Many people think that insurance is a scam and insist not to buy insurance. Insurance has never had a good reputation. Looking into the reason, it is inseparable from claims settlement.

It is difficult to settle insurance claims. Who is responsible for this? Insurance company, agent, or policyholder? Claim settlement is a matter for both parties, and the difficulty of claim settlement is not caused by one party.

As an insurance policy holder, you should get rid of your prejudice against insurance and look at various requirements in claims calmly. At the same time, in order to protect your own interests, you should invest more energy in insurance. Pay attention to insurance, learn insurance knowledge, enhance legal awareness, do not violate the rules when applying for insurance, follow the claims process after an accident, prepare all claim materials, and clearly understand the ins and outs of claims.

Some excellent insurance companies have begun to improve their claims services and are restoring consumers' confidence by establishing efficient and smooth claims systems. This is the hope of policyholders.

Is it really difficult to settle insurance claims?

There are not many insurance claims disputes reported in the press, and the amount involved is a drop in the ocean compared to the more than 200 billion yuan in claims expenditure nationwide each year (statistics from the China Insurance Regulatory Commission in 2007). But why do many consumers have the deep-rooted impression that insurance claims are difficult to settle?

There are various reasons why it is difficult to settle insurance claims

Many consumers have been unable to make up their mind to buy insurance because they are worried about the trouble of settling claims afterwards or even not being compensated; even if they buy insurance, I am also worried about whether I will encounter trouble when making claims in the future. Insurance claims have almost become the biggest obstacle preventing the public from choosing commercial insurance.

Insurance companies cannot absolve themselves of the blame

As the saying goes, there is no smoke without fire. In the actual claims settlement of insurance companies, there is an objective phenomenon of reluctance to compensate. Hesitating to claim is a phenomenon, and it is also a mentality of insurance companies when settling claims. When the operating pressure of an insurance company reaches a certain level, or the insurance company needs to obtain more profits, it will exercise certain control over compensation, which generally manifests as delayed compensation, reduced compensation, or refusal of compensation. Of course, this is not unrelated to the fact that insurance companies encounter about 10% to 30% of fraudulent claims every year and treat insurance claims with caution.

As a for-profit institution, it is normal for insurance companies to pursue profit maximization. However, if there is an incentive to reduce claims expenses at the expense of the interests of policyholders, it will only be a small loss, or even a loss outweighing the gain. . A good market reputation is extremely important to an insurance company's business development. It is very difficult and slow to build a good reputation, but it is very easy to destroy it.

Many insurance companies are aware of the seriousness of this problem. In addition, supervision has been strengthened and the cost of protecting policyholders' rights has been reduced. Now they deliberately make things difficult for policyholders, and the number of cases where compensation should be paid or not has been greatly reduced. However, insurance companies have many branches, the quality of employees varies, and insurance companies have internal profit assessment requirements, so it is impossible to completely eliminate such cases.

Some data show that when a company provides services to policyholders, if the policyholder feels good, he will tell 10 people about his experience; if the policyholder feels bad, he will tell his experience Tell 50 people. As the saying goes, "Good things don't go out, but bad things spread thousands of miles." Therefore, even though insurance companies have now corrected their attitude on the issue of claims, it will still take some time to eliminate the negative impact caused by the early hesitancy to compensate.

The quality of some agents is low

The low professional ethics or lack of professional knowledge of some insurance agents is also a major reason why consumers find it difficult to settle insurance claims.

False propaganda and deliberate or unintentional misleading, irregularities in the insurance process, such as exaggerating the coverage and claim amount, signing on behalf of the policy holder, encouraging the policy holder to not truthfully inform the existing diseases, and over-reporting income. etc., all of which lay hidden dangers for policyholders in future claims settlements. Some policyholders believed in the salesperson's propaganda and thought they had bought an insurance that "covered everything." Only when an insurance accident occurred and went to the insurance company to collect the insurance money with high hopes did they realize that they had been deceived. When the time comes, it will be difficult to avoid disappointment and anger, and it will also be easy to blame an agent's bad behavior on the entire insurance industry, amplifying the difficulty of insurance claims settlement.

