2022 Casino Cases ｜ Actively find a reason for paying for customers, Xinhua Insurance does this

1. Case details

Ms. X in Bo City is a housewife. Five years ago, she configured Xinhua Insurance's "Multiple Security Insurance Insurance" for herself under the recommendation of her friend, with a insurance amount of 100,000 yuan.

In mid -June 2021, Ms. X went to the hospital for "more than 20 days of dizziness". She was diagnosed with the central nervous cell tumor and intracranial occupying lesions of the right side of the right side, and was later discharged by surgery.

For more than half a year after discharge, due to her condition, she moved to many hospitals for review and rehabilitation treatment. The expenditure of medical expenses caused the family to fall into trouble. In February 2022, Ms. X found the insurance policy that he allocated for herself 5 years ago while packing housework, and immediately dialed Xinhua Insurance Customer Service Hotline 95567 Consulting Insurance Liability and Calculating Cosmetics.

Ms. X submitted a claim application after finishing the complete materials, but according to the "International Statistics Classification of Diseases and Health" (ICD-10), the central nervous cell tumor (WHO Ⅱ) is The terms stipulate that Ms. X's disease diagnosis does not meet the "benign brain tumor" compensation standards stipulated in the contract.

"Think of what customers think, urgent customers," the company's debt officers went to many hospital interview doctors who had visited the client for the first time to understand the condition and diagnosis basis, and obtained more detailed pathological materials. According to the "Outstanding Repairing Plan for Disease Insurance Products" formulated in November 2020, ICD-O-3 tumor morphology codes are 0 (benign tumors) and 1 (dynamic unsatisfactory tumor). It is "severe non -malignant intracranial tumor." The company's claims are more conducive to customers from the perspective of "selection of excellent claims". Based on the results of the investigation and the coding and treatment plan of the tumor morphology of the customer's disease, the claims that meet the "severe non -malignant intracranial tumors" are issued. in conclusion.

In the end, the insurance liability for "Multiple Security for Major Disease Insurance" is normal to pay 100,000 yuan in major illness insurance, 50,000 yuan in the first 10 years of the insurance insurance, and exempts a total of 62,400 yuan in insurance premiums in the future. The insurance policy continues to be effective. After the case was closed, Ms. X thanked the company for giving humanized compensation standards. She could continue to improve the claims service standards while entering the development of medical technology with the times, and received unanimous praise from customers and institutions.

2. Case Revelation

With the latest progress of modern medicine and the development of major illness insurance in my country, and extensively studying international experience, the China Insurance Industry Association has formulated the "Definition and use of Disease Insurance (revised version of 2020). Xinhua Insurance has updated the definition of major illness standards in accordance with the requirements of regulatory requirements and development status. In November 2020, the "Outstanding Listing Plan for Disease Insurance Products" was formulated.

Xinhua Insurance will always adhere to the brand characteristics of "fast -term claims, excellent services", protect all new and old customers rights, and specifically define all new specifications, including major disease insurance products, malignant tumors or cardiovascular and cerebral vascular disease Disease insurance products will be more conducive to the definition of customer compensation in accordance with the disease in the new and old specifications as the basis for claims. Bleak

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