At the time of the insurance policy, one of them was not clear
The answer is yes, but one step must be taken and time-bound。
Under article 16, paragraph 3, of the insurance act, the right to discharge from a contract is extinguished after more than thirty days have elapsed since the insurer became aware of the cause of the discharge。
If the contract has been in existence for more than two years, the insurer may not terminate it。
That is to say, if the insurance company does not terminate the contract within thirty days after knowing that you did not give the correct information, this right disappears。
Two years after the contract was established, the matter could no longer be dealt with directly。
This provision has a special name, which is called an irrefutable clause. It protects not the policyholder's false statements, but the insured's trust in the long-term viability of the contract。
The following 30 articles, from insurance to compensation, are cross-referenced to each article。
I. Factual information at the time of insurance
Serial number
You must know the points
Legal basis and consequences
If the insured person asks about the subject matter of the insurance or about the condition of the insured person, the insured person shall be informed accordingly
Article 16 (1) of the insurance act
The obligation to inform is limited to the scope and content of the insurer's enquiries
Article 6 (1) of the judicial interpretation of insurance law
The policyholder is obliged to inform only what he knows
Judicial interpretation (ii) article 5
Court does not support a request for termination of a contract based on a breach of the obligation to inform a general clause
Judicial interpretation (ii), article 6, paragraph 2
The insurer shall not be liable for wilful failure to comply with the obligation to inform in good faith and shall not refund the premiums
Article 16, paragraph 4, of the insurance act
Non-acceptance of liability but refund of insurance premiums for failure to report gross negligence and serious impact on insurance incidents
Article 16 (5) of the insurance act
The right to discharge is extinguished by non-exercising more than 30 days from the date on which the insurer becomes aware of the cause of discharge
Article 16 (3) of the insurance act
An insurer may not terminate a contract for more than two years from the date of its establishment
Article 16 (3) of the insurance act
Articles 2 and 3 are the two most important to be remembered by the insured person。
The obligation to inform is not unlimited, but only when two conditions are in place: the insurer asked and the insured knew。
No questions asked, no obligation to inform. It is neither known nor possible for the insured person to know。
Many people are required to fill out long health information questionnaires when they are insured, and the point here is not whether you have any minor health problems, but whether the questionnaire asks about this。
Articles 7 and 8 are a dual time limit。
Thirty days from the date on which the insurance company became aware of the cause of discharge; two years from the date on which the contract was formed。
Both figures had passed and could no longer be used to terminate the contract without being properly informed。
Ii. What to do after the risk
Serial number
You must know the points
Legal basis and consequences
When an insurance accident occurs, the insurer should be notified promptly
Article 21 of the insurance act
10
Claims for compensation shall include proof and information relevant to the confirmation of the nature of the accident, its causes and the extent of the loss. ]
Article 22, paragraph 1, of the insurance act
Eleven
If the information is considered incomplete by the insurer, it should be supplemented by a timely one-time notification
Article 22, paragraph 2, of the insurance act
12
It's complicated. The insurer should have done it in 30 days. Approved
Article 23, paragraph 1, of the insurance act
13
Compensation or payment obligations are performed within 10 days of agreement for those who are covered by insurance liability
Article 23, paragraph 1, of the insurance act
14
If this is not an insurance liability, a notice of rejection shall be issued within three days of the date of approval, together with the reasons. ]
Article 24 of the insurance act
The two words in article 9 are the most contentious in practice。
The insurer is not liable for the undetermined part of the accident, where the nature, cause and extent of the loss are difficult to determine, either intentionally or due to a lack of timely notice of gross negligence。
However, the insurer could not refuse compensation if he knew or ought to have known by other means that the accident had occurred。
The first thing to do after the incident is to report the case, leaving a mark on the case, which is much more useful than ex post facto explanations。
The one-time notification under article 11 is a reduction of the insured person's burden. The insurance company cannot ask for one today and another tomorrow, and must finish the story once and for all。
Articles 12 and 14 are a pair of time requirements. The insurance company is required to approve the claim within 30 days, and within three days of the approval of the claim not falling under the insurance liability, it is required to submit a written rejection of the claim with reasons。
The notice of refusal cannot be a mere statement of non-payment under the contract and must be clearly justified。
Grounds for refusal and defences
Serial number
You must know the points
Legal basis and consequences
15
Compensation cannot be determined within sixty days and should be paid first on the basis of available information
Article 25 of the insurance act
16
Failure by the insurer to exercise the right of discharge to refuse compensation directly on the ground that it was not informed in good faith
Judicial interpretation (ii) article 8
17
No contract may be terminated if it is established that the premium has been collected without being properly informed. ]
Judicial interpretation (ii) article 7
18
An insurer may not terminate a contract if he or she knew at the time of its conclusion that the information had not been properly communicated
Article 16, paragraph 6, of the insurance act
19
In the absence of a hint or a clear statement of the exemption clause, the provision has no effect
Article 17, paragraph 2, of the insurance act
20
Exemption from liability, exemption, exemption rate, proportional payment, etc
Judicial interpretation (ii), article 9, paragraph 1
21
The burden of proof on the insurer as to whether the obligation to specify has been fulfilled
Judicial interpretation (ii) article 13
22
Where the formal provisions are explained in more than two ways, they should be interpreted in favour of the insured and the beneficiary
Article 30 of the insurance act
Article 16 is the strongest defence in practice。
The insurance company had to terminate the insurance contract before it could refuse compensation on the grounds that the policyholder had not been informed in good faith。
