Hello everyone, I am Wenwen Dabao Beier, an insurance blogger responsible for every customer’s claims.
01
In recent years, "outbound travel" seems to have become an unreachable dream.
flights are often circuited and have to be isolated back and forth, which blocks many friends from "the world is so big, I want to go and see it."
Some time ago, there was only one of the most convenient outbound travel destinations in China, which is Macau.
Macau Tourism Bureau has also launched a series of Macau tourism recovery plans, and Macau Airlines launched a round trip air ticket buy one get one free event.
And the round trip policy is quite friendly:
Mainland residents who travel to Macau are in low-risk areas 14 days before entering the country. They only need to bring a 7-day valid nucleic acid test negative certificate, Macau visa and "Macau Health Code" to enter Macau. Mainland residents do not need to be quarantined when traveling to and from Macau.
A young man from my client went to Macau in June this year. I know this because he asked me to take out a travel accident insurance before going there and told me about the situation.
At that time, I thought that there should be no big problem. After all, Macau has been open for tourism for several months, so it should be nothing.
Who would have thought that just when he was about to go home, an epidemic broke out in Macau.
After a plane flight was fuse, the little brother finally set out on the way home.
However, because it happened to catch up with the epidemic in Macau, the young brother was directly taken away to undergo centralized quarantine after the landing.
I looked at the policy at that time, which was to implement the "7-day centralized medical observation + 3-day home health monitoring" health management measures for all incoming personnel in Macau.
is related to the overall situation of epidemic prevention, and we must support and abide by it. So the young brother went into centralized quarantine for 7 days, and the day when the quarantine was started and the ended quarantine took a total of 8 days.
02
After the isolation was completed, the little brother found me with the certificate and said, can this be claimed?
To be honest, when I first watched it, I felt that it might be a bit controversial -
is indeed a good centralized isolation, but it is not said that it is because of the close contact with the confirmed patient, or because it is quarantined in the medium and high-risk areas.
So I think it may be asked to supplement the materials:
But the little brother is also in a difficult situation. After all, everyone has such a proof, and they will not open one more for him alone.
In the end, there was no other way. We decided, why don’t we submit the application for a claim first.
Apply first, see what the insurance company reviews. It really needs additional materials. We will find a way later. The review process of
is very uncomfortable. It took nearly 30 days to close the case.
, the young brother was a little depressed at one time:
Did the insurance company deliberately delay time? In this way, I can’t get a certificate later. If I can’t get a certificate, the insurance company will not need to pay a claim!
insurance is indeed a scam!
But 30 days are indeed in the insurance company's claim review time limit, so it's useless to be anxious, and all we can do is wait.
After the insurance company conducted a claim investigation, finally, as the claim review expired, the young brother's claim application was successfully closed!
was reviewed correctly, and the quarantine allowance was successfully settled at 1,600 yuan!
and the insurance company quickly completed the claim payment:
It is a really a happy day~
03
Issue a happy day~
03
Isolation allowance claims are difficult and simple.
compensation conditions are two:
1. Work, routes, residence and other places are judged as medium and high-risk areas and are required to be quarantined.
2, confirmed or close contact, was required to be forced to isolate.
Why is there any rejection of compensation?
1, mistakenly treating "home health testing" as "isolation"
like "home health testing", the requirements for isolation are "not going out unless necessary". This situation does not meet the requirements of "mandatory isolation" and cannot meet the compensation conditions.
2, actively going to or leaving known medium and high-risk areas, resulting in forced isolation
If it is an act of actively going, it will definitely not meet the claims conditions.
knows that you will be isolated when you go, and you can avoid this situation, but you still take the initiative to go and be isolated when you take the initiative to pay.
The young brother in this case was the claim that " work, routes, residence and other places were judged as medium and high-risk areas, and was required to force quarantine ".
After all, when he went to Macau to play, there was indeed no epidemic in Macau at that time. It happened that it was in the past few days that the epidemic occurred in Macau and was judged as a medium- and high-risk area, which led to his return and being quarantined.
so there is no problem with claim settlement in this case.
As for why we did not ask us to submit the materials later, it may be that the insurance company and the centralized isolation point confirmed the situation, so the claims were settled smoothly.
3, it cannot be proved that the area you are in is a "medium- and high-risk area"
There are many disputes in claims for isolation insurance , mainly because of this reason.
As the prevention and control upgrades, many areas not only need to be blocked in medium and high-risk areas, but nearby areas will also be adjusted to "control areas" to implement closed management.
insurance company also agreed that the definition of "medium and high-risk areas" is based on the announcement of relevant departments:
There is also a clear agreement in the contract for this:
In this case, it is difficult to judge whether to pay, because the region is indeed not in line with the definition of medium and high-risk areas.
says that the insurance company is wrong, it is indeed not a medium-to-high-risk area; say that the insurance company is wrong, it seems that it is not so favorable.
can only be said that the issue of isolation insurance being rejected in large quantities due to the "medium- and high-risk division" cannot be completely considered the insurance company's fault, but it cannot be said that it is completely innocent.
has developed to this point, and it seems that everyone has some reason, but it seems that no one is completely responsible.
In fact, the claims teacher of insurance companies is also an ordinary worker like us.
Workers mean that they don’t have much authority. They will make any compensation as agreed in the contract, and will not hesitate to compensate for it indiscriminately. They will have no grudges against us, and they will really not make things difficult for us.
So what we need to do is to actively prepare the claims materials and make them well-founded, so that we can get the claims better, faster and smoother.
