The COVID-19 pandemic has been around for nearly 3 years, and it has really changed our lives in the past two years. There are always several confirmed cases coming from time to time. After we thought we could breathe a sigh of relief, another city has an epidemic.
Faced with the unpredictable epidemic and the risk of being quarantined at any time, various insurances for the epidemic came into being. With the idea of being prepared for danger in times of peace, many people have purchased epidemic isolation insurance online.
However, when I went through the claim process, I was told that my own situations did not meet the claims conditions. Therefore, I have great doubts and confusion about the claims settlement of isolation insurance. Why did I not get a good compensation even if I bought the isolation insurance?
Take isolation insurance as an example. We ordinary people understand that as long as you purchase isolation insurance and are isolated for any reason within the time frame when the isolation insurance takes effect, you must make a claim according to the amount specified in the insurance.
But things are not as simple as imagined. Major insurance companies have many deductible terms, and the inability to settle claims has made many people who purchase insurance very angry and have caused many complaints.
The reason why many complaints about claims issues occur is mainly because "quarantine insurance" itself has many risks:
1. During the product promotion process, some insurance companies will focus on low prices and high compensation, and the publicity of exemptions has been weakened, so it is very easy to mislead consumers and thus lead to disputes.
2. In the process of designing the "quarantine insurance" product, the exemption terms and claims conditions are unreasonable, resulting in many "quarantine insurances" being "easy to buy and difficult to compensate".
3. Such "quarantine insurance" products are usually sold through Internet channels. Most consumers have not read the terms and take out insurance based on product introduction alone. Once a dispute arises due to claims, it is easy to be difficult to get compensation because of the existence of disclaimer clauses.
The following are several legal application issues for insurance claims during the epidemic. Please check it.
01
Q
In insurance contract disputes, what should be done if the policyholder and the insured require the insurance company to make a claim on the grounds that the insurance company has made relevant commitments in epidemic prevention and control?
A
During the epidemic prevention and control period, the insurance company promises to cancel the waiting period (observation period), deductible amount, designated hospital and other restrictions on customers infected with COVID-19 in insurance contracts such as disease insurance, medical insurance, and health insurance. If the scope of insurance liability is expanded, the people's court shall include the promise in the content of the insurance contract and determine the rights and obligations of the two parties and the claims liability of the insurance company based on this.
02
Q
How should the insured person apply for a claim if the insured person does not meet the agreed claims conditions?
A
People's courts shall strictly review the definition of insurance risks such as "quarantine", "centralized isolation", and "home isolation". If relevant terms are prompted and clearly stated, they shall be handled in accordance with the contract agreement. If the insurer and the insured or beneficiary have disputes over the terms of the contract, it shall be interpreted as usual. If there are more than two interpretations of the contract terms, the people's court shall make an explanation that is beneficial to the insured and the beneficiary.
The insured person submitted with the seals of the health administrative department, streets, townships, residential (village) committees, hospitals or epidemic prevention and control departments, centralized isolation medical observation cancellation form, or home health monitoring certificate issued by the online platform designated by relevant government agencies such as "Suishenban" can be used as evidence to prove that he is quarantined. If the insurer believes that the occurrence or start and end time of the insurance accident is false, he or she should provide corresponding evidence.
Insurer has sufficient evidence to prove that the insured intentionally violates the epidemic prevention and control management and isolation measures issued by people's governments at all levels, resulting in him being infected with new coronavirus pneumonia or being isolated from confirmed or close contacts, the people's court may determine that the insured's behavior is a intentional insurance accident, and the insurer has the right to refuse compensation.
03
Q
During the epidemic, some insurance companies donated insurance products to medical staff, volunteers, community property staff, neighborhood (village) committee staff, etc. who participated in epidemic prevention. How should subsequent insurance disputes be handled?
A
Gift insurance means that the insurer exempts the insured from the obligation to pay insurance premiums when entering into an insurance contract, or performs the obligation to pay insurance premiums on behalf of the insured. According to relevant regulatory regulations, insurance companies may give away personal insurance for promotions or public welfare purposes, but they shall not give away property insurance; they shall not conduct illegal and irregular business or engage in unfair competition in disguise on the grounds of giving away insurance. During the epidemic prevention and control period, insurance companies shall give personal insurance to medical staff, volunteers, community property staff, residential (village) committee staff involved in epidemic prevention. If they do not violate the mandatory provisions of laws and regulations and public order and good customs, the validity of the insurance contract shall be recognized. After an insurance accident occurs, the insured and the beneficiary have the right to claim compensation from the insurance company based on the insurance products given.
04
Q
How should financial investors or financial consumers ask financial institutions to bear corresponding compensation liability on the grounds that financial institutions take advantage of the epidemic to implement improper financial product marketing behavior and cause losses?
A
Financial institutions should effectively strengthen industry self-discipline, maintain market order, and shall not use the epidemic to conduct improper financial marketing and publicity. If a financial institution violates the principle of honesty and trustworthiness, engages in false product promotion, violates investor suitability obligations, fails to fulfill the obligations of prompts and clear explanations in accordance with the law, and causes damage to financial investors and financial consumers, the people's court shall determine the corresponding liability based on the request of the parties and in accordance with the parties' breach of contract or infringement facts, damage consequences, causal relationships and the degree of fault of each party.
Claims Ways
01
Negotiation
During the claim process, both parties to the insurance contract can negotiate and resolve the matter. If the negotiation fails, you can go to the court to resolve the matter.
02
Consolidation compensation
Consolidation compensation refers to the act of an insurance company not bearing the compensation liability under the insurance contract, but still paying or partial compensation. In this case, first, the insurance broker represents the interests of the policyholder in accordance with the law. Secondly, there is a cooperative relationship between the brokerage company and the insurance company. If the results are vague, or the insurance company considers its own interests and social impact, it adopts a loan compensation.
03
Arbitration
Highlights are difficult to negotiate with each other, so you can apply for arbitration. At present, the state has very strict supervision of insurance companies and has an arbitration committee. In practice, as long as the insured has evidence, the results can be obtained on the same day as the case applying for arbitration.
04
Litigation
Both parties to the insurance contract can resort to the court. The court will finally look at the evidence and determine the compensation result based on the evidence.
Written by: Jinhuan
Review: Feng Zuo Xuanxuan Shawn
Feifei Kara
Reference article: "8 Q&As of the Shanghai High Court on the Application of Law in Financial Disputes Cases involving Epidemic"
pictures are all from the Internet and copyright holders cannot be contacted. If there is any infringement, please contact the background to delete it.
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-