1.
Two years is undefensible, many people know it, at least have heard of it.
It derives from the provisions of Article 16 of the current Insurance Law:
To put it simply, after 2 years of life insurance policy, the insurance company cannot terminate the contract and has to bear the liability for claims.
In previous years, the two-year indefensibility was a magic weapon for some agents to promote the policy, and the insured's health did not meet the requirements of the inquiry, and the agent would tell the policyholder to fill in the requirements, as long as two years passed, it would be fine.
Because of this kind of misleading sales, there are many claims disputes, but most of the judgments in this kind of claims lawsuit will be biased towards consumers.
Because the insurance clause is a standard contract provided by the insurance company, and the health notice is issued by the insurance company, and the initiative before insurance is in the hands of the insurance company, then when it comes to claim disputes, the judicial judgment will be more biased towards the weaker consumers.
In addition, there are a very small number of insured persons who deliberately fail to tell the truth, using the two-year indefensibility as a talisman.
However, in fact, the interpretation of the two-year incontestability clause itself in the industry is also controversial.
Because the premise of the clause is that the insured is truthfully informed, but it is a bit difficult to define whether the insured has been truthfully informed, but once it is defined by the court as intentionally not truthfully informed, the talisman of indefensibility for two years will be invalid.
As early as 2017, Brother Bao wrote about the topic of two years of indefensibility, and the original text is here:
【Uncontestable】As long as the life insurance is two years old, regardless of whether it is truthfully informed or not, the insurance company will have to pay after the accident?
Brother Play believes that the significance of the two-year indefensibility lies in protecting the rights and interests of consumers to the greatest extent under reasonable and legal circumstances. However, don't over-interpret the indefensibility because of this, thinking that compensation must be made after two years, and if it is defined as intentionally not informing the truth, even after two years, there are many cases in which the court decides not to compensate.
At that time, someone left a message under the article:
This message can be said to be a substitute for many people's mouths:
- Why doesn't the insurance company check before applying for insurance?
Especially when there is a claim dispute on the Internet, netizens have to say this sentence.
Insurance companies don't do this, mainly because the cost of pre-insurance verification is too high.
Therefore, the process of applying for insurance is to inform the insured truthfully on the basis of following the principle of good faith.
2.
But what if the policyholder can't tell the truth?
In addition to the insurance company's claim interception, if the insurance product's rate is relaxed, there is enough room to cover the very small number of untruthful information.
But those cost-effective products do have this risk.
In this case, since consumers can use the two-year indefensibility to protect themselves, insurance companies can also make full use of the two-year indefensibility to protect their interests.
Recently, I saw a claim case about Beijing Life Bumblebee Critical Illness Insurance that occurred at the end of last year:
On November 24, 2021, a mother in Shaanxi Province insured her child with 500,000 bumblebee critical illness insurance, with a protection period of 30 years, an annual premium of 580 yuan, and 20 years of payment.
In December 2022, the child was diagnosed with leukemia, and the mother's claim was rejected.
The reason for Beijing Life's refusal of compensation is: between August 6, 2021 and November 26, 2021, the child had an unexplained fever and did not meet the health notification inquiry.
However, according to the verdict, although the blood routine test data of the physical examination on August 6, 2021 was abnormal, the doctor did not request further examination; November 26, 2021 is the post-insurance situation, and it is because of the fever caused by hand, foot and mouth disease.
In the end, the first and second instance both ruled that the insurance company should pay the full amount of the claim, and according to the terms, the leukemia compensation was doubled, plus an additional 50% in the first 10 years, a total of 1.25 million.
(The verdict of this claim case, I put it at the end of the article "Read the original text", interested friends can go to view the details)
Beijing Life's Bumblebee Children's Critical Illness Insurance has been a representative product of cost-effective critical illness insurance in recent years, and we also recommend many customers to apply for this product.
