Word games you don't know about in the policy

The content of the professional clauses in the insurance contract is already obscure, and the game that the insurance company plays the word trap makes it more impossible for the insured to resist and protect their own interests.　　The disorderly flower gradually wants the attractive eye. China's insurance industry has undergone these years of development, both in terms of scale and products have undergone great changes. But there are some irreconcilable contradictions behind the booming. With the increasing number of insurance products on the market, the complex insurance provisions began to cause more and more misunderstandings and disputes, which is evidenced by the increasing amount of insurance claims disputes in various courts.　　In the case that has been tried since this year, the insured has accounted for most of the disputes over the life insurance claims after the injury and accidental death. The reason, some are ambiguous in terms of themselves, the literal meaning of ordinary people's understanding is different from that of insurance, some are intentionally or unintentionally misled by sales people in the course of sale, for example, when they buy insurance, the clauses of insurance contract are interpreted in a broad sense, and the final customers have a narrow explanation when they want to　　In addition, various types of property insurance business disputes abound, most of the reasons for the dispute is the professional law, the provisions of the understanding of differences.　　Although the CIRC has issued a number of norms in the past two years, attempts to prevent the misunderstanding caused by the irregular terms and phrases and the "bully clause" of the Insurance "overlord" to the vulnerable consumers, but the "word game" and the selling skill of the insurance contract are still widely used, when the policy holders pay enough attention to it. Ailing risk: exemption clauses to pay special attention to cases a few years ago, Ms. Cao insured herself for a major disease risk, insurance companies to be insured after medical examination. Ms. Cao paid the premium, the insurance company issued the insurance policy, and the contract was established. Ms. Cao was diagnosed with an acute myocardial infarction in three hospitals after she was ill during the insurance period. Cao thought just have insurance, is unfortunate in the lucky, then to the insurance company filed claims, insurance companies to pay premiums. The insurance company made a clear reply: Refuse payment. 　　The insurance company thinks that although Ms. Cao is suffering from myocardial infarction, but her illness does not conform to the requirements of the "3 medical indicators that myocardial infarction should have" at the same time, according to the contract, the insurance company shall be exempted from the liability for payment if the above 3 indicators cannot be met. After identification, Ms. Cao's myocardial infarction does not meet the insurance provisions of the indicators, however, she claims that the insurance company did not explain the "3 medical indicators at the same time" in the contract and did not know the medical meaning of the 3 medical indicators, so the clause was invalid. In particular, the policy is "literally" without highlighting the exemption clauses of insurance companies, without making a clear explanation.　　The insurance company argues that when the contract is entered into, we will make an oral statement to the applicant stating the exemption clause, which is valid. Since August 1, 2007, the insurance company signed the ailing risk contract should be in line with the new edition of the China Insurance Regulatory Commission issued a "major disease insurance disease definition use code." The greatest contribution of the specificationis to change the criterion from insurance medicine to clinical medicine, so it is more advantageous to the insured.　　According to the reporter understand, the Chinese life as a representative of many insurance companies have modified its provisions on the definition of disease and coverage. According to the above case, Shanghai Delli law firm Zhou Lawyer said that the insurance contract on the exemption clause is not highlighted, and this part of the format clause, should be invalid, so should be liable for compensation. "The so-called format clause is that the parties in order to repeat the use of the proposed, and in the conclusion of the contract did not negotiate with the other party, that is, a strong position in advance to the other party prepared the contract, where the insurance companies to prepare the contract, in this case, because the insured in a weak Therefore, insurance companies must be required to focus on certain provisions that involve vital interests. Zhou said that the insurance company's so-called "oral statement" requires insurance companies to testify, if the proof is not valid. [Page] auto insurance: Careful terms and agents double misleading case in early September, Xiangfan Xiangcheng District People's Court of Hubei province made a trial of an insurance exclusions dispute case. Car owner Cui a car after the insured traffic accident damage, the traffic Police Department to determine the other party's full responsibility. Cui asked the insurance company to claim, was rejected. 　　