What if the insurance company doesn't pay the claim? Which department should I call?
What if the insurance company doesn't pay the claim? Which department should I call? 1 If the claim conditions are not met, it is reasonable for the insurance company not to make a claim, and the loss needs to be borne by itself.
On the other hand, if the agreed claim conditions are met, the insurance accident is not included in the exemption clause, and it is obviously unreasonable for the insurance company not to make claims. Individuals who want to claim their rights should consult with the insurance company first. If negotiation fails, you can call "12378" to complain to the CIRC. If the complaint still doesn't solve the problem, they can keep the evidence to sue the insurance company.
? 1. What are the reasons why insurance companies don't pay claims?
1. Insure against diseases. If the insured insured fails to tell the insurance company the actual situation of the disease, the insurance company has the right not to claim compensation.
There is danger during waiting. General critical illness insurance and medical insurance are not responsible for insurance while waiting. In this case, the insurance company can not pay the claim.
3. It doesn't meet the definition. If the insured's accident is not within the scope of the contract, the insurance company will not settle the claim.
? Second, what if the insurance company does not claim?
1, settled through negotiation. Both the insurance company and the insured agree to negotiate on the disputed part and solve the problem amicably. If negotiation fails, other ways can be adopted to solve it.
2. arbitration. If the two parties fail to reach a settlement, arbitration can be adopted, and an independent third party institution will decide whether to settle the claim, and both parties must implement the ruling.
3. litigation. The insured can bring legal proceedings against the insurance company through the court according to legal procedures, and the court will settle the dispute and make a ruling according to the procedures.
What if the insurance company doesn't pay the claim? 2 insurance companies do not claim the following solutions:
1, complain to the insurance company;
2. Complain to China Banking Regulatory Commission;
3. sue the insurance company in the local court and demand compensation.
Article 157 of the Insurance Law stipulates that the insurance supervision and management institution in the State Council shall establish a supervision and management information sharing mechanism with the People's Bank of China and other financial supervision and management institutions in the State Council.
When the insurance supervision and administration institution performs its duties according to law and conducts supervision, inspection and investigation, the relevant departments shall cooperate with it.
If the insurance company refuses to pay compensation, the insured needs to ensure that the insured's danger falls within the scope of compensation and meets the compensation conditions. In this case, the insured can directly call the customer service telephone number of the China Insurance Regulatory Commission 12378 to complain, or bring a lawsuit directly to the court, and then the insurance company needs to honestly bear the liability for compensation. If the insured has a mistake in understanding the insurance clauses and the accident does not fall within the scope of insurance company's claim, then it is reasonable not to claim.
First of all, it must be clear that all insurance companies are under the unified supervision of the China Insurance Regulatory Commission. How to complain about the effectiveness of insurance companies, the insured should pay attention to the following points:
1, please fill in your name, address and contact information carefully, so that the CIRC can further understand the relevant situation and reply to the handling opinions;
2. The complainant shall put forward the complaint objectively and truthfully, be responsible for the authenticity of the materials provided, and shall not fabricate or distort the facts, or falsely accuse or frame others.
3. Letters and visits shall include the facts and reasons of the respondent and the complaint, and the insurance supervision and administration institution shall not accept complaints of letters and visits without purpose.
4. In order to solve the petitions put forward by the appellant in time, please abide by the provisions of the Measures for Letters and Visits of China Insurance Regulatory Commission and submit them to the competent unit of letters and visits.
? In addition, when complaining about insurance companies, the CIRC will ignore the following points, please pay special attention:
(a) reflect the illegal behavior of the staff of an insurance company, an insurance asset management company or an insurance intermediary institution, but it does not involve insurance regulatory laws, administrative regulations and the provisions of the China Insurance Regulatory Commission;
(two) insurance contract disputes (including claims disputes), insurance disputes, marketing and after-sales service disputes and other civil disputes caused by insurance business practices;
(three) reflect the internal management issues such as labor contract disputes and agency contract disputes between insurance companies, insurance asset management companies, insurance intermediaries and their employees or sales personnel;
(4) Description of insurance products, and consultation on the operating conditions of insurance companies, insurance asset management companies and insurance intermediaries.