"Isolation Insurance" Frequent Claims Disputes

Our reporter Pan Fuda

  "Don't worry about isolation, just lie down at home and count money" "People sit at home, money comes from the sky" "I get 200 yuan for one day of isolation, and the money for a cup of milk tea is guaranteed for one year"... In the past two years, due to the repeated epidemics and the Influenced by the uncertainty of the situation, many insurance companies have launched "isolation insurance", and users can get a total insured amount of several hundred thousand yuan after spending tens of yuan a year in premiums.

As soon as the isolation insurance was launched, it became very popular and became an "Internet celebrity" product.

However, many policyholders report that isolation insurance is "difficult to settle claims", and claims disputes have emerged in an endless stream recently.

Why can't users get compensation after being quarantined due to the epidemic?

What should consumers pay attention to when buying such products?

  There are more than 1,000 complaints about isolation insurance

  "Our building has been diagnosed and has been closed for so long. After being quarantined for such a long time, the application has been refused twice, so what's the use of me buying isolation insurance?" New crown patients are in close contact, or they are isolated in medium and high-risk areas." This made him very angry.

Many Shanghai users who have purchased isolation insurance have reported that insurance companies have refused to pay claims on the grounds that "Shanghai does not have medium and high risk areas".

  On a complaint platform, the keyword "isolation insurance" was searched, and there were more than 3,000 related complaints, involving products of many insurance companies. The reasons for refusing claims included "not meeting the classification of medium and high risk areas" and "unable to issue a quarantine certificate". Lack of diagnostic certificate" "asymptomatic infection is not a confirmed case" and so on.

The insurance company took the insurance contract to explain the reason for the refusal, and consumers believed that it should be based on "substantial isolation facts", rather than playing "word games" according to the terms of the policy.

  Some insurance companies disclosed that the industry makes claims in accordance with the insurance contract and the risk delineation standards displayed on the State Council's client applet.

Some users have obtained "accommodation compensation" from insurance companies through complaints and other methods, but some users have reported that they have not yet received compensation.

  Product claims rules vary greatly

  The popularity of "isolation insurance" began in the second half of 2021. Insurance products including the protection liability of the new crown isolation allowance were popular for a time because they hit the pain points of consumers and high leverage ratio, which brought high traffic to insurance companies, but consumers complained Continuing, this Internet celebrity insurance product has been controversial.

  Song Zhanjun, deputy secretary-general of the Insurance Research Center of Beijing Technology and Business University, introduced that in fact, isolation insurance existed before the outbreak of the new crown pneumonia epidemic. The reason why vision is popular is because consumers want to share the risk of income reduction or expense expenditure caused by isolation through insurance. Insurance companies also use it as an innovative drainage product, which is sold in insurance agent channels and Internet insurance platforms. , the supply and demand sides jointly promote the isolation risk.

  However, the isolation allowance insurance products lack a basis for pricing, and insurance companies follow the trend to pursue market traffic, laying hidden dangers for claims disputes.

The reporter looked through a variety of products and noticed that different products have different definitions of relevant responsibilities. If consumers "close their eyes" to insure, they will easily be rejected for claims after the event.

  For example, the "Anti-epidemic Insurance (including New Crown Isolation)" products launched by Ant Insurance and PICC Property Insurance, the isolation compensation only includes centralized isolation, excluding home isolation, and the "centralized isolation self-paid loss allowance" liability only pays the insured for centralized isolation The accommodation expenses, meal expenses, quarantine expenses and the loss of lost work expenses caused by the isolation and lost work during the period of self-payment; another "Huatai New Crown Isolation Insurance" also claims that the insurance liability does not include home isolation, and only covers the insured. Suspected or confirmed infection of the new coronavirus pneumonia caused by taking public transportation is subject to compulsory isolation in accordance with laws and regulations, and no asymptomatic infection is included.

  According to industry insiders, one of the reasons for the difficulty in claim settlement is that policyholders blindly apply for insurance. Under the attraction of advertising gimmicks, they directly apply for insurance without distinguishing the key points of the contract; in order to control the risk of claims, insurance companies have refined the exemption clauses and increased claims restrictions.

  Be clear about your responsibilities when applying for insurance

  In February of this year, in response to the problems of false propaganda and difficulty in settlement of claims for "isolation insurance", the Property and Casualty Insurance Department of the China Banking and Insurance Regulatory Commission issued the "Emergency Notice on Regulating the Operation of "Isolation" Allowance Insurance Business, and conducted a review of the "isolation" allowance insurance business. Regulations require insurance companies to regulate relevant products, and not to conduct one-sided publicity and malicious hype for the purpose of attracting consumers' attention.

Under the guidance of the regulatory authorities, a large number of "isolation insurance" products have been rectified and re-listed.

  Song Zhanjun introduced that after the release of the "Notice", insurance companies have become more standardized in their publicity and sales pages, and the situation of one-sided publicity and malicious hype in the early stage, which has led to claims disputes, has improved. Insufficient, etc., still cause trouble to consumers.

  "And we must see that under the influence of the Omicron variant, there is a risk of excessive compensation in early product pricing. Insurance companies must fully understand the uncertainty of the epidemic and fully evaluate the operational guarantee capability and claims risk of isolation insurance." He suggested that insurance companies should clearly define the claims conditions, avoid "accommodating claims", and reduce the ambiguous area of ​​claims; consumers should also further understand the product's claims trigger conditions and claims material requirements when purchasing, and make correct purchase decisions. .

  The China Banking and Insurance Regulatory Commission has previously reminded consumers that they need to understand the "secondary insurance" before purchasing isolation insurance, that is, "what is not insured" and "what is insured", and should pay attention to keeping relevant isolation certificates after purchasing.

In particular, it should be noted that when purchasing isolation insurance, the "isolation" as understood by consumers is not necessarily the "isolation" defined in the insurance clauses. Health monitoring and home isolation are not covered by the above-mentioned isolation insurance. When purchasing, you should read the insurance terms carefully, clarify the responsibility and scope of protection, carefully judge whether it meets your actual needs, and apply for insurance carefully. Before applying for a claim, you should consult the insurance company where the insurance is insured to understand the list of materials and relevant requirements for claim settlement.

Keywords: