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Chapter 376 Insurance contract disputes (1)

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    In the afternoon, Wu You brought Li Yike to the Legal Aid Center on time, and met Xu Lei from the Legal Aid Center and Ma Yanyan, the client.

    When Wu You saw Xu Lei, Wu You almost burst into tears like seeing a relative.

    Due to the presence of the person involved, Wu You had no choice but to restrain his emotions.

    Li Yike stood aside, only thinking it was funny, but for the sake of his brother's face, he decided to endure it.

    Xu Lei hasn't seen Wu You for a long time, and seeing Wu You's complexion is good, she is really happy for Wu You, and then greets Wu You warmly and familiarly as always: "Wu You, Yi Ke."

    "Xu Lei." Wu You responded politely.

    "Sister Xu Lei." Li Yike greeted with a smile.

    "Let me introduce to you, this is the client, Ms. Ma." Xu Lei introduced.

    Ma Yanyan is 43 years old, of medium build, wearing a hat, and has a gloomy complexion.

    Then he introduced Wu You to Ma Yanyan: "This is the lawyer entrusted by our legal aid center for you, lawyer Wu You and lawyer Li Yike."

    "Ms. Ma, hello." Wu You smiled and nodded at Ma Yanyan, and Li Yike, who was standing aside, also bowed slightly.

    Wu You and Li Yike's sincere attitude suddenly shortened the distance between them and Ma Yanyan.

    "Thank you for your hard work, Lawyer Wu and Lawyer Li." Ma Yanyan said, obviously lacking in energy.

    "Sit down and talk." Xu Lei beckoned everyone to sit down.

    The four sat down, and Xu Lei took out the file and began to introduce the case.

    On June 1 this year, Ma Yanyan, as the policyholder, signed a life insurance contract with a life insurance company.  , Ma Yanyan paid the insurance premium, and the insurance policy became effective on the date of signing the contract.  The insurance terms stipulate: 1. The basic insurance amount of universal major disease insurance type c' is 100,000 yuan, and the insurance period is lifelong.  2. The scope of mild and severe diseases includes: 1. Non-life-threatening malignant lesions The definition of mild and serious diseases includes: non-life-threatening malignant lesions, such as carcinoma in situ The insurance amount for mild and serious diseases is equal to this additional  20% of the basic insurance amount of the contract During the validity period of this additional contract, we undertake the following insurance liabilities: within 90 days from the date of this additional contract becoming effective (or finally reinstated), one of the following circumstances occurs to the insured:  (1) 'Minor and severe illness' or 'major illness'; (2) We do not bear the insurance liability for seeing a doctor for a related disease that causes 'mild or severe illness' or 'major illness' The insured suffers from accidental injury or  If an insured accident occurs after the waiting period, we will pay insurance benefits in the following ways: mild and critical illness insurance benefits, if the insured is diagnosed with the major diseases (no matter one or more) stipulated in this additional contract for the first time, through our  If a specialist doctor in a recognized hospital diagnoses for the first time the mild and severe illness (no matter one or more) stipulated in this additional contract, we will pay the minor illness and severe illness insurance according to the insurance amount of the minor illness and severe illness, and this liability will be terminated.

    Insurance contracts cover five "critical periods".

    The first is the hesitation period, also known as the cooling-off period. The hesitation period is stipulated in the contract and stated in the policy. Depending on the product, the hesitation period is generally 10-20 days.  During this period, the policyholder can surrender the policy without any loss of premium.  The hesitation period is to give consumers a chance to go back on their word. For example, if a consumer buys this insurance and finds that the insurance does not meet his needs after a few days, he can return the insurance without any loss.

    The second is the waiting period, also known as the observation period or exemption period, which means that during the waiting period, if an insured accident occurs, the insurance company will not bear the insurance liability, but the paid insurance premium will be refunded without interest.

    The setting of the waiting period is to protect the insurance company. It can prevent the insured from knowing that an insured accident will occur, and immediately apply for insurance to obtain the insured amount.

    For example, a feels that he is not feeling well recently, and he feels that he is suffering from some kind of disease, so he quickly buys a medical insurance from the insurance company, and the policy will take effect tomorrow, and then he also goes to the hospital tomorrow, and is diagnosed with diabetes.  If there is no waiting period, the insurance company will pay for the cost of treatment.

    The setting of the waiting period is actually to prevent insurance fraud.

    The length of the waiting period for each type of insurance is different. There is no waiting period for accident insurance, the waiting period for medical insurance is generally 30 days, and the waiting period for critical illness insurance and life insurance is generally 90-180 days.

    The third is the grace period, which is the period during which premiums can be paid if the insurance premiums are not paid on time; the insurance company still needs to bear the insured accidents that occur during the grace period.

    Only long-term insurance products have a grace period, such as long-term critical illness insurance, life insurance, etc.

    The grace period is only available for long-term insurance products, and the period is generally 60 days.

    ? For insurance products with a period of one year or less, one?There is no grace period, and the insurance coverage will be terminated upon expiration.

    The fourth is the reinstatement period. During the reinstatement period, the premium is not paid within the grace period. At this time, the effectiveness of the policy is suspended, but it is not terminated. However, if an insured accident occurs during this period, the insurance company will not be liable for compensation.

    If you want the policy to continue to be valid, you must apply to the insurance company for policy reinstatement. The period during which the policy can be applied for reinstatement is the reinstatement period, which is generally 2 years.

    However, to apply for reinstatement, you need to make up all the premiums during the invalidation period.

    The fifth is the statute of limitations, that is, the policyholder or beneficiary must apply for a claim within the statute of limitations. After this period, if you apply for a claim again, you cannot file a lawsuit, and the insurance company can refuse the claim without reason.

    The statute of limitations for life insurance claims is generally 5 years, and the statute of limitations for other insurance claims is generally 2 years.

    Ma Yanyan's case involved the waiting period, and the insurance company and Ma Yanyan had different understandings of diseases occurring during the waiting period.

    ? On June 20 this year, Ma Yanyan participated in the unit physical examination. The conclusion of the physical examination showed that Ma Yanyan's double breasts had clear layers, thickened glandular layers, uneven echoes, and grid-like distribution.  The right mammary duct was dilated locally, the wider part was 0.2cm.  A 0.6*0.5cm hypoecho can be seen on the outside of the right mammary gland, and the peripheral blood flow is abundant.  A 0.8*0.4cm lymph node can be seen in the right armpit, and a 0.9*0.5cm lymph node can be seen in the right armpit.  Ultrasound tip: the right milk duct is limitedly dilated, the hypoechoic nodule of the right breast is double breast hyperplasia, and both axillary lymph nodes are visible. Further examination is recommended.

    From August 23rd to 27th, Ma Yanyan went to the Affiliated Hospital of Huaihai Medical University for examination according to the doctor's advice. On August 27th, the University Affiliated Hospital of Huaihai Hospital issued a diagnosis: "1. Breast mass (right side): Breast cancer?  Breast fibroadenoma? Breast hyperplasia? 2. Breast benign tumor (left side) 3. Double breast hyperplasia." On September 6, the Affiliated Hospital of Huaihai Medical University issued a certificate to record the diagnosis and recommendations: solid symptoms on the right side  cancer.  (Remember the site URL: www.hlnovel.com
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