When will critical illness insurance be denied, and when will insurance be denied

1) The existence of moral adverse selection of the policyholder and the insured.

That is, the motive of insurance is not pure, there is a tendency to deliberately create risks, if a person does not have a major illness, but through various means to obtain a hospital certificate, in the process of declaration after insurance application, deliberately conceal the facts, lie about the condition, in an attempt to defraud the insurance money. In the case that the policyholder has such an intent, the insurance company will definitely refuse the policy.

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2) There is a certain health risk to the insured.

The policyholder has certain health problems before purchasing critical illness insurance. In the Health Notice, the following conditions may be denied:

1. Congenital diseases, epilepsy, physical or local disabilities, deafness in both ears, blindness in both eyes, etc.;

2. Cardiovascular and cerebrovascular diseases (hypertension, coronary heart disease, stroke, etc.);

3. Respiratory diseases (asthma, tuberculosis, chronic obstructive pulmonary disease, etc.);

4. Endocrine or immune system diseases (diabetes, hyperthyroidism, systemic lupus erythematosus).

The insured should inform the insurance company when the above health problems occur before applying for insurance to avoid the possibility of refusal of insurance.

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Chronic diseases, such as diabetes, high blood pressure, Dasanyang, or those who have already suffered from a serious illness or a mild illness, are basically denied coverage by critical illness insurance.

At present, most nodules and polyps are excluded, and some companies will increase fees appropriately. Hepatitis B carriers need to be covered at an additional cost depending on the liver function.

In short, according to the physical condition, the specific situation is analyzed.

1.Not meeting age and occupation restrictions: In order to control the risk of claims, insurance companies have strict restrictions on age and occupation, and those who exceed the age and occupation scope will be denied insurance.

Extended Materials. The so-called refusal of insurance refers to the judgment of the underwriter of the insurance company according to the actual situation of the insured, and the decision to refuse the risk that the insured has determined. Normally, insurance companies refuse to insure for the following reasons:

1. Exceeding the age limit for coverage.

When applying for life insurance, insurance products often have a requirement for the age of the insured, and if the age of the insured exceeds the underwriting age set by the insurance product, the insurance company will refuse to insure. For example, if the age of coverage of a medical insurance is 30 days old to 55 years old, and the age of the user is 60 years old, the insurance company will naturally refuse to cover the insurance.

2. Exceeding the occupational limit.

The probability of insurance has a greater relationship with the occupation of the insured, and in general, the occupational category.

The higher the risk of the insured. Therefore, insurance companies often have occupational restrictions when designing life insurance products, so they take critical illness insurance.

It often supports 1-4 occupational groups to be insured, and refuses to insure 5-6 occupational groups.

3. Not in line with the health notice.

When purchasing an insurance product, users may be required to fill out a health notification. The health notice is the basis for the insurance company to determine whether to underwrite the insurance, and if the insured person's condition does not meet the health notice, the insurance will be denied. At present, medical insurance, critical illness insurance, life insurance and other products often need to fill in health notices, and if people with health problems are likely to be denied insurance.

4. Financial status.

Users need to pay a certain amount of premiums when applying for insurance, but if the insurance company judges that the user cannot afford to pay the premium from the aspects of the policyholder's income, expenses, deposits, and debts, it will also refuse to insure.

5. There is moral adverse selection.

If the insurance company discovers the moral adverse selection of the policyholder and the insured (that is, the user has impure motives for applying for insurance and has a tendency to deliberately create risks), the insurance company will also make a decision to refuse the insurance.

In recent years, insurance has penetrated into ordinary people's homes and has become an indispensable guarantee for every household, and the role of insurance as a risk management has attracted more and more attention. Insurance is important, but when it comes to buying insurance, you find that you want to buy it but can't buy it, every year there are many customers who are rejected by insurance companies, and there are many factors that are rejected by insurance companies, mainly in three categories: health factors, financial factors, and personal factors.

1. Why was the insurance denied?

Health is a key point in insurance companies' underwriting, and 70% of insurance refusals are due to health problems. Insured persons with certain health problems, such as overweight, excessive smoking, abnormal blood pressure, hyperlipidemia, diabetes, hepatitis B virus carrier, fatty liver, family history of hereditary or potentially hereditary diseases, etc., are professionally referred to as "unhealthy individuals". It is up to the insurance company to determine which "non-healthy individuals" can be covered and which people are denied coverage because of their own health conditions and lifestyles.

The main financial problem is that the insurance company has to measure whether the policyholder has the ability to pay the premium and whether there is a possibility of insurance fraud. For high-value insurance, insurance companies generally require proof of the customer's earning and labor ability (personal income tax and proof of personal net worth).

Other factors include a wide range of factors, generally with age and occupation category restrictions, such as personal hobbies are also considered, especially those who like high-risk sports may also encounter problems when applying for accident insurance and life insurance products.