There are also insurance agents who, although there are no violations when consumers apply for insurance, have very little awareness of after-sales service; or they find that the policyholders have lost the ability to add insurance and make referrals, and their services are poor. This is a big discount, and when a claim occurs, policyholders are allowed to prepare their own information and go to the insurance company to apply for a claim. Many policyholders are not professionals and have little research on claims issues. They often have to go back and forth several times to get things done because the information they prepare is incomplete or does not meet the requirements of the insurance company. Even if you have no objection to the claim amount in the end and get the claim successfully, you will still feel that it is difficult to settle insurance claims.

If the policy salesperson has left the insurance company and the policy becomes an "orphan policy", the above phenomenon may easily occur. As we all know, the vast majority of insurance agents have been in the industry for a short period of time, and the turnover rate among insurance companies is higher than that in other industries.

The policyholder’s own fault

Some policyholders, insured persons, and beneficiaries’ own faults are also a major cause of claims disputes.

The more common mistakes include not telling the truth when applying for insurance, concealing medical history and applying for insurance despite being ill; being unclear about the specific insurance responsibilities, such as not carefully reading the terms when applying for insurance, or sometimes even if the agent made it clear at the time , but as time goes by, I can’t remember it clearly or remember it wrongly, and subconsciously I hope to protect as much as possible; to sign on behalf of the insured; to trigger exemption clauses, such as drunk driving or driving without a license, etc.

One of the most common erroneous behaviors is to take a chance and not truthfully inform your health status when applying for insurance because you are worried that the insurance company will increase fees or refuse insurance, hoping that even if an insurance accident occurs, you can avoid the insurance company. After investigation, the medical history was revealed during the claim settlement and the insurance company refused to pay. These mistakes are related to the fact that many policyholders do not pay enough attention to insurance, lack insurance knowledge, and have indifferent legal awareness.

Public opinion guidance contributes to the flames

The reasons for the impression that insurance claims are difficult also involve media publicity and social public opinion guidance.

A very simple truth, if it is a normal claim settlement case by an insurance company, newspapers and television will generally not report it, because there is no news at all and "cannot catch the public's attention"; only the occurrence Only cases of claims disputes, that is, negative news, are likely to be seen in the media and even exaggerated, because this is in line with the public's attention orientation. Over time, consumers will naturally have the impression that insurance claims are difficult to settle.

Compared with insurance companies, policyholders are a vulnerable group. When disputes arise over claims, public opinion will tend to sympathize with the vulnerable groups emotionally, thus having a certain negative impact on insurance companies.

It is also common to spread rumors by word of mouth. When one person tells another person about a case in which "insurance claims are really difficult to settle", few people delve into the specific circumstances of the case, such as contract terms, accident situations, reasons for rejection of claims, etc., but they are keen to actively spread the word that "insurance claims are difficult to settle." "Such a seemingly popular conclusion.

To eradicate the "chronic disease" of claims, multiple parties need to join forces

The crux of the difficulty in insurance claims lies in many aspects. If we want to improve this long-standing problem, we need regulatory authorities, insurance companies, Policyholders are working together from many parties.

Increased supervision

From a regulatory perspective, the China Insurance Regulatory Commission’s supervision and management of insurance companies and penalties for violations are increasing year by year. Strict supervision and high penalties have increased the cost of insurance The company's violation costs can cut off the insurance company's subjective motivation to not act in accordance with the contract at the source. At the same time, cleaning up various overbearing clauses is also one of the actions. For example, after the "Critical Illness Insurance Crisis", the Insurance Industry Association issued the "Regulations on the Use of Disease Definitions for Critical Illness Insurance", which clarified the disease definitions, terminology, and exclusions of critical illness insurance. etc. have been standardized.

Insurance companies have strengthened their internal controls

Insurance companies have also made progress in recruiting agents, exposing violations, strengthening agents’ professional ethics and professional standards education, and are working hard to ensure that The policy provides 100% return visit within the hesitation period. In order to solve the short-sightedness problem of some agents, some insurance companies are also exploring new ways to increase their sense of belonging, such as increasing benefits, staff system, employee stock ownership, etc.

