Category: Insurance tips Release Date: 2006-08-01
Case Playback
Zhang insured because of sudden cardiac hospitalized for emergency treatment of aortic dissection and obtain the ability to work testing center in Shanghai, issued by the "completely lost the ability to work," the expert conclusion the book
Zhang decided to exempt insurance premiums for two years, two years after the physical condition of Zhang's right to re-evaluate the decision whether to continue Waiver of Premium
September 6, 1999, customers Zhang participated in the Shanghai A Life Insurance Company's "brilliant life" whole life, including the exemption from payment of additional premiums to protect the interests of the terms. March 25, 2002, with Zhang because of the seriousness of the disease --- sudden cardiac aortic dissection was admitted to hospital rescue; June 17 the same year, Zhang made the ability to work testing center in Shanghai, issued by the "completely lost the ability to work "The expert conclusion the book.
According to the insurance contract premium exemption clause contained in the relevant provisions of Zhang on September 26 premium to the insurance company made an application for exemption. Insurance companies it was decided that the first two years of exemption Zhang insurance, two years later they would go to the Zhang's condition re-evaluated and based on the assessment findings to decide whether to continue the premium payment obligations Zhang exemption.
Triggered complaints
Zhang believe that, A practice of insurance companies is contrary to the insurance contract stipulations:
First, to avoid safeguard clause the provisions of Article IV coverage, I am in the insurance contract is in force, due to illness lead to "total incapacity", are exempted from safeguards in insurance coverage, insurance companies, additional provisions should be based on Article V -- - interest payment terms of a one-time waiver of the provisions of the future I should pay the full premium.
Second, the exemption clause to protect the interest payment provisions of Article V of the stipulations, and I suffered "total incapacity", a hospital designated by the insurance company or a medical certificate is true, indeed in the interests of the terms of payments within the scope of insurance liability, insurance companies should be In accordance with the contract exempted the main contract, the relevant contracts include the additional premium attached to some due until the payment maturity date. Now insurance companies have breached the contract, unilaterally change the insurance policy, just my two-year premium waiver is unreasonable.
Accordingly, Zhang complaints to the relevant regulatory authorities, insurance companies want them to urge A promise to abide by the contract, in accordance with terms of the contract as soon as possible to the premium waiver Zhang handling procedures.
Need to re-evaluate
In mediation, the underwriting insurance company A, said that under the exemption safeguard clause of Article V of "benefit payment clause" provisions in the laws about the life, such as the insured suffer from a "total incapacity", by the "Company" designated hospital or medical certificate is true, indeed in the interests of the terms of insurance payments within the scope of responsibility, "the company" should be exempted from the main contract in accordance with the contract and related contracts include the additional premium payable attached to some; until the expiry of payment day, or the insurance person-years over 65 years of age, or the insurer may engage in any work to get any reward or later.
A insurance company that insured Zhang, the ability to work due to illness after the operation identified by the Center for identification, are "totally incapacitated" and therefore the Department has decided to allow claims of Zhang's application for exemption, and in view of the relevant provisions of these terms, as unable to Zhang forecast when they can start working, so the company decided to temporarily exempt from two-year premium, if two years later are still unable to engage in any work, the company will continue to provide exemption benefits until the insured person may engage in any work to get the any payment.
Case Comments
When the total incapacity of the insured person before the expiry of the payment, physical condition has been restored, you can engage in certain kinds of work and receive remuneration, the insurance premiums exempt from the insured person may engage in any work to get any terminate compensation
Temporary exemption from the insurance companies for insurance premiums for two years and two years later to reassess the decision of whether to continue the premium exemption, there is a certain degree of rationality
This case, the additional exemption from payment of insurance premiums to protect the interests of the explicit terms of the provisions of the insured person is valid in the subsidiary at about internal disease, or "accidents" lead to the insured person "total incapacity", the insurance company will be based on the fifth attached to some of " interest payment "exemption under the provisions of the insured person's obligation to pay insurance premiums.
Zhang insured in the contract within the validity period, hospitalization due to illness, and is testing center in the ability to work are identified as "completely lost the ability to work", are attached to some of the insurance coverage, the insurance company should be based on the interest payment attached to some provisions of Article V immunity insurance premiums paid by the insured person.
The other benefit payments under the provisions of Article V, the premium fee waiver until the expiry date, or until the insured person reaches 65 years of age, or the insurer may engage in any work to get any reward or later. Taking into account the terms of the premium exemption initially developed to regulate, the provision should be understood as follows: first, when the total incapacity of the insured person before the expiry of the payment, physical condition has been restored, you can engage in certain kinds of work and receive remuneration, the insurance premiums exempt from the insured person may engage in any work to receive any remuneration to terminate. Second, the other cases the termination of the insurance exemption of time to pay the basic insurance contract expiry date and the insured person reaches 65 years of age, whichever occurs first.
Thus, insurance companies insured the premium end time exemption to the provisions of laws about the three possible whichever occurs first. This case, the insured person due to authority identified as "totally incapacitated" to the insurance company to apply for exemption of insurance premiums, but taking into account the physical condition of the insured person may change the future, therefore, the insurance company decided to temporarily exemption two years of premiums, after two years if they are insured person's condition has not improved, the insurance company will continue to be exempt in accordance with the contract to fulfill the obligations of insurance premiums.
Understand the crux of the problem is to correctly distinguish between "permanent" completely lost the ability to work and the "temporary" loss of ability to work. This case, it may not yet determined the time of Yang are "permanent" completely lost the ability to work. Therefore, the insurance companies for temporary exemption from the premium for two years and two years later to reassess the decision of whether to continue the premium exemption, there is a certain degree of rationality.