It may be that Bumblebee has the risk of too high a loss ratio, and this year Beijing Life Insurance has conducted a policy investigation:
——Check the effective policies one by one, and if there is any situation that is not truthfully informed, the insurance company will contact the policyholder to request supplementary information for re-underwriting!
One of our customers received a message from Beijing Life Insurance that he had not truthfully informed him that his child had an "atrial septal defect" and needed supplementary information for underwriting.
The customer who received the call looked confused.
Because his child was insured for Bumblebee 30 days after he was born, the child did not seek medical treatment before the insurance, and he was busy in the hospital alone when the child was born, and the doctor did not inform him of any abnormalities in the child.
Now that the premium has been paid in 2 installments, the insurance company said that his child has health abnormalities, and the father is speechless.
It wasn't until I flipped through the discharge summary at birth that I found out that there really was such a situation, and it said that there was an atrial septal defect.
Now the child is 2 years old and has always been healthy, and went for a follow-up examination, which showed that there was no obvious defect, but there was "a small amount of regurgitation of the tricuspid valve".
Then the customer confidently submitted the review results, but the insurance company's underwriting actually failed, allowing the customer to surrender the policy!
We are also depressed because this situation is very common, and under normal circumstances, we can all be insured through smart underwriting.
However, the communication with the insurance company was ineffective, and in the end, he pulled several times and surrendered the insurance without leaving a record of refusal of insurance.
3.
For example, Beijing Life Insurance has investigated the situation of requiring surrender of the policy, and other companies have also appeared.
There is a similar example in the previous Guofu Jiahe Bao:
According to the situation at that time, if the insured was able to apply for insurance through Genor Bao's intelligent underwriting, the customer saw that the intelligent underwriting could be passed, and the insurance was directly applied for without passing the intelligent underwriting.
More than a year later, the customer received a call from the insurance company and was asked to surrender the policy.
For this matter, Brother Bao also posted a complaining video:
If the policy is surrendered for more than a year, isn't the insurance company playing hooligan?
It's useless to complain, and in the end, the two parties negotiate, and it is also a surrender process, but there should be no surrender record.
At that time, we guessed that the insurance company operated in such a reverse way, probably because the male rate of Guofu Jiahe Insurance was indeed too low, about 10% lower than other products in the same period, and in order to control the claim rate, we had to investigate it head-on.
It is reported that behind the investigation of Bumblebee is the pressure given by the reinsurance company, in the above surrender case, the reinsurance company gave the opinion that the insurance company can increase the underwriting, but the insurance company does not have a premium rate at all, how to increase the fee, the insurance company can only persuade the surrender of this road.
From this point of view, the investigation of Guofu Jiahebao should be the same.
4.
To sum up, basically the products that are investigated are too cost-effective and have high compensation pressure.
Because of the pressure of reinsurance, I had to spend energy on policy investigation, and use the two-year indefensibility to screen all the policies that have not been completed for 2 years to reduce the risk of compensation.
The policy is persuaded to surrender within 2 years, and the insurance company is indeed legally tenable, and the policyholder is almost indisputable.
In the past, indefensibility was often a talisman for consumers, but now it can also be a magic weapon for insurance companies.
Because most people will be confused when they suddenly receive information from the insurance company, and they don't know what to do at all.
Therefore, I will share it today to remind you that in case of the same situation above, if the insurance company asks for surrender, even if the effort is invalid, the insurance company must surrender the insurance without a record of refusal.
I have to complain, the insurance company's operation is really disgusting, its investigation notice is often more than 1 year, almost 2 years when the policy is over, and at this time the age of the insured is one year older, and the health can also change, affecting the consumer to re-insure.
Therefore, even if you want to investigate, please act earlier, the 15-day hesitation period will not be completed, and it will be okay in one or two months, and it will be very unkind if you have to delay it for almost two years and then persuade you to quit!
Pay attention to play insurance, don't be insured to play!
Xueqiu/Headlines/Weibo/Sohu
Zhihu: Players who play insurance records/insurance records
玩保哥微信：inspler