What should I do if I refuse to pay an insurance claim, what should I do if my insurance company ref

1.The insured has fulfilled its responsibilities, taken appropriate measures, reported the accident in a timely manner, and truthfully stated the accident. In this case, if the insurance company wants to refuse to handle the claim, they must find strong evidence to prove that the accident is not true, otherwise they can only pay normally.

In this case, lodge a complaint with the IA to put pressure on the insurer or appeal.

2.The insured failed to fulfill his or her own responsibilities, took improper handling measures, failed to report the case in a timely manner, and stated the facts unclearly. In this case, the nature of the accident cannot be confirmed due to the insured's failure to fulfill the corresponding obligations, and the insurance company has a basis to refuse to pay compensation.

Extended information: 1. The significance of buying insurance is to transfer the risks around us. Life is fragile, and people's lives are not peaceful.

Risks and accidents can happen at any time. In the event of an accident, it can cause huge damage. Insurance is there to reduce losses.

The function of insurance is to protect against sickness, accidents, medical and pension risks. The significance and role of insurance can be seen from the following points:

1. It can provide a reliable guarantee for the life of the elderly, whose physical function declines and cannot work as they did when they were young. If they don't have enough money to live on, it will be difficult to maintain a normal quality of life. Raising children and preventing old age is the traditional old-age thinking of Chinese, but modern society is fiercely competitive and stability is not easy.

It is not known whether the child will have the ability to support the elderly when he grows up. But insurance is different. It guarantees at least a fund for everyone.

Paying your insurance premiums is like saving yourself alimony. At a certain time, you can receive a pension in accordance with the provisions of the insurance contract to ensure that you have no worries in your old age.

2.People with disabilities are well protected, and in the journey of life, illness and accidents are the most unpredictable. When an accident occurs and causes illness and disability, it will encroach on the labor force, resulting in reduced or deprived income, and the consequent high medical costs will increase the financial burden.

Buying life insurance can make up for the lack of social security, reimburse the uninsured part of social security, provide economic security for the insured due to illness and disability, and get effective ** when disabled due to accidents, so as to avoid the phenomenon that one person is sick, the quality of life of the whole family is not guaranteed, or the whole family returns to poverty.

3.With the function of preparing for a rainy day, saving is not only a means of preparation, but also a means of accumulation, which plays a proactive role. They are the practical needs of modern man.

Generally speaking, the premiums paid by insurance are generally divided into annual and monthly payments. For some products, after the expiration of the insurance period, the insurance company will refund the premium paid by the eligible policyholder on a pro-rata basis. Just like saving, you can get your money back.

It is also a virtue. It is to prepare for a happy life in the future.

If the claim is denied, the first thing is to protect your own interests and know the reasons for the insurance company's refusal, because the insurance company needs to accept strict supervision by the state, must be implemented in accordance with the terms of the contract, and the compensation must be justified. If you encounter any insurance problems, you can find a third-party compensation agency for legal insurance consultation, they can provide you with professional claims advice.

1. Call ** to the insurance company to complain. This method is generally suitable for situations such as the slow progress of insurance companies' claims;

2. Call ** to the China Banking and Insurance Regulatory Commission to complain. The China Banking and Insurance Regulatory Commission (CBIRC) is the department that manages insurance companies, and complaints to the CBIRC will generally attract the attention of insurance companies.

3. Take the evidence of the insurance contract and the insured accident to the local arbitration commission to request arbitration, and you will get a fair result;

4. If there is a big disagreement with the insurance company on the claim, let the court give the final result through litigation, but this procedure generally takes a long time, if the number is not large, it is not recommended to go through this procedure.

Hello, at present, it can only be said that the insurance company refuses to pay for no valid reason, if it is clearly written in the contract that the claim will not be claimed, it will be difficult to do!

If the insurance company refuses to pay compensation without justifiable reasons, it can protect its rights in the following ways:

1. You can negotiate with the relevant personnel of the insurance company to deal with the claim matters first, and try to solve the dispute of the claim matter;

2. If the negotiation fails, you can go to the special complaint center of each insurance company to complain and ask the insurance company to deal with the claim as soon as possible;

3. If the problem is still not solved, you can go to the CIRC for complaint handling;

4. You can also protect your legitimate rights and interests through litigation.

Legal basis] Article 11 of the Insurance Law stipulates that when concluding an insurance contract, a consensus shall be reached through consultation, and the rights and obligations of all parties shall be determined in accordance with the principle of fairness. Except where laws and administrative regulations stipulate that insurance is mandatory, insurance contracts are concluded voluntarily.

