The following are real cases of my participation, not from the Internet. If you have different opinions, please feel free to comment and leave a message.
Insured: Netizen Liu Mou 1 insured his son Liu Mou 2 on November 1, 2019, with an insured amount of 500,000 yuan, the coverage period is lifelong, the annual premium is 5,395 yuan, and the payment is paid in 20 years.
Insurance Policy
Liu Mou 2 was hospitalized four times before taking out insurance. 1. Liu Mou 2 was hospitalized from April 9, 2016 to April 18, 2016, and was diagnosed with: bronchiolitis, iron deficiency anemia, , and liver function damage; 2. On December 28, 2017, he was diagnosed with nasopharyngeal hyperplasia; 3. The third time he was hospitalized from December 31, 2017 to January 7, 2018, he was diagnosed with adenoid hypertrophy and chronic serous otitis media; 4. The third time he was hospitalized from October 6, 2018 to October 11, 2018, he was diagnosed with acute suppurative otitis media .
claim : But when taking out insurance in November 2019, the insurance broker did not ask about Liu Mou 2's specific situation. Liu Mou did not know that there was such a health notification process. He thought it was all small problems and had been cured, but he did not actively inform the salesperson. Unfortunately, Liu Mou 2 performed a surgery due to illness in December 2020. The operation was a major disease stipulated in the contract, and he applied for claims from the insurance company. However, after the investigation, the insurance company issued a claim decision notice on the grounds that the insured truthfully informed the obligation of , and refused to pay the insurance premium and terminated the insurance contract.
Claim decision notice
sued to court : After communicating with Liu Mou 1, it was decided to file a lawsuit directly in the court. At the same time, it was also expected to achieve the purpose of using lawsuits to promote remediation, but due to the large dispute between the two parties, they failed to do so. The first instance judgment was made by the insurance company, and the insurance company was ordered to pay 500,000 yuan in insurance premiums, and all insurance fees were exempted, and the insurance contract was continued.
First instance judgment 1
First instance judgment 2
After the first instance judgment, the insurance company was dissatisfied and continued to appeal. Finally, after the second instance court heard the case, it made a decision to "dismiss the appeal and uphold the original judgment." The insurance company had to pay 500,000 yuan of insurance to Liu Mou 1, and the insurance contract continued to take effect, and it also exempted nearly 100,000 yuan of insurance.
second instance judgment 1
second instance judgment 2
share such a case, not to encourage everyone to learn from such practices, nor to promote myself. I just hope that when you encounter a refusal to pay, whether it is the policyholder or the salesperson, you can look at it calmly, rationally, objectively and professionally, and try to consult some professionals in the legal field. If you can not consult an insurance salesperson or an insurance practitioner around you, try not to consult. This is not a bias against insurance salesperson or insurance practitioners. I just think that a few practitioners have little contact with refusal to pay, and their understanding of refusal to pay is relatively simple. Even if you can give opinions and suggestions, you are only from the perspective of the insurance company and cannot give objective and fair opinions and suggestions from a legal perspective. At the same time, you also hope that when a claimant encounters a situation involving a non-true obligation, you will not rush to refuse compensation first, and often refuse compensation at an unreasonable time. It is necessary to let the insured go a long way to fight for an insurance premium.
To summarize: Although there are objective facts that the insured fails to fulfill the obligation to truthfully inform, there are many different reasons for such results in the actual insurance sales process, and it should not be simply understood as the insured failing to fulfill the obligation to truthfully inform, and adopting a one-size-fits-all rejection of compensation indiscriminately. Such a refusal to compensate can be said to be legitimate from the insurance company's position, but it is wrong for us. I think as long as there is no situation where there is no intentional or serious negligence that fails to fulfill the obligation to truthfully inform
