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Critical illness insurance: exemption clauses should pay spe

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Critical illness insurance: Exemption clauses should pay special attention to the case. A few years ago, Ms. Cao insured her major illness insurance, and the insurance company gave it after the physical examination. Ms. Cao paid the insurance premium, the insurance company issued the insurance policy, and the insurance contract between the two parties was established. Ms. Cao was sick during the insurance period and was diagnosed by three hospitals and agreed to have an acute myocardial infarction. Ms. Cao thought that she had just insurance. It was a blessing in the unfortunate case. She immediately filed a claim with the insurance company and asked the insurance company to pay the insurance premium. The insurance company replied clearly: refusal to pay. The insurance company believes that although Ms. Cao suffers from myocardial infarction, her condition does not meet the requirements of the three medical indicators for myocardial infarction in her insurance clause. Therefore, according to the contract, if the above three indicators are not available at the same time, the insurance company The responsibility for payment should be waived. After identification, Ms. Cao’s myocardial infarction did have an indicator that did not meet the insurance clause, but she claimed that the insurance company did not explain the provisions of the three medical indicators that the myocardial infarction should have at the time of contracting. Knowing the medical implications of the three medical indicators, the clause is invalid. In particular, the insurance policy does not explicitly address the insurance company's exemption clauses and does not clearly explain it. The insurance company argues that when the contract is concluded, the company will make an oral statement to the policyholder on the exemption clause, and the exemption clause is valid. Since August 1, 2007, the insurance contract signed by the insurance company should comply with the new version of the Code of Practice for the Definition of Diseases for Major Sickness Insurance. The biggest contribution of the regulation is to change the criteria from insurance medicine to clinical medicine, which is more beneficial to policyholders. According to the reporter's understanding, many insurance companies represented by Life have revised the definition and scope of diseases in their articles. In response to the above case, Zhou lawyer of Deli Law Firm stated that the insurance contract did not emphasize the exemption clause, and this part is a format clause and should be invalid, so it should be liable for compensation. The so-called format clause is the clause that the parties pre-planned for repeated use and did not negotiate with the other party at the time of conclusion of the contract, that is, the contract placed by the party in a strong position in advance for the other party, here is the insurance company preparing for the insured. Contract, in this case, because the insured is in a weak position, the insurance company must be required to highlight some of the provisions that involve immediate interests. Lawyer Zhou said that the so-called verbal explanation of the insurance company requires the insurance company to provide evidence, and it is invalid if it cannot be proved.


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