1. The insurance company does not refuse to pay for the sake of rejecting the claim. The most important thing is that there is no truthful health notice, which is the hardest hit area of critical illness insurance claims, 80% of the refusal is because there is no truthful health notice, and when the claim is made in the later stage, the insurance company finds that "the first disease in the early stage" is not compensated for the insurance with illness; The second is that the policyholder does not know the scope of coverage, and sometimes there is a discrepancy between the illness that people understand and the illness or accident that is defined in writing. For example, accidents caused by falls, collisions, etc. are all within the scope of accidental claims, but cosmetic surgery, orthodontic tooth extraction resulting in death, these are subjective, and insurance does not pay.

The insurance company will appeal after the denial of the claim as follows.

2. Reliable insurance brokers. Many insurance salesmen have handled a lot of claims cases, and are very familiar with the claim rules and operations, and will tell you what is the written evidence in their favor, which is very helpful when making a claim.

3. Complaints from the headquarters of the insurance company. Many times the "refusal" is only responsible for the local business hall, because of the fear that after their own claims, the headquarters will not be able to pay, the result is to fill in the pit by themselves, such a thing must not be done, so at the beginning it is often a refusal to claim, but if the complaint to the headquarters, this is very serious, after all, the claim is the reputation of the insurance company, and the complaint will be immediately tracked and handled, and the claims manager is worried about making mistakes, and will be more cautious in handling things, and strictly verify the claim matters.

4. Complaints from the local Banking and Insurance Regulatory Commission. The China Insurance Regulatory Commission is the top boss of the insurance company, and every year it will make statistics on the claims complaints of the insurance company, as well as score the claims service, and regularly publish the ranking on the official website. Therefore, when encountering complaints, it must be properly resolved, if it is not properly resolved, not only will it leave a "bad reputation" in the CIRC, but the complaint ranking at the end of the year will affect the sales volume of the whole year in the second year, which will outweigh the losses.

5. The court is above. The court is our last reliance, all policy contracts have legal effect, many times in front of the court, the court determines that the insured belongs to the "vulnerable group" most of them will take care of it, but after all, it is also in accordance with the rules, so there will still be cases of refusal of compensation when there are obvious loopholes that cannot be compensated.

When you buy insurance, the worst thing is to settle claims, no one who buys insurance wants anything to happen, let alone have a claim, but once something really happens, you have to face these things.

When making a claim, there are two outcomes: one is compensation; Second, there is no compensation.

The insurance company does not compensate, that is, refuses to pay. No one is not annoyed when faced with a claim rejection, but the insurance company really does not dare to casually refuse to pay an insurance contract, because a notice of refusal (to the beneficiary) must be signed by layers of management personnel. If you disagree with the denial, you can protect your rights and interests in the following ways:

1. Find a lawyer directly and file a lawsuit with the court.

2. You can call the "12378" insurance consumer rights protection complaint specially opened by the Insurance Regulatory Commission to file a complaint, and there is no need to dial the area code.

3. You can file a complaint by mailing the complaint materials and mail it to the Insurance Regulatory Commission or your local insurance regulatory bureau.

4. You can directly go to the petition reception place designated by the China Insurance Regulatory Commission and its dispatched agencies to complain in person.

PS: You can also file a complaint in the complaint column of the CIRC or the official website of your local insurance bureau.

First of all, you have to carefully check what are the reasons for the denial? For example, more than 90% of the cases of refusal to pay compensation due to failure to truthfully inform the health are carried out, and the next step is to deal with them. Since it is the insurance company that refuses to make a claim, the most direct way is to raise an objection to the insurance company, ask the insurance company to self-examine, re-evaluate, and settle the claim in accordance with the contract.

If the insurance company is still cheating, then it will have to complain to the regulator, and the insurance company must accept the supervision of the China Banking and Insurance Regulatory Commission, which is a hard and fast rule. But if you want to deal with it efficiently, the best solution is to negotiate compensation. I know that the more reliable compensation platform in Guangzhou is Xiaoyi Youyou, and my sister-in-law was rejected before the claim was handled there, and there were special people to help collect evidence, and finally the claim was successfully settled.

1. Beyond the scope of protection stipulated in the terms of the contract, many policyholders do not have the habit of carefully reading the terms of the contract when applying for insurance, just a quick glance, the insurance contract is full of a large number of professional terms, it is indeed obscure, but for the two parts of the protection responsibility and the deductible liability should be carefully read. The insurance company will only pay for the protection liabilities specified in the contract, and if you buy critical illness insurance, you should specify the type of disease specified in the contract. Many policyholders think that the critical illness insurance they buy can be paid as long as they have a serious illness, but the disease is not the type of disease specified in the contract, and they will naturally be denied insurance when they go to make a claim.