2. Are the consequences of underwriting refusal serious?

In the process of contact with customers, it was found that many customers were reluctant to submit medical records or "tell the truth" when making health notices, fearing that they would not pass the review and be rejected by the insurance company. However, in fact, the general insurance company can only be regarded as being denied insurance if it is issued by a notice of refusal, and if it is only a simple verbal notification and there is no formal refusal document, it cannot be counted as a refusal.

Each insurance company has its own underwriting standards, and each company's strategy has some differences, so even if the same person is insured at the same time, the underwriting conclusion may be different in different insurance companies.

It is recommended that when you have doubts about your health, you may wish to choose several insurance companies to insure at the same time.

3. Can I no longer apply for insurance after being denied?

The rejection of insurance means that the risk of the policyholder has exceeded the level that the insurance company can bear, and if the subsequent risk point changes, it has been reduced to the range acceptable to the insurance company, and it can be purchased. For example, if a child is denied critical illness insurance due to hand, foot and mouth disease, but after **, the body recovers to health without sequelae, and after two years without **, it is possible to successfully underwrite the insurance again at this time.

It is worth noting that different types of insurance can bear different risk intensity, even if the initial insurance for critical illness insurance is denied, but there is still a chance to underwrite accident insurance, life insurance, education insurance, and annuity insurance, and you need to choose according to your own situation.

Extended reading: [Insurance] How to buy, which one is better, teach you to avoid these insurance"pits"

1. High blood lipids directly refuse insurance. High blood lipids directly and seriously affect people's health, such as causing coronary heart disease, arteriosclerosis, etc., for this, if too many policyholders with high blood lipids are insured, the insurance company will definitely lose money, and often high blood lipids are one of the direct refusal of insurance.

2. High blood pressure refuses insurance. As the saying goes, the three highs circulating in the medical community are "high blood lipids, high blood pressure, and high blood sugar", and the above has also said that high blood lipids are one of the circumstances that cause the refusal of insurance, then, high blood pressure will cause headaches, palpitations, general malaise, etc., and serious ones will also be denied insurance.

3. Breast problems are denied insurance. It is reported that 99% of breast cancers occur in women, and the probability of disease has remained high over the years.

4. Alcoholism refuses insurance. As the saying goes, a little wine is pleasant, but a big wine hurts the body. If the insured is alcoholic, it will directly damage the liver, and the liver tissue will begin to form a hard crust, and when the damage is irreversible, the liver will gradually harden, so in such a situation, the insurance company will also refuse to insure.

5. Overweight. Obesity is a topic that cannot be ignored in today's society, in the eyes of insurance companies, when the insurer's BMI exceeds 26, it will be directly included in the situation of premium increase, once the BMI exceeds 30, it is very likely to refuse insurance.

1. Laqiao Wang did not tell the truth. When purchasing critical illness insurance, there will be a health notice, if the policyholder does not truthfully inform the health of the person, the company will refuse to make a claim later.

2. It is still in the waiting period. Critical illness insurance has a waiting period, usually 90 days or 180 days, and if the company refuses to pay if the critical illness insurance is still within the waiting period after purchasing critical illness insurance.

3. Failure to meet the claim standard. As the name suggests, critical illness insurance is for critical illnesses, and if you have a small cold, it is naturally impossible to apply for a claim.

4. Triggering the disclaimer clause. The protection liability determines what is insured, and the exemption determines what is not insured, so you must look at the exclusion clause when buying wheel insurance.

5. In order to avoid the phenomenon of claim rejection. When you buy critical illness insurance, you must fill in the health notice truthfully, and then carefully read the contract, insurance is essentially a paper contract, which not only stipulates which circumstances will be compensated, but also clearly states which circumstances will not be compensated. As long as the terms are met, the insurance company will not not pay and dare not pay.

1. Failure to truthfully inform: When purchasing critical illness insurance, there will be a health notice, and if the policyholder does not truthfully inform the health of the policyholder, the company will refuse to settle the claim in the later stage;

2. Still in the waiting period: Critical illness insurance is the only waiting period, usually 90 days or 180 days, if the company refuses to pay if the insurance company is still in the waiting period after purchasing critical illness insurance;

3. Failure to meet the claim standard: Critical illness insurance, as the name suggests, is for critical illnesses, and if you have a small cold, it is naturally impossible to apply for a claim;

4. Trigger the exemption clause: The protection liability determines what is insured, and the exemption determines what is not insured, so you must look at the exemption clause when buying insurance.

Hello, under normal circumstances, insurance companies will not choose to refuse insurance for this reason.

For commercial insurance, the main reason for rejection is that the underwriting risk is too high. For the underwriting of commercial insurance, there are generally the following criteria:

The risk is within normal range, covered at standard rates;

The risk is higher than normal, and additional coverage is required;

The risk is unacceptable, but the scope is relatively limited, and the contractual liability is excluded from coverage;

If the nature of the risk is unknown, it is agreed to observe for a period of time and extend the underwriting;

The risk is too great to refuse to underwrite.

Your actions are routine and will not affect your re-insuring, so you can rest assured that you are insured.

Hope it helps.

Extended reading: [Insurance] How to buy, which one is better, teach you to avoid these insurance"pits"