How to complain about the rejection of critical illness insurance, and what should I do if the criti

If you have purchased critical illness insurance, and an insured accident occurs and meets the conditions of the contract, but the insurance company refuses to make a claim, we can complain in the following ways:

1. Complain to the insurance company.

Informing the insurance company of non-compliance, requiring the insurance company to self-examine and self-correct, require re-underwriting, and make claims in accordance with the contract is the lowest cost and most efficient method.

2. Complain to the regulatory authority.

Every insurance company must accept the supervision of the China Banking and Insurance Regulatory Commission, we can call the insurance consumer rights protection complaint ** "12378" to complain, or through the way of visits, directly to the local banking and insurance regulatory commission and other institutions to complain.

3. Filing a lawsuit with the court.

If the first two still do not solve the problem, you can choose to file a lawsuit with the court. More rights protection methods and specific steps, senior sisters have been sorted out in this article, and there is a need to poke: If you encounter an unreasonable refusal to compensate, you can deal with it like this!

According to the data disclosed by major companies, the number of claims rejection cases is not large, and the success rate of claims cases remains at a high level, basically between 97% and 99%. What are the reasons for the insurance company's refusal to pay compensation, and then the senior sister will give you a good analysis.

First of all, the insurance company's refusal may be because it does not meet the standard of claims, many people think that as long as the diagnosis of the disease specified in the contract can be paid, that is, the so-called "diagnosis of compensation", in fact, the claim of critical illness insurance can be divided into three categories: diagnosis of the claim, after the adoption of specific means and after the claim is reached a specific state, whether you can get the compensation depends on whether the compensation standard is met. If you still have questions about the compensation standard of critical illness insurance, you can take a look at this insurance knowledge

Ultra-complete! Everything you need to know about insurance is here.

Secondly, most critical illness insurance products will have a corresponding waiting period, and if the insurance is insured within the waiting period (except for accidents), the insurance company will not be liable for the claim.

Of course, if the insured person has a situation in the exclusion clause, the insurance company will generally refuse to pay. What are the exclusion clauses of critical illness insurance? This article has been summarized: what are the exclusion clauses of insurance and how to look at them? If you don't understand, you'll suffer a big loss!

If you meet the conditions for critical illness insurance, but the insurance company does not make the claim in accordance with the contract, you can file a complaint with the regulator.

In China, all insurance companies are under the supervision of the former China Banking and Insurance Regulatory Commission (now the State Financial Supervision and Administration Bureau), and they will not ignore such problems when they arise.

In addition, you can also file a lawsuit with the court to protect your legitimate rights and interests.

How to do it, you can also learn about this article: Is it reliable to buy insurance? Will the insurance company be a rogue and refuse to pay?

First of all, it is necessary to find out whether the claim is within the scope of insurance liability, which is the only place where you can judge whether the denial is reasonable. If the claim is refused, it depends on whether the insurance company's reason for the refusal and the contract are in line with the contract, and if the contract clearly states that this situation is not guaranteed, then it is useless to complain. If there is a dispute over the refusal of compensation, the only way to resolve the claim is to sue for legal means, and the law will be tilted in favor of the insured.

First of all, understand why the claim will be denied, if it is because of your reasons, then there is no way, if the insurance company finds all kinds of excuses to refuse the claim, it means that the insurance company is tired, and you can directly complain to the insurance company.

You can report to the China Insurance Regulatory Bureau, or directly appeal to the court, which can protect your legitimate rights and interests.

Then you can bring your relevant information to the court and take the insurance company to court.

3. Settle with the insurance company to obtain your own maximum benefits through medical insurance. Of course, people who buy critical illness insurance will definitely be able to get more protection from the economic aspect, and at this time, it is also possible to make a reasonable settlement with the insurance company, so that they can also get more benefits. If the insurance company refuses to settle, it must use the law to protect its rights and learn to get its own sufficient benefits, because this is what you should get if you buy insurance.

It is necessary to understand what the insurance company does not pay, pursue the advantages and avoid the disadvantages, and minimize your own losses. If the insurance company refuses to pay compensation without reason, it can be resolved through three legal channels: negotiation, arbitration and litigation.

At this time, you should find the problem, and then solve the problem in time, you can also change to an insurance company to buy, but you must ensure your own credit problems, and then you also need to be honest, and you also need to fill in the insurance policy completely.

Points to note when applying for two major critical illness insurance:

First: not telling the medical history truthfully.

Failure to tell the truth has become an important reason for insurance companies to refuse to pay for critical illness insurance. For example, an insured person who had suffered from nephritis concealed when he purchased critical illness insurance. Later, when I made a claim for kidney failure, I was not informed because I had nephritis, and I was not paid in the end.