In court, the insurance company believed that Cui MoU not directly to the perpetrator to claim, is abandons to the third party compensation behavior, according to the insurance contract may not compensate. Another high-profile case is that the insurance company refuses to admit that the salesman is affiliated with the company.　　The insurance company claims that the salesman who provides the business for the owner is not the company's employees, but the staff agent, the insurance companies fail to receive the premiums paid by the owners, so the policy cannot take effect and make exclusions decision on the accident. In the previous case, the insurance company's statement is the "Insurance law" of the misunderstanding, Cui MoU in accordance with the contract directly to the insurance company insured vehicle loss insurance claim is correct. Insurance companies in the settlement can be on behalf of the recovery, that is, the insurance company should be in accordance with the contract first compensation to the insured car owners, the loss of the money by the insurance companies themselves to the parties to the accident recovery. The 45th article of the Insurance Law stipulates: "As a result of the third party's damage to the subject-matter insured, the insurer shall, from the date of compensation to the insured, exercise the right of the insured to claim compensation from the third party within the amount of compensation."　　"The law gives the insured the right to claim directly to the insurer (ie Insurance Company) and the subrogation right of the insurer after compensation."　　In the latter case, the insurance company's intermediary agent in which may play the role of embezzling premiums, but this is the insurance company and intermediary units between the problem, to the insured to pay tuition fees, bear the loss is unreasonable and illegal. Repair shop, 4S shop These automobile service organizations as the current insurance companies to obtain insurance business is an important channel for many insurance insurance people are convenient and compliance. As the insured, see the insurance agent issued a policy and agent certificate, after normalmeans to pay premiums, but can not enjoy the normal claims, of course, to appeal to the court. The Nanhui People's Court of the case considers that as the insurance company does not provide evidence, confirmed that the applicant's said agent and the agent on the policy signed as the same person, according to the insurance contract and the certificate issued by the agent, as the applicant has reason to believe that it has the right to the agent, and on behalf of the insurance company charged premiums, The insurance company should bear the insurance liability, after the insurance vehicle Chuxian, it should fulfill the payment obligation in time. According to the agreement of both parties, the insurance company shall reimburse the insured person for the accident claim payment. [Page] Accidental insurance: "accidental" difficult to define the case of unclear liability the Shanghai Jing ' an court coordinated a case of accidental insurance claim which caused the insurance company exclusions due to the "accidental" definition. The deceased sun was in July 2001 with an insurance company signed the "Life insurance Contract", but also agreed to include 10,000 yuan incidental injury insurance. 2006 Sun was killed in the Los Angeles Medical Center for intentional injury.　　Mr. Gong, his husband, made an insurance claim to the insurance company in the identity of his deceased beneficiary, but was exclusions. After the court, the insurance company argued that it did not recognize that sun was an accidental cause of death, that Sun is mainly "injured, custody or poor care and the complications resulting from death, the direct cause of death is a number of his own organ failure, not in accordance with the contract for the injury suffered by accident and disability or death", expressed disagreement with Mr. Gong's request for action.　　Finally, under the mediation of the court, the two sides agreed on the amount of compensation paid by the insurance company. Coincidentally, Beijing Shunyi District People's court in August also heard an accident insurance dispute case: The child died in a continuous insurance company insured students, infant accidental injury insurance, after the sudden liver disease treatment invalid death, and then their parents to the insurance company to claim an accidental deceased insurance premiums, Insurance companies that the case does not belong to the scope of claims and the scope of the additional risk deductible by exclusions, the insurance company said, because the child before the insurance has been diagnosed with abnormal liver function, and in the course of treatment is not approved by the insurance company, it is irresponsible.　　The case is still awaiting trial.　　For similar cases, Sunshine insurance accident risk experts explained that the "accident" in insurance is different from the accident in our daily life. "Accidents" in insurance are "sudden", but it also includes elements such as "exotic, unintended, violent, non-disease", and what people usually think of as accidents is highly subjective-as long as it's unexpected, it can be called an accident. According to the definition of "accident" in the insurance, the death disability or medical expenses caused by the disease are not covered by the accident insurance, because the disease comes from the internal alteration of the insured, and does not conform to the "foreign" standard.　　