There are also some exclusions that need to be clearly stated, such as suicide, crime, and intentional acts resulting in injury and death, which have been clearly stated as exclusions.

2. Beyond the claim periodGenerally speaking, the policyholder should report to the insurance company as soon as the risk occurs, which is conducive to the collection of claim materials. However, often after the risk occurs, the policyholder or the insured ignores this point, and when they think about it, the claim settlement period has passed. Under normal circumstances, the insurance company should report the case to the insurance company within 10 days after the occurrence of the insured event, of course, the claim limitation period is not exactly the same for different types of insurance, and the terms on the claim settlement time limit will also be specified in the insurance contract.

Be sure to report the case in a timely manner according to the requirements in the contract to avoid the denial of insurance due to delays.

3. Failure to truthfully inform the policyholder when the insurance contract is signed, especially for health insurance. Some policyholders conceal their illness experience in order to be able to successfully apply for insurance, although they are successfully insured, but once they suffer from illness, when making a claim, the insurance company will check the past course of the disease according to the hospital's network records, in this case, the insurance company can refuse to compensate in accordance with the regulations.

Fourth, this article is mainly aimed at commercial medical insurance, if the insured has social security, and the social security has been reported when the hospital has **, this situation should be presented to the insurance company in advance of the medical expenses split sheet. As part of the claim materials, the medical expense split form will also cause the claim to fail if it is missing.

Nowadays, many insurance companies have optimized the claims process, and it is not difficult to settle claims.

Commercial insurance companies, they are independent accounting, self-financing units, if you all want to take advantage of her, his money from the **? Will pie fall from the sky? Before buying insurance, you should read the manual carefully, and you should chew the words, otherwise you can take advantage of your loopholes in the text, and you can refuse the claim.

If you don't get it right, go to court and sue it.

What are you going to do with the insurance company. It's good to be stuffy with a lot of rules. You can consult with a lawyer. However, we are justified and unworthy to sue. I can't say anything about insurance in our country. Users: Ordinary people.

What should I do if my claim is denied by the insurance company? 3 ways to cope.

An important reason why the insurance company does not pay is that it does not meet the requirements of the terms. The insurance company will only pay if it fully complies with the description of the clause.

Summary. The reason for the insurance company's refusal to pay compensation is actually the problem in the insurance contract itself, the insurance contract provided by the insurance company often stipulates a series of exemption clauses, some of which may be invalid clauses, but as the policyholder has no absolute choice for this, only the relative right to choose, because almost all insurance companies have similar agreements on this part, and the policyholder has almost no other choice to sign the contract in a knowing situation. Therefore, when purchasing insurance, the policyholder should ask the insurance company to clarify the specific division of the scope of compensation and the exemption part in the insurance contract as much as possible.

Hello, I am honored to answer for you If the insurance company fails to fulfill its obligation to inform, you can negotiate with the insurance company first, and raise it on the grounds of failure to inform, if you fail to negotiate, you can file a lawsuit with the court. If the insurance company still refuses to pay if the insurance company is eligible for compensation, the effective way is to sue the insurance company. In insurance claims, denials by insurance companies often occur.

The reason for the insurance company's refusal to pay compensation is actually the problem in the insurance contract itself, the insurance contract provided by the insurance company often stipulates a series of exemption clauses, some of which may be invalid clauses, but as the policyholder has no absolute choice for this, only the relative right to choose, because almost all insurance companies have similar agreements on this part, and the policyholder has almost no other choice to sign the contract in a knowing situation. Therefore, when purchasing insurance, the policyholder should ask the insurance company to clarify the specific division of the scope of compensation and the exemption part in the insurance contract as much as possible.

Insurance, which is meant to be safe and reliable; It is a tool used to plan life finances, a basic means of risk management under the conditions of market economy, and an important pillar of the financial system and social security system.

Insurance refers to the commercial insurance behavior in which the insured pays the insurance premium to the insurer in accordance with the contract, and the insurer bears the responsibility for compensating for the property loss caused by the occurrence of the accident that may occur as agreed in the contract, or the insured bears the responsibility of paying the insurance money when the insured dies, is disabled, sick, or reaches the age and time limit agreed in the contract.

From an economic point of view, insurance is a financial arrangement for apportioning the loss of an accident; From a legal point of view, insurance is a contractual act, a contractual arrangement in which one party agrees to compensate the other party for its losses; From a social point of view, insurance is an important part of the social and economic security system, and it is an "exquisite stabilizer" of social production and social life. From a risk management perspective, insurance is a method of risk management.