In the eyes of many people, as long as they have not had the critical illness stipulated in the contract before applying for insurance, there is no need to "inform". Therefore, when applying for critical illness insurance, the policyholder must inform his medical history as clearly as possible, and do not take a chance to take out insurance with illness. If you have the conditions, you may wish to consult with relatives and friends with medical knowledge before applying for insurance.

Second, we should pay attention to "quantity" rather than "quality".

The insured accident claimed by the policyholder does not meet the scope and standard of claim settlement agreed in the contract, which is another major reason for the denial of claims by critical illness insurance. Out of the mentality of "the more complete the better", policyholders are more inclined to purchase products that cover a wider range of diseases. In order to cater to this mentality, the types of diseases protected by critical illness insurance in the market are also increasing, expanding from 10 to 30 or even 40.

However, in fact, it doesn't make much sense to buy critical illness insurance with the most types of illness coverage. It is revealed that more than 95% of the claims of critical illness insurance appear in about 10 major diseases such as cancer and benign brain tumors, and the incidence probability of many other diseases is very small, such as the incidence of "myasthenia gravis" is about 1 in 100,000. At the same time, the definition of the same disease varies from company to company.

For example, for paralysis, some companies define it as "disability of a limb that lasts for at least 6 months", while others define it as "permanent and complete loss of limb function".

Critical illness insurance claims are most likely rejected because they did not meet the conditions of the insurance claim, or did not understand the terms of the contract. So, the contract is the top priority! I have summarized several methods and learned that it is definitely not a problem to understand the insurance contract:

How to read a contract? Three ways to do it!

There are many reasons why a critical illness insurance claim is denied, and you need to look at the specific situation to know why the insurance company refusedIn general, there are several reasons why an insurance company refuses to make a claim:

1.There is no truthful health notification

Health notification is an important part of the insurance before applying for insurance, which is a questionnaire survey made by the insurance company on the physical health status of the policyholder, and the results of the questionnaire can directly determine whether the insurance company underwrites or what conditions to underwrite. If you fail to comply with your obligation to tell the truth, the insurance company has the right to reject your claim if it finds out that the situation is true.

Therefore, when filling out the health notice, it is important not to conceal the medical history!! If you do this, the insurance company will not pay 100%!

2.The condition does not meet the contractual definition

In the claim settlement of critical illness insurance, different diseases have different claim requirements, which will be stipulated in the contract you sign, as shown in the following figure:

If the insured person's medical condition does not meet the requirements of the claim, then the claim will not be granted.

3.Waiting period for insurance

The waiting period refers to the time during which the insurance contract is in effect, even if an insured event occurs, the insurance company will not pay compensation, and the waiting period for critical illness insurance is generally 90 days or 180 days. If a critical illness occurs during the waiting period, the insurance company will not pay for it. Hope!

Arnold answers: Hello!

There are many reasons why a critical illness insurance claim may be denied, and you need to look at the specific circumstances to know why the insurance company is refusing. The insurance company will state the reason in the rejection application issued by the insurance company, and you can check the rejection application for details.

Generally speaking, insurance companies have refused to make claims due to the following reasons:

1.The policyholder did not truthfully inform about the health situation. If the policyholder fails to fulfill the obligation to truthfully inform, then the insurance company has the right to reject the insured's claim once it discovers the true situation.

2.The insured's condition does not meet the contractual definition. In the claim of critical illness insurance, different diseases have different claim requirements, and if the insured's condition does not meet the claim requirements, then the claim cannot be made.

3.Accidents during the observation period. If the insured's illness occurs during the observation period of the critical illness insurance, the claim will not be granted.

Critical illness insurance denies because the situation arises that does not qualify for critical illness coverage. No matter which insurance company is a critical illness insurance product, it will be paid in accordance with the terms of the critical illness insurance contract. As long as the situation is eligible for critical illness insurance, the insurance company will pay for it.

The China Insurance Regulatory Commission (CIRC) has specified 25 critical illnesses, and all critical illness insurance products include these 25 critical illnesses.

The 25 types of critical illnesses are divided into 3 categories according to the underwriting method:

1.Diagnosis is a claim, 12 types;

2.Claim after taking a certain means, 5 types;

3.Claims after reaching a certain status, 8 types;

There are three main situations in which an insurance company will refuse a claim:

a. Insured accidents are not covered by insurance.

b. The accident is within the scope, but the conditions for compensation are not met.

c. Failure to truthfully inform when purchasing insurance.

So, if your situation doesn't qualify for the insurance company's payout, the insurance company won't pay you.

This depends on the specific reason for how to refuse compensation, if it is not truthfully informed when applying for insurance, then there is no way to solve it, unless you go to litigation, see how the court finally decides, the insurance company will not refuse to pay for no reason.

I bought insurance, but I was denied a claim for a critical illness. Do you think this detail is an overlord clause?