Focus on individual efforts

What external efforts change is the general environment, and the individual policy holder’s emphasis on insurance is the key. If you can work hard to learn some insurance knowledge, choose your agent carefully, read the terms carefully when applying for insurance, report insurance accidents in a timely manner, prepare claims information in accordance with the insurance company's requirements, and communicate with the insurance company anytime you encounter problems, I believe insurance claims will no longer be a problem. (Li Xiaoyan)

9 Reasons for Reasonable Denial of Claims

Insurance companies are the transferees of risks and the managers of insurance funds. In order to protect the interests of most policyholders from infringement, insurance companies will refuse to pay a small number of claims that do not comply with laws, regulations and terms and conditions. What are the reasons why some people spend money to buy insurance but cannot get claims services?

Failure to tell the truth

Failure to tell the truth ranks first among the reasons why insurance companies deny claims. Before purchasing insurance, policyholders must be fully aware of the serious consequences of not making truthful disclosures. If you conceal or omit the information listed in the insurance policy form by the insurance company, you may not get the protection you deserve, and you may not even get your premium back.

Ms. Fang has suffered from cataracts for many years and has been diagnosed by a doctor and received some treatment. When purchasing critical illness insurance, she did not realize that it was related to her purchase of insurance, and the agent did not inquire in detail. A year later, Ms. Fang felt her eyesight gradually declining and went to the hospital for a checkup. The result was that she needed surgery and hospitalization. When Ms. Fang’s family made a claim, the insurance company refused to pay the claim on the grounds that it had not been truthfully informed.

For several mistakes that are easy to make when fulfilling the obligation to tell the truth, and how to fulfill the obligation to tell the truth, you can refer to the special topic "Tightening the String of Telling the Truth" (Issue 3, 2008) in the insurance column of this magazine ). Again, policyholders are reminded that if they find that they have made a mistake in the notification process before an insured accident occurs, they should contact the insurance company in time. Most insurance companies will handle matters fairly.

Exceeding the scope of insurance liability

Insurance only provides protection against specific risks, and each insurance product has a specified coverage. Insurance companies will only cover accidents within the scope of insurance coverage.

Mr. Ping has been engaged in long-distance freight work for a long time. At the end of 2007, he purchased an accident insurance (including accidental medical insurance) for himself. During the Spring Festival of 2008, Mr. Ping caused a traffic accident while driving, causing his legs to become disabled. During the treatment, Mr. Ping's relatives believed that Mr. Ping had purchased accident insurance, so they decided to use expensive imported prostheses. After completing the relevant procedures, Mr. Ping’s family members went to the insurance company to make a claim. However, the insurance company only covered Mr. Ping’s hospitalization examination and treatment costs, and did not pay compensation for the prosthetic limbs, which accounted for the largest proportion. The reason was that the prosthetic limbs exceeded Beyond the scope of national social security, insurance companies do not bear liability for compensation.

Many policyholders take insurance literally. For example, they think that if they buy car insurance, they can claim for compensation in case of an accident; if they buy critical illness insurance, they can claim compensation for any serious illness. Each insurance policy has its own specific protection content. A rational policy holder should understand the scope of insurance liability of the product he buys in advance with a responsible attitude, instead of blindly condemning the insurance contract as "overlord clauses".

Belongs to the scope of the exemption clause

In the insurance contract, the policyholder should not only look at the "insurance liability" part of what can be insured, but also focus on the "exclusions (disclaimer clause)" .

Mr. Qian bought an accident insurance policy in February 2007. In June, he went on a wild trip with his friends and unfortunately fell while climbing. After being treated and discharged from the hospital, Mr. Qian went to the insurance company to settle a claim, but was told that rock climbing was not covered by accident insurance and refused to compensate. Mr. Qian went home and looked through the terms of his insurance, only to find that rafting, horse racing, rock climbing, etc. were listed as excluded from the insurance.

All current insurances have exclusions. For example, in car insurance, overloaded vehicles and drunk driving are not covered by the insurance; critical illness insurance excludes hereditary diseases; death is a condition for payment. The insurance has exclusions for suicide, intentional homicide, etc. Even for the same insurance type, different products have different provisions on exclusions, so pay special attention to them. Generally speaking, high-risk activities and dangerous projects will be included in the insurance company's exemption clause.

