1, a 55-year-old man in Wuhan was diagnosed with lung cancer.
Because Li works outside all the year round, he seldom goes home to visit his 55-year-old father. To this end, at the suggestion of a friend, Li helped his father insure a critical illness insurance with a coverage of 500,000.
20 19 12, Li's father went to the hospital for examination because of physical discomfort. As a result, he was diagnosed with lung cancer. He followed the advice of the hospital and received treatment in the hospital. In order to reduce the pressure of treatment, Li immediately took the previous policy information to the insurance company to apply for compensation. As a result, three days after reporting the case, the insurance company actually sent a notice of refusal to pay Li.
The insurance company refused to pay 500,000 yuan. Why? Is it reasonable?
Li doesn't understand why the insurance company refuses to pay, because the premium has never been broken in recent years, and all the 30 thousand premiums have been paid. In this regard, Li came to the insurance company and asked the other party to give a reasonable explanation.
It turned out that when the insurance company investigated Li's father, it found that Li had a lung cancer hospitalization record three years ago, but Li did not inform the insurance company when he was insured. Therefore, the insurance company claimed that Li's insurance for his father violated the principle of utmost good faith, so he could not claim.
However, for this matter, Li, who has been away all the year round, does not know. His father also said that he was indeed diagnosed with early lung cancer. In order not to worry his family, he didn't say anything about it. I just thought it could be cured, but no one expected that after so many years, lung cancer was still not completely cured, but it was more serious.
3. What is the most common reason why insurance companies refuse to pay compensation?
In fact, in this insurance dispute, the most important issue is whether the insured has complied with the principle of utmost good faith and fulfilled the responsibility of telling the truth. But in fact, apart from this reason, when we handle insurance claims, the insurance company can not compensate if it encounters the following situations.
(1) Genetic diseases are not compensated.
The insurance company will not pay for serious diseases caused by congenital diseases.
(2) No compensation shall be paid for illegal acts.
Such as drunk driving, drug driving, driving without a license and other serious diseases, or suicide, the insured does not pay for killing the insured.
(3) Independent classes are not compensated.
Plastic surgery or various extreme sports (such as skydiving and rock climbing) and other serious diseases will not be paid.