99%的保险拒赔,都是因为….

保险的主要功能就是在意外发生时,为投保人或被保险人提供抵御风险的保障。因此,“理赔”成为每一位客户最关心的问题。只有顺利完成理赔,保险才能发挥其最大效用。然而,在专业性较强的理赔流程中,一些“插曲”可能会影响最终的赔付结果,甚至导致拒赔。那么,到底是什么情况会导致保险公司拒赔呢?

我们整理了以下八大常见的拒赔原因,希望能引起大家的重视,避免投保后遭遇拒赔困扰。希望大家都能够“清楚了解风险,明白购买保险,踏实享受生活”。

 

1. 故意隐瞒?不可尝试❌

2019年,邓先生被查出患有甲状腺恶性肿瘤,随后试图向保险公司索赔。调查中,保险公司核实到邓先生曾在两年前的体检中查出甲状腺结节,因故意未如实告知,保险公司拒绝赔付并解除保险合同,不退还已交保险费。

拒赔原因:未如实告知

没有如实向保险公司告知真实情况而被拒赔,通常发生在重疾险、医疗险、意外险等过程中。

投保TIPS📌:根据新加坡《保险法》规定,投保人故意或因重大过失未履行如实告知义务,足以影响保险公司决定是否承保或提高保费的,保险公司有权解除合同。投保时记得如实告知健康状况,理赔时才会顺利。

 

2. 等待期?不能忽视⏳

2022年,陈女士为儿子投保了一份重疾险,附加投保人豁免保险费重大疾病保险。合同于2022年7月23日零时生效,还需经过180天等待期。2023年1月12日,陈女士确诊为乳腺癌,申请豁免保险费责任时被保险公司拒绝,理由是“等待期内出险”。

拒赔原因:等待期内出险

不同险种的等待期不同,重疾险和寿险的等待期通常为90-180天,医疗险一般为30-60天。投保时要格外留意等待期时长。

 

3. 先天疾病?免除责任🚫

谷女士在儿子出生后不久,为其投保了重疾险。孩子一岁时确诊为室间隔缺损。保险公司认为这是先天性疾病,属于合同约定的责任免除范围,因此不予赔付。如果你买孕期险的话,新加坡某公司可以不排除先天性疾病的情况来投保。

拒赔原因:责任免除

每份保险都会明确划定免责条款,健康险会排除先天性疾病和投保前已有的疾病或症状。投保前可联系保险顾问,确保选择适合的险种。

 

 4. 诸多限制?逐一确认✅

2021年,刘先生投保了一份综合意外伤害保险,意外医疗保险金额1万元。合同规定,被保险人如受伤,应到二级以上医疗机构治疗。刘先生在乡镇医院就诊后申请赔付,因医院不符合规定被拒赔。

拒赔原因:未在合同规定的医院就医

保险条款通常规定就医医院的类别,出险后应到符合规定的医院治疗。急需救治时可就近治疗,但情况稳定后应回到符合条款规定的医院。

 

 5. 突发险情?及时告知📞

2019年,王女士在一家保险公司投保了车险。2020年,王女士驾驶车辆发生单方交通事故,事发后未及时报案。保险公司以未及时通知影响事故性质认定为由拒绝赔付。

拒赔原因:未在有效时间内报案

保险事故发生后,及时通知保险公司是投保人的义务。不同险种报案时间不同,应及时联系保险顾问,协助办理理赔。

 

6. 高危活动?自担风险⚠️

小陈热爱极限运动,父母为其投保了一份短期意外险。在一次跳伞活动中,小陈意外受伤。保险公司认为跳伞属于高风险活动,合同中明确除责,拒绝赔付。

拒赔原因:自担风险行为超出可保范围

喜欢极限运动的人群可以考虑涵盖此类风险保障的保险产品,投保时确认保障范围及理赔细节。

 

7. 承保范围?谨慎确认🔍

2019年,老李在工地做工,包工头为其购买了一份意外保险。某日老李因急性心肌梗死死亡,家属申请赔付时被拒,因死亡原因非意外导致。

拒赔原因:不在保险责任范围内

每份保险都会在保单中清晰阐明保险责任范围,超出该范围的理赔申请将被拒绝。

 

8. 自杀认定?不予赔付💔

2015年,贾先生投保了一份含身故责任的短期意外险。2016年,贾先生因情感原因在家中自杀。保险公司根据自杀免责条款不予赔付。

拒赔原因:自杀免赔

健康险和伤害险不承保自杀行为。但保险法规定,合同成立满一定的年份后被保险人自杀的,保险公司可以赔付。

 

总结📝

对于保险,大众多抱有“投保容易,理赔难”的误解。大部分拒赔情况是由于投保人对保险条款不够了解或缺乏赔付相关信息。专业的事情应交给专业的人来做。保险顾问在保险条款分析及方案制定等方面有丰富的知识和经验,能帮助客户选择适合的险种,避免理赔环节中的隐患。

购买保险的初衷是为自己增添一份抵御风险的勇气。在您前行的路上,我将牢记使命,帮助客户“清楚了解风险,明白购买保险,踏实享受生活”。

你的宝库管家
Jolysse邬宇思
微信:Yusi_Wo / WhatsApp:90088276
新加坡全牌照理财顾问
Representing Financial Alliance Pte Ltd
Singapore Largest Independent Financial Adviser
#保险 #重大疾病保险 #健康保障 #新加坡 #财务规划 #年轻人理财 #早期准备

Important: The information and opinions in this article are for general information purposes only. They should not be relied on as professional financial advice. Readers should seek independent financial advice that is customised to their specific financial objectives, situations & needs. This advertisement or publication has not been reviewed by the Monetary Authority of Singapore.

Published By:

JolysseWu 邬宇思

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Hi, I’m Jolysse. Thank you for visiting my website and I’m looking forward to getting to know you personally.

I’m an independent financial consult and strive towards helping my clients and their families to accumulate wealth and helping them grow their investment portfolios.

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我是一名具有8年财富管理经验的独立理财顾问,金融学&管理学双学士,先后服务过近千个私募客户,个人美股及衍生品投资最高年化收益率达366%。在信息爆炸的时代,为您用中立、专业、挑剔的眼光去选择最合适您的理财方案!

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