No compensation will be paid beyond the payment grace period

Most life insurance policies are long-term contracts, with the payment period sometimes lasting for decades. During the payment period, policyholders may be unable to pay on time due to business trips, forgetfulness, temporary financial constraints and other reasons. In order to prevent the insurance policy from easily becoming invalid, insurance companies generally give the policyholder a grace period. If an insured accident occurs during the grace period, the insurance premium will still be paid. However, if the grace period has passed and the premium has not been paid, and there is no automatic advance payment of insurance protection clause, the policy will enter the expiration period, and no compensation will be obtained if an insured accident occurs.

Mr. Peng purchased a whole life insurance policy from an insurance company on May 1, 2001, with a payment period of 30 years. Since 2003, Mr. Peng has failed to pay premiums on time due to business losses. In August 2004, Mr. Peng died in an accident. His family's claim was rejected by the insurance company on the grounds that Mr. Peng's policy had exceeded the 60-day grace period stipulated by the company and therefore the policy had expired.

The grace period stipulated in the Insurance Law is 2 months. If for some reason, the premium is not paid within 60 days, the policyholder has one last chance to "resurrect" the policy, and that is to apply for policy reinstatement. Policy reinstatement can be processed within 2 years from the date of termination of the contract. The policy holder must fill out the reinstatement application form and, in accordance with the requirements of the insurance company, provide a new health declaration or go to a designated institution for a physical examination.

Signing on behalf of others

Signing on behalf of others means that the insurance company requires customers to (The policyholder, insured, beneficiary or guardian) has a personal signature but is not his or her signature. If this provision is violated and the autograph requirement is missing, the insurance contract will not be established and claims settlement will be out of the question.

Ms. Ma purchased a critical illness insurance for her husband last year. At that time, because her husband was on a business trip and the agent did not raise any objection, Ms. Ma signed his name on the policy on behalf of her husband. But this year, Ms. Ma's lover suddenly suffered from acute myocardial infarction. When she filed a claim with the insurance company, the insurance company refused to pay on the grounds that the signature on the insurance policy was untrue and the insurance contract was not established.

In order to avoid unnecessary troubles and disputes, even couples cannot take it for granted to sign the name of the policy holder to avoid being passive in the future. If you are really unable to sign in person and need someone else to sign on your behalf, you must also obtain the other party’s written authorization when signing the insurance policy on your behalf. If you have signed on behalf of someone else, you should contact the insurance company immediately and negotiate with the insurance company to resolve the matter.

An insured accident occurs during the observation period

The observation period is also called the waiting period, which refers to the period of time after the insurance contract is signed (usually 3 months to 1 year). If If the insured suffers from a disease stipulated in the contract or dies due to illness, the insurance company will not be liable for compensation. This is most common with health insurance.

Mr. Huang purchased a critical illness insurance policy from an insurance company on August 15, 2004, which stipulated that the observation period was 90 days. On October 8, 2004, Mr. Huang was diagnosed with liver cancer. By reading the relevant terms, Mr. Huang learned that critical illness insurance is a timely payment insurance. As long as the hospital diagnoses the disease, you can obtain full insurance benefits in advance.

So he submitted a claim request to the insurance company on October 13, 2004. After reviewing the policy situation, the insurance company refused to pay on the grounds that the policy was still within the observation period and did not require coverage.

The failure to pass the observation period means that the insurance contract has not officially come into effect and the policyholder cannot receive corresponding compensation. The reason for this provision is that insurance companies are considering risk prevention and also to prevent unfairness to healthy policyholders caused by taking out insurance while sick. The observation period is generally calculated from the effective date of the contract when the insured first takes out insurance, and generally only applies to the first insurance year. For renewable policies, there is no waiting period for the renewal year.

Duplicate claims for medical expenses

The compensation of some insurance products is based on the compensatory principle. For losses caused by insured accidents, compensation will be based on the actual loss, and the policyholder will not benefit from the loss compensation.

