The article turns from " manage compensate is helped " date of small letter public, manage compensate side gathers together expert of authority of dimension of compensate of manage of 1000 lawyers, insurance, here you are attainable authority of free dimension of insurance manage compensate seeks advice.
As masses insurance consciousness gain ground, the improvement of national superintendency environment, insurance company " rejecting claims " the small probability event that already made a trade, sufficient evidence is more on the manage compensate data that each insurance company publishs this.
Insurance company rejects the consideration that compensate pays, return roughly for the following:
1, the client casts the existence when protecting not to inform behavior according to the facts, the risk that affects insurance company fixes a price or manage actually.
2, the account that the client offers manage compensate, do not belong to insurance liability or be except responsibility.
3, the disease is safe / medical treatment insurance is awaiting period inside be or get out of danger.
4, flaw of sale link existence.
When incident of occurrence rejecting claims, because become the issue is bilateral (policy-holder and insurance company) located point of view is different, professional knowledge is incorrect wait, legal position is not quits, often be immersed in a kind of contrary awkward situation so.
Lawsuit is to break the step with this the most immediate situation, but a large number of output that lawsuit engages in a lawsuit to also mean monetary cost, manpower cost, time cost, be not highest effect however directly.
Policy-holder still can have the 2nd kind of choice -- " manage compensate is reconsidered " , insurance broker undertakes harmony to rejecting claims incident as the bridge that communicates when thing both sides. Of insurance broker intervene unscramble clauses and manage compensate case more can efficiently, professionally not only, still can the identity with tripartite, have manage compensate suit afresh on behalf of the client.
In be being operated actually, reason of this kind of rejecting claims is put in amphibolous circumstance, it is the nuclear compensate personnel as a result of insurance company, the discretion of professional ability, right of the clause unscramble difference, and the consideration that stems from pair of subject companies (for instance not active reminder changes application etc) the judgement that made rejecting claims, and the acknowledge that client itself did not make clear to clauses, eat likely " be unable to speak out about one's grievances " .
Two are shared below " manage compensate is reconsidered " case, look to be adjudged " capital punishment " guarantee slip, it is how to be passed " manage compensate is reconsidered " of bring the dying back to life.
A client bought health of Kang Shaoer of * new treasure 2015 (major disease) insurance plan, by December 2016, insurant lasts 6 days high fever, at Beijing grind be seen a doctor, the 8th day is by diagnose plain Qi is ill, on January 13, 2017 at die of Beijing children hospital.
On April 7, 2017, the client finds insurance broker, hope insurance broker shares follow-up insurance work with the identity of client, assist manage compensate. Right now, insurance company already to client make known to lower levels reject compensate to pay an announcement, the reason is:
1, this insurance does not contain disease die responsibility.
2, the requirement of compensate of plain Qi pathology that client place has a disease not to accord with the agreement in clauses.
Through the communication with the client, diagnose the comparative discovery of the proof to insurance contract provision, hospital, the reason of insurance company is belonged to really solid.
Nevertheless, client before one's death disease state accords with clauses to " deepness is insensible " definition: The deepness that clauses agrees is insensible, because disease or accident harm bring about consciousness to lose,point to, to the outside the demand inside stimulation and body all does not have report, insensible degree is pulled according to case this insensible classification (Glasgow Cama Scale) eventuate 5 cent or 5 minutes the following, and had used life of lung ventilator etc to maintain a system 96 hours continuously above.
Through be opposite the client is in Beijing grind the record of go to a doctor of place checks discovery: "The client enters children to weigh disease to guard ward time for 20170108, 22:20, give serious illness to guard time 20170113, 23:15, accordingly insensible time is in judgement client 96 hours above " , accord with deepness the partial requirement of insensible compensate Fu Zhong; In the meantime, the 8th page keeps medical record of go to a doctor clearly " examine system: Narcosis, glasgow gives a mark 5 minutes " . Afore-mentioned at 2 o'clock, in already according with major disease clauses, agree " deepness is insensible " manage compensate condition.
That day, as the client's client, insurance broker puts forward to change application project to insurance company, by application compensate of plain Qi pathology is changed for deepness insensible manage compensate, put forward to insurance company " manage compensate is reconsidered " , compensate of sum of requirement insurance company pays serious illness insurance gold 100 thousand yuan (the result does not say to also know) .