A direct letter of rejection stated that you had a history of failure to notify, that you would refuse compensation if the contract was not terminated, and that it was not legally valid。
The following is a set of counter-arguments to common grounds for refusal:
Common grounds for refusal
Grounds for defence
Key points of appreciation
Failure to inform upon insurance
Article 16, paragraph 3, of the insurance act and article 8 of the judicial interpretation (2)
Whether to terminate the contract first, 30 days or 2 years internal
I haven't heard from him
Article 6 of judicial interpretation (ii)
Did the health questionnaire ask about this
Within the scope of the exemption clause
Article 17, paragraph 2, of the insurance act
Whether to add a rough hint and specify
Application of waivers, proportional payment
Judicial interpretation (ii), article 9, paragraph 1
Compliance with the obligation to indicate
The interpretation of the clause is controversial
Article 30 of the insurance act
It should be interpreted in favour of the insured person
Never approved
Article 23, paragraph 1, of the insurance act
Complexity should be approved within 30 days
We're talking about the amount
Article 25 of the insurance act
Partial payment should be made within 60 days
Known to collect premiums without informing them
Judicial interpretation (ii) article 7
This shall constitute a waiver and no further termination. ]
Taken together, articles 19 and 20 are a useful key。
The exoneration clause is not only the part of the contract that contains the four words of exoneration。
The exemption, the exemption rate and the proportional payment, provided that they are substantially exempt or lessen the liability of the insurer, are subject to the obligation of prompting and specifying。
These provisions do not have effect without warning or explanation。
Article 22 referred to differences of interpretation. Where there are more than two interpretations of the same sentence, the court shall give an interpretation in favour of the insured person and the beneficiary。
The insurance clause was drafted by the insurance company and the author bore the consequences of a lack of clarity。
Iv. Proceedings, corporation and other
Serial number
You must know the points
Legal basis and consequences
23
Insurance other than life insurance, with a limitation period of two years for claiming compensation
Article 26, paragraph 1, of the insurance act
24
The statute of limitations for life insurance claims is five years
Article 26, paragraph 2, of the insurance act
25
Contracts in which death is the condition for the payment of insurance are null and void without the consent and approval of the insured person
Article 34, paragraph 1, of the insurance act
26
If the beneficiary is not appointed, or if the beneficiary dies before the insured person and there is no other beneficiary, the benefit shall be an inheritance
Article 42, paragraph 1, of the insurance act
27
If an insured person commits suicide within two years of the establishment of a contract in which death is the condition for payment of insurance, the insurer will not be liable
Article 44, paragraph 1, of the insurance act
28
If the insured person terminates the contract, the insured person shall refund the cash value of the policy within 30 days of receipt of the notification
Article 47 of the insurance act
29
If an accident occurs as a result of a third person's conduct, the insurer will not have the right to recover from the third person upon payment
Article 46 of the insurance act
30
In the event of an accident caused by a third party's damage to the subject matter of the insurance, the insurer may, after compensation, assume the right to claim compensation
Article 60, paragraph 1, of the insurance act
The figures for articles 23 and 24 are easily misrecorded。
Life insurance is subject to a five-year statute of limitations and other insurance is two years from the date on which the insurance accident occurred or should have been known。
This is a special provision of insurance law, which is shorter than ordinary civil disputes and cannot be delayed。
Articles 25 and 27 refer to two rules that are specific to the risk of death。
A contract in which death is the condition for the payment of insurance benefits must be approved and approved by the insured person, otherwise the contract is invalid。
If the insured person commits suicide within two years of the date of the formation or restoration of the contract, the insurer shall not be liable for payment, except in cases where the insured person is incapable of civil action at the time of suicide。
The value of the cash clause in article 28 is the first word that many people hear when they withdraw。
Retrospect, rather than paying the premium, is the cash value of the policy. Long-term insurance premiums were retired in previous years, often with a value of cash well below the premium paid。
At the end
Insurance disputesThe two most common error zones for insured persons are the opposite。
A mistake is that the insurance policy is voided by a small omission。
The law limits the scope of the obligation to inform, the time limit for the right to discharge, and the insurance company has to terminate the contract in order to refuse compensation and complete it within 30 days or two years。
Another area of error is that you think you can pay for insurance。
Excusing clauses are valid if they fulfil the obligation of prompting and specifying; two-year, five-year prescriptions have passed, and the rights are asleep。
It's really working at the moment of insurance。
The health questionnaire is article-by-article, and the inexplicable questions are clearly asked and recorded in the field; a copy of the insurance policy, the insurance policy, the full text of the terms, and the certificate of contribution are kept after signing。
Each step of the settlement is in writing: the reporting number, the submission list and the record of each communication。
The failure of the insurance company to approve the claim within 30 days, the failure to issue a notice of rejection within three days and the failure to pay the claim before 60 days are all points of contention。
Summary of highlights
4 "don't."
Never check the health questionnaire without looking at the content - signature confirmation is considered a personal indication. It is important not to delay subsequent non-reporting — failure to notify in a timely manner makes it difficult to determine the loss and the undetermined portion is not compensable. It is important not to assume that the refund will take back the principal — it is the value of the cash that retreats, often well below the premium paid in previous years. The two-year statute of limitations should never be inappropriate — life insurance for five years and other insurance for two years — and it is difficult to claim expiry。
Did you take a good look at that page when you bought insurance