Ms. Guo had purchased accident insurance before and experienced an accident. Although the insurance company compensated her, the final compensation did not fully make up for the medical expenses paid. Therefore, Ms. Guo wants to buy another medical expense insurance, even if the insurance company cannot pay the full compensation after the accident, she can get two compensations. In early 2007, she bought an additional medical expense insurance from another insurance company. In December 2007, Ms. Guo was hit on the head by a plate falling from above while dining in a restaurant and was hospitalized. She successfully received compensation from the first insurance company, but when she made a claim with another insurance company, she was told that the compensation was denied.

Article 4, paragraph 4, of the "Health Insurance Management Measures" that came into effect on September 1, 2006, stipulates that "the payment amount of cost-compensation medical insurance shall not exceed the actual medical expenses incurred by the insured "That is, the insurance amount paid by several insurance companies will not exceed the amount actually used when settling the bill for discharge from the hospital.

In addition, most of the current hospitalization medical expense insurances are based on urban basic medical insurance. Self-paid drugs and some special examination fees in urban basic medical insurance are paid out of pocket in proportion, and the same is true for commercial medical insurance. Cannot be reimbursed.

Incomplete claims materials

Insurance companies determine the nature of the accident and the degree of compensation for losses, to a large extent, rely on the relevant supporting materials provided by the applicant. If the materials are incomplete, the insurance company will not be able to judge the accident. If some materials are lost or difficult to obtain in the short term, the claim will be delayed. In serious cases, the claim will be invalid during the validity period of the insurance.

Mr. Li bought a hospital medical insurance for his child in 2007, which is valid for 10 years. At the end of 2007, Mr. Li's child was hospitalized for treatment due to tuberculosis. The treatment lasted for half a year and cost 45,000 yuan. When he was discharged from the hospital, he only took an invoice and went home. After settling the child, Mr. Li thought about the medical insurance purchased for the child, and immediately submitted a claim application to the insurance company. When applying for insurance claim later, he found that he had to submit medical records, expense list, etc. information, so I went to the hospital several times. Exhausted from all the tossing. According to him, completing these procedures is even more tiring than taking care of his children.

In order to make the claim settlement smoother and faster, after an accident, you should immediately ask the insurance company what claim information is needed, and carefully prepare it as required. Submit all the claims at once to avoid causing trouble to yourself. Another mistake.

Omission of necessary procedures

Many claim settlement disputes are caused by policyholders not understanding the insurance terms, or failing to follow the approval procedures or formal procedures required for claim settlement. For example, failure to complete transfer procedures may cause unnecessary claims conflicts.

In July 2006, Hu purchased a car from Lang for 80,000 yuan, and the registered owner of the car was Lang. In May 2006, Lang insured the car for 50,000 yuan in third-party liability insurance for a period from 0:00 on May 15, 2006 to 0:00 on May 15, 2007. After Hu purchased the car, he did not complete the vehicle transfer registration procedures and did not notify the insurance company. On November 5, 2006, Hu was involved in a traffic accident while driving the car, resulting in the death of one person. The traffic police determined that Hu bore full responsibility. When making a claim, the insurance company refused to compensate because Hu failed to notify the insurance company in time when he purchased the car and failed to go through the insurance transfer procedures.

Article 34 of the "Insurance Law" stipulates: "The transfer of the insurance subject matter shall be notified to the insurer. After the insurer agrees to continue underwriting, the contract shall be changed in accordance with the law." Transfer of the insurance subject matter (resale, transfer, donation, change purposes, etc.), mostly found in property insurance, such as car insurance and home insurance. Therefore, when a vehicle or house is transferred, the insurance company must be notified in writing and go through the transfer procedures in accordance with the insurance contract.

Four steps for smooth claim settlement

While Mr. Zhao from Beijing was traveling to Xinjiang with his father, his father unfortunately died in an accident. Mr. Zhao did not report the case to the insurance company and hurriedly handled the funeral affairs locally. After returning to Beijing, with the pain of losing his husband, he went to the insurance company to claim compensation, but he could not get the compensation immediately because he could not provide the necessary accident certificate, corpse disposal certificate and other materials. It was a long journey from Beijing to Xinjiang. In order to obtain complete claim materials, Mr. Zhao had to make another trip, wasting a lot of money in travel expenses and delaying the claim settlement for a long time.