B client bought the old age of 4 insurance company to prevent cancerous risk at passing insurance broker 2016, at the beginning of March 2017, client by diagnose colon cancer.
At the beginning of April 2017, as the client's agent, submitted manage compensate application to 4 insurance company at the same time, 3 insurance company reply quickly and manage smoothly among them compensate.
On May 9, 2017, ** person life is informed according to the facts with was not being fulfilled rejecting claims advice note allotted to the client for obligation, and be not returned already the insurance cost of pay. Rejecting claims reason is: ** person life is checked, at the beginning of 2013, the go to a doctor that in Shenyang outpatient service of some hospital existence treats cerebral block records the client, cast the client when protecting to was not informed according to the facts to insurance company.
On May 9, 2017, insurance broker is started as the client's client " manage compensate is reconsidered " , offer ask for an explanation to the rejecting claims of ** person life:
1, the outpatient service go to a doctor 3 years ago records the client (symptom of slight head stalk) with reason of this second be or get out of danger (colonic cancer) nonexistent inevitable connection, need quote of insurance company respect.
2, basis " Chinese insurance law " the 16th: "Tell obligation what the money before policy-holder perhaps was not fulfilled intentionally because of gross error sets according to the facts, enough affects an underwriter to decide to whether agree with accept insurance to perhaps raise premium rate, the underwriter has authority to remove contract " , a place difficult of access that client place buys is planted for special the danger that prevent cancer, if second go to a doctor records insurance company to exist to be contacted necessarily with reason of this second be or get out of danger before indemonstrable client, criterion the client did not inform item to should be not belonged to " main item " , can't affect the effectiveness of insurance contract;
3, the client casts a place difficult of access that protects 4 companies to plant at the same time, the others 3 insurance company all normal compensate pays, put in doubt to rejecting claims of one-sided of * person life.
On May 11, 2017, answer of ** person life is normal compensate pays, 3 weekday reach compensatory fund Zhang.
" Chinese insurance law " the 118th regulation:
Insurance broker is the interest that is based on policy-holder, conclude for policy-holder and underwriter insurance contract provides intermediary service, and lawfully the unit of collection commission.
Insurance broker serves as the client's delegate, assist a client to make clear a risk, offer all-around, individuation, one-stop risk to safeguard, asset is configured and seek advice from a service. The professional knowledge that uses oneself reachs independent legal place, the unreasonable behavior in process of reasonable to insurance company compensate offers different opinion, safeguard a client to close right increase; On the other hand, if because the fault of insurance broker is being cast,be protected, assistance causes a loss to policy-holder on the link such as claim for compensation, insurance broker assumes liability to pay compensation independently, from inside decreasing to sell segment on certain level " cast accuse without the door " phenomenon.
Of course, "Manage compensate is reconsidered " the service is equal to " ensure compensate pays " , regard independent tripartite intermediary as the orgnaization, the station acts as between insurance company and client in objective and indifferent angle mediator. Be based on the professional dominant position of oneself, have judge in the light of manage compensate case, not deflection at any one party.
"Manage compensate is reconsidered " advantage depends on, give policy-holder major the support of the level on one hand; On the other hand, avoided the openly conflict when thing both sides. What this is just like medical treatment dispute is optimal settle a way, it is to pass independent medical treatment to investigate an orgnaization to intervene, be based on factual basis to make reasonable judgement. If let become give tit for tat of thing both sides, avoid very hard " war photograph to " , appropriative mediator can prevent agent produce conflict when thing both sides, produce the front to conflict.
What we advocate fair and logical manage compensate conclusion, it is oneself feebly in you, when striving for due manage compensate for family, professional support is sure somewhat help.
Manage compensate side is home the first law that enters a place to cut with insurance manage compensate serves platform. The advisory body of claim for compensation that expert of compensate of the lawyer that has way of a perfectness insurance not only, manage forms team, offer law of insurance claim for compensation freely still to seek advice from a service for the user, already was user of many 10000 insurance to had been offerred at present seek advice from a service freely.