There are, of course, many accidents that conform to the definition of "accident" in insurance, but are not covered by the terms "liability exemption". The applicant can not help but question, the definition of standards are by the insurance company, ordinary people how toWhich of the many words in the insurance clause is the literal meaning and which is the special "insurance meaning"?　　Such wording and distortions are clearly excuses and scams that insurers are unwilling to take responsibility for. In this respect, the expert said that the accident risk is divided into accident insurance and accidental medical insurance. In the previous case, Sun was insured for accidental injury insurance, which generally included accidental death and accidental disability, and some products included many times the cost of public transport and the liability for burns and burns. The insurance liability of accidental medical insurance generally contains the outpatient service, emergency medical expenses, hospitalization expenses reimbursement and accidental hospitalization subsidy.　　If Sun is insured against accidental insurance covering accidental medical liability, the insurance company will pay for the treatment. In the second case, the child died and sudden death is not included in the liability of accident insurance, and there are children's medical cases such as the evidence that it has been infected with the policy before the commencement of the disease, is a sickness insurance, it can not be claims.　　According to the terms of the additional hospitalization insurance: The insured person has not cured the disease before the insured and the treatment of the disabled, or without the consent of the insured medical treatment expenses of hospitalization expenses of the insured, the insurer does not bear the responsibility for the payment of insurance. Experts also remind consumers, before purchasing, should require the agent to issue a complete insurance contract, the accident insurance exemption scope, underwriting matters and claims and other provisions to fully understand, so as to avoid claims disputes. The insured should also pay attention to truthfully fill in the accident insurance policy, avoid filling in the wrong information and make the insurance company exclusions in Chuxian, causing unnecessary loss. [Page] Property insurance: The keyword understanding is very different case Shenzhen a decoration company buys the total insurance amount to 1 million yuan property insurance, because the air-conditioning water pipe fitting quality problem causes the water pipe leakage, the economic loss amounted to more than 200,000 yuan. expressly stated in the policy: "In the insurance period, due to the water tank, water pipe burst (but not including due to corrosion) and other risks caused by direct material losses, the company agreed to be responsible for compensation in accordance with this policy." "The owner of the decoration company was very relieved to have bought the insurance.　　This thought compensation is inevitable, which material insurance company played a word game, said the water pipe is "off" rather than "burst", refused compensation. The person in charge of the decoration company who received the "exclusions" notice strongly questioned: "We have searched the Insurance law contract and have not found a more detailed explanation of the ' water burst '." According to the insurance company, the water pipe must be torn apart in order to be compensated. In fact, the water pressure to a certain extent will only be a metal tube two joints of the crack teeth, to produce cracks is very difficult. "A policy can produce multiple understandings, which is the most typical example of an insurance company playing word games." According to common sense, leakage caused property loss is a very frequent risk, most property insurance policy will be listed as one of the main risks, many families, companies are directed at such a common risk to insure property insurance. In this case, the insurance company said "No cracks are not compensable", but in the customer chargeThe premium was not expected to inform its "burst of water mains are divided into several cases, in a few cases is not compensable", because once this, customers are likely to be deterred, affect the sale of the policy. The same word, the contract stipulation and the applicant's understanding often is horseshoes, striking.　　When buying insurance, the applicant should remember to ask "which cases can be claims" to ensure their own rights and interests. Mr. Pan, who has worked in the insurance company for many years, told reporters general customers if the insurance and the scope of responsibility is not very clear, you can choose the more common property insurance "all risks", it is "other than the cause of the loss of the subject of insurance" should bear the liability, that is to say, Compared with other kinds of property insurance, it has a wide range of responsibilities and claims, which is advantageous to the insured.