The granddaughter was scratched by a cat and was refused compensation at the insurance company. Mr. Song of the district questioned: Is this “student accidental injury insurance” for the granddaughter’s insurance reasonable?
Some time ago, Mr. Song bought a small cat, and the 7 granddaughters were very happy with it. However, a few days ago, when the granddaughter teased it, he was accidentally scratched by a kitten. The family suddenly panicked and quickly went to the epidemic prevention station to give the child a rabies vaccine and spent more than 300 medical expenses.
Mr. Song remembers that the child bought an accidental injury insurance in the kindergarten he was attending, so he organized the relevant documents and applied for compensation from the insurance company. A few days later, Mr. Song was told that he could not compensate. "If the insurance policy states that it can't be compensated by a cat or a dog, this is no problem. But there is no indication at all!" Mr. Song wanted to discuss.
It is understood that every child in Tongxin Kindergarten, where Mr. Song’s granddaughter is studying, has purchased a “School Student Accident Insurance”, which pays 90 per person per year. The person in charge of the kindergarten said that when the insurance was originally paid, the clerk of the insurance company did not explain to the school what circumstances could not be settled.
Mr. Wang, the person in charge of the claims department of the insurance company complained by Mr. Song Lao, took out the insurance policy and pointed out that the back of the “social medical insurance insurance department stipulated that the reasonable medical expenses can be settled,” said the terms of the dog and dog. The bite is reasonably claimed to be reimbursed for accidental injury, but after the bite is injected with the rabies vaccine, this is not a reimbursement of the scope of medical insurance coverage, so no claims are made.
Miss Wang has calculated an account: According to the regulations, Mr. Song’s granddaughter uses the drug fee of 330, minus the self-funded vaccine fee, and then subtracts 50 deductible. The remaining medical expenses multiplied by 90% is the claim amount. "But there is more than 300 vaccines for light, and the money that can be lost is gone." Miss Wang said.
The supervisor of a large insurance company introduced that each insurance company now refers to the local basic medical insurance and industrial injury insurance drug list as the basis for claims. Among the social medical insurance drugs, the national C drugs are self-paid drugs, and the vaccines are C. medicine. "Being a pet bite is an accidental injury that can be settled, but it depends on what medicine you used at the time." Industry insiders said.
People from the legal profession also agree with this statement. Qiu Yibin, a lawyer of Zhongji Law Firm, believes that the insurance company’s indemnity clause has been stated to “conform to the reasonable medical expenses stipulated by the local social medical insurance authorities” before the claims can be paid. The state has also announced the relevant provisions of the current social medical insurance drug reimbursement, which is equivalent to the obligation to use the drug to sue, the insurance company does not pay compensation also has their reasons.
According to the doctor of the CDC, there are many similar incidents such as bites and dogs, and only 2,000 people went to the hospital to inject rabies vaccine last year. Therefore, the industry reminds consumers to be careful when choosing accident insurance. If you feel that your risk of being bitten by a pet is relatively large, you may wish to make a special mention on this point and confirm it. You can understand it in your heart.