Zhongxin Finance, April 18th, how should disputes arising from "isolation insurance" be handled?

According to the "Shanghai Release" on the 18th, the Shanghai High Court responded to the three situations of the "isolation insurance" dispute.

1. In an insurance contract dispute, how should the insured and the insured request the insurance company to settle a claim on the grounds that the insurance company has made relevant commitments in epidemic prevention and control?

  The Shanghai High Court stated that during the epidemic prevention and control period, insurance companies promised to cancel the waiting period (observation period), deductible, If the scope of insurance liability is expanded due to restrictions such as designated hospitals, the people's court shall incorporate the commitment into the content of the insurance contract, and determine the rights and obligations of both parties and the insurance company's liability for claims accordingly.

2. What should the insurer do if the insurer claims that the insured's application for claim settlement does not meet the agreed claim settlement conditions due to disputes arising from "isolation insurance"?

  The Shanghai High Court stated that the people's court should strictly review the insurance contracts' definitions of insurance risks such as "isolation", "centralized isolation" and "home isolation".

If the insurer has a dispute with the insured or the beneficiary over the terms of the contract, it shall be interpreted according to common understanding.

If there are two or more interpretations of the contract terms, the people's court shall make an interpretation favorable to the insured and the beneficiary.

  The quarantine certificate with the seal of the health administrative department, sub-district township, neighborhood (village) committee, hospital or epidemic prevention and control department, etc. submitted by the insured, the release form of centralized isolation medical observation, or the relevant government The home health monitoring certificate issued by the government-designated online platform, etc., can be used as evidence to prove that they are quarantined.

If the insurer believes that the occurrence or start and end time of the insured event is false, it shall provide corresponding evidence.

  If the insurer has sufficient evidence to prove that the insured deliberately violated the epidemic prevention, control, management and isolation measures issued by the people's governments at all levels, resulting in the infection of new coronary pneumonia or contact with confirmed or close contacts and isolation, the people's court may determine the behavior of the insured The insurer has the right to refuse to pay for an insured accident that is intentionally created.

3. During the epidemic, some insurance companies donated insurance products to medical staff, volunteers, community property staff, and residential (village) committee staff who participated in epidemic prevention. How should insurance disputes be handled?

  The Shanghai High Court stated that the gift of insurance means that the insurer exempts the insured from the obligation to pay the insurance premium when concluding the insurance contract, or performs the obligation to pay the insurance premium on behalf of the insured.

According to relevant regulations, insurance companies may donate personal insurance for the purpose of promotion or public welfare, but not property insurance; they may not conduct illegal business or conduct unfair competition in disguise on the grounds of giving insurance.

During the period of epidemic prevention and control, insurance companies present life insurance to medical staff, volunteers, community property staff, and staff of residential (village) committees, etc. participating in epidemic prevention. If it does not violate the mandatory provisions of laws and regulations and public order and good customs, the insurance contract shall be recognized. efficacy.

After an insured accident occurs, the insured and the beneficiary have the right to claim compensation from the insurance company based on the donated insurance product.

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