sure to carefully study the terms of the contract
clarify in advance "what to protect" and "what to protect"
At the same time, you must consult the insured insurance company in advance to clarify the list of materials required for
and related requirements for claims
avoidance For avoiding subsequent disputes
Source of this article: Shangguan News
Author: Li Si
Shanghai Securities News, sponsored by Xinhua News Agency, and the China Securities Regulatory Commission legally disclosed securities market information media. It was founded in 1991. It is the first national financial daily in New China to provide authoritative financial securities professional information. It has now formed an all-media financial media matrix covering newspapers, websites, clients, videos, WeChat, Weibo and other platforms.
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