Many people feel overwhelmed when it comes to the claims process.

The reporter has also encountered readers like Mr. Zhao who are exhausted both physically and mentally from the issue of claims settlement. In fact, as long as you understand the links and steps of the insurance company's claim settlement, and have a good idea of ??what needs to be paid attention to at each step, you will find that the claim settlement threshold is not as high as imagined, the claims settlement procedure is not complicated, and you will feel much more at ease.

Report the case in a timely manner

Article 22 of the "Insurance Law" stipulates that "the policyholder, the insured or the beneficiary shall promptly notify the insurer after becoming aware of the occurrence of an insured accident." When an insured accident occurs After (an accident), the relevant persons (the policyholder, the insured, the beneficiary) should notify the insurance company of the occurrence of the insured accident as soon as possible, which is called a report. This is a legal obligation.

Reporting a case is the first step in applying for a claim. Timely reporting is very important to the insurance company and may affect whether the claim can be settled: on the one hand, necessary measures can be taken to prevent the loss from expanding; In terms of safety, we can investigate the occurrence and collect evidence in a timely manner.

Different insurance products have different reporting time restrictions. Among them, accident insurance, home property insurance, car insurance and major accidents have the strictest reporting time requirements, and some are even limited to 24 hours after the insured accident occurs. Inside. In the insurance contract, there is an "insurance accident notification clause", and you must follow the requirements. If the policy does not indicate a specific time limit for reporting a crime, it is best not to exceed 7 days.

Reports can be made in writing or verbally. For example, you can report a crime by calling the insurance company's service hotline (reporting phone number), sending a fax, entrusting an agent, or going directly to the insurance company's branch.

There are several things that need to be explained when reporting a crime.

1. Basic information of the insured: name, ID number (or date of birth of the insured).

2. Basic information about the policy: policy number, insurance type, insurance amount, insurance period, payment status, etc. Among them, the policy number is particularly important.

3. Basic information on the insured accident: time, location, cause of the accident and current damage status, current situation of the insured, etc. If it is property insurance, the relevant agency's handling situation must also be informed; if it is medical insurance, the notification should also include the hospital visited, diagnosis results, etc.

4. Basic information of the reporter: name, ID number, relationship with the accident victim, contact information, etc. The contact information is very important and should be kept open at all times.

In addition, for cases where there is a possibility of abnormal causes of insured accidents, such as car accidents, homicides, unexplained deaths, and cases where insured accidents cause damage to third parties, which may trigger litigation, etc. In addition to reporting the case to the insurance company, you should also promptly report the case to the public security, traffic police and other government law enforcement departments in order to detect the case as soon as possible and settle the claim as soon as possible.

Tip1

It is more convenient to report the crime by phone. The service calls of many insurance companies are free, and most insurance companies will record the call process and keep the recording for a certain period of time. To be on the safe side, the reporter can also write down the time of reporting and the operator's number so that the recording can be retrieved when necessary.

Submit relevant materials

Article 23 of the "Insurance Law" stipulates: "After an insured accident occurs, when requesting the insurer for compensation or payment of insurance benefits in accordance with the insurance contract, the policy holder and the insured shall Or the beneficiary should provide the insurer with the certificates and information it can provide to confirm the nature, cause, extent of loss, etc. of the insured accident. "The insurance company will determine whether to file a case based on the supporting materials provided, and therefore provide a claim application. Materials are the most critical and tedious step. Many claim applications require supplementary proof and information because the supporting materials are incomplete and unclear, which delays time.

The necessary materials for a claim application include: the original identity document of the insured and the applicant, the original insurance contract, the latest payment voucher, and the "Claim Application Form". If the policy holder is unable to apply for a claim, , when you need someone else to handle the claim on your behalf, you must also submit a "Power of Attorney for Claim Settlement" (indicate the scope of authorization). Filling in various materials completely and accurately and retaining the customer copy of the "Claim Application Form" are two things that applicants need to pay attention to.

