shares a case handled by yourself, which is representative, so share it.
1⃣️Case summary:
March 21, 2020 Xing's child was diagnosed with "heterochromatinous white matter malnutrition?" (Unconfirmed)
On March 23, 2020, the insured critical illness insurance was insured by the agent with a 450,000 yuan in specific critical illnesses, and an annual payment of 4,680 yuan.
On March 27, 2020, the agent purchased a million-dollar medical insurance from the agent. Before the examination, the agent kept selling child insurance to Xing, and knew that the child was quite normal. The health notifications in the insurance contract were not questioned one by one (the court made an inquiry record for him), and Xing did not take the examination seriously and did not take the initiative to inform him.
In May 2020, about 2 months after taking out insurance, hematopoietic stem cell transplantation was performed after being diagnosed with "heterochromatinous leukoplasma dystrophy".
In September 2020, Xing applied for a claim, and the insurance company paid Xing 4,680 yuan in major disease claims; medical insurance informed Xing that he could still make a claim in hospitalization except for previous diseases, and later collected a million-dollar medical insurance premium from 2021 to 2022.
In April 2021, Xing applied for part of the medical insurance claim again, and the insurance company issued a notice of refusal on the grounds that it did not truthfully inform.
In September 2021, Xing filed a lawsuit for serious illness of 454,680 yuan, and specific serious illness of 450,000 yuan, and medical insurance plus hospitalization subsidy of 282,354.62 yuan, totaling 1187,034.62 yuan
2⃣️Insurance company's view: ① Serious illnesses occur within 180 days, and the insurance premium has been compensated for 4,680 yuan in insurance during the waiting period within the contract; ② The medical insurance part terminated the contract and refused to pay on the grounds that Xing did not truthfully inform him, which complies with the law.
3⃣️ Court opinion: ① The waiting period belongs to the disclaimer clause , which plays a role in reducing the liability of the insurance company, resulting in the insured date and the contract date, and the obligation to make clear statements is not fulfilled. The waiting period clause does not take effect and will be paid as normal;
② The insurance company has no right to terminate the contract of millions of medical insurance, and the agent admits that the health notification has not been asked one by one, and the system defaults to "No", and the responsibility lies with the insurance company, and the medical insurance is paid as normal;
③ Xing did not actively inform the inspection before the insurance, and he is negligent in this case, and he should bear the corresponding liability;
Results: The court ruled at its discretion to the insurance company to bear 50% of the insurance liability, and the compensation is 588837.71 (593517.71-4680) yuan, if there is any appeal, I will share it later.