In addition, depending on the circumstances, the applicant must provide other necessary supporting materials.

Accident certificates Accident certificates generally include accident certificates, disability certificates, death certificates, account cancellation certificates, etc.

Medical certificates include diagnosis certificates, surgical certificates, outpatient medical records and prescriptions, pathology and blood test reports, medical expense receipts and lists, etc.

Proof of beneficiary’s identity and relationship with the insured Proof of beneficiary’s identity (it means that the beneficiary himself can hold his ID card; if he entrusts someone else to take the lead, he needs to provide a notary letter of entrustment issued by the local notary office and the Proof of personal identity), proof of the relationship between the beneficiary and the insured (such as proof of relationship between husband and wife, parent, child).

Tip2

Claim-related certificates and materials can be prepared in accordance with the specific requirements of the "claim application" in the insurance contract. However, relevant personnel from the insurance company also said that due to some reasons, the specific requirements in actual operations may be slightly different from those stated in the contract. After an accident, you should read the policy in detail and consult the insurance company staff when reporting the accident to understand the claim materials that should be collected and their validity. If conditions permit, the consultation process can also be recorded.

Waiting for approval

According to the requirements of the insurance company, after the applicant provides all certificates and information, the insurance company staff will collect relevant evidence in accordance with regulations to verify the insurance accident and the authenticity of relevant materials. If no problems are found, the claim application will enter review status. After the case handler determines the objective facts and determines the insurance liability based on relevant evidence, he or she will calculate the payment amount and make a claim settlement conclusion. After the case is closed after being reviewed by the signer, the beneficiary of the policy can receive the compensation.

It takes a while from submission of materials to completion of the case, which will vary depending on the situation. If the case is simple, the insurance amount is small, and the materials are complete, the claim settlement decision will be made quickly; on the contrary, the investigation process will take longer and the applicant will have to wait longer. Article 24 of the "Insurance Law" stipulates that insurance companies "should make timely verifications" on the claim settlement period. In the "Explanation of the Supreme People's Court on Several Issues Concerning the Trial of Insurance Dispute Cases (Draft for Comments)", the interpretation of "timely" is, "generally thirty days, except in cases of real difficulties."

Currently, regulatory agencies and insurance companies are trying their best to shorten the waiting time for insurance claims. For example, the "Beijing Insurance Industry Accident Insurance and Health Insurance Service Standards (Trial)" launched by the Beijing Insurance Industry Association in 2006 stipulates that "for claims applications that meet the claim conditions and have complete application materials and do not require further verification, The insurance company shall make a claim settlement decision within 10 working days from the date of acceptance and promptly notify the customer of the processing result. For a claim application whose processing result cannot be determined within 10 working days, the insurance company shall notify the client of the processing progress. "

Tip3

In the investigation stage, insurance company staff not only need the cooperation of relevant departments and agencies, but as applicants, they must also actively cooperate with the needs raised by the insurance company, otherwise it will Affects timely payment of claims.

Notification of claim payment

After the insurance company makes a compensation decision, it will contact the relevant beneficiary according to the contact information and address on the application form to collect the claim payment.

Inheritance order

If the beneficiary is the designated beneficiary, the insurance money will be received in the designated order according to the contract.

If the beneficiary is the legal beneficiary, it must be received by the first-order heirs (spouse, children, parents). The recipient must sign a written guarantee before receiving the money, guaranteeing that he will notify other first-order heirs. .

If the beneficiary is a person without capacity for civil conduct, his guardian will collect it on his behalf.

Method of collection

For the convenience of policyholders, the payment methods provided by the insurance company are: cash, cash check, transfer check or bank transfer, etc. If cash payment is adopted, the recipient needs to provide relevant certificates.

Tip4

It is recommended to provide a copy of the beneficiary's passbook as much as possible and choose to receive insurance benefits by transfer to reduce cash risks. Before using this method, you need to sign a contract with the insurance company agreeing to entrust the bank to transfer funds. In addition, beneficiaries are reminded not to disclose their bank account passwords to outsiders.

Extended reading: How to buy insurance, which one is better, and step-by-step instructions to avoid these "pitfalls" of insurance