新保险法“十一”起实施30天内需完成理赔审核

新保险法“十一”起实施30天内需完成理赔审核
2009年10月02日 17:17 来源：火凤网

　　伴随着新《保险法》实施期限的逐渐临近，各家保险公司的产品调整和条款修改也进入最后攻坚时刻。昨日中意人寿又向本报记者发来声明，称公司因内部产品策略调整，将于本月25日暂停销售个人营销渠道产品“中意年年创意理财投资连结保险”。

　　记者从多家寿险公司了解到，各公司在对产品条款进行适应性修改的同时，也对营销人员展开了培训。记者在新《保险法》具体修订条款中发现，新法实施后将在多个方面提高投保人利益保障力度。

　　不再“雾里观花” 签字时即知道具体规定

　　目前消费者购买保险颇有“雾里看花”的味道，即使在签字投保那一刻也不知道所买保险产品的具体规定。记者此前接到不少市民投诉，反映保险公司销售规定太过“霸道”，一定要签订投保合同后才能看到详细的保险条款。有寿险公司工作人员曾对记者表示，这一规定确实有些不合理，但目前业内各家公司基本上都是这样操作。而在新《保险法》实施后，这一做法将不再适用。

　　根据新《保险法》规定，订立保险合同，采用保险人提供的格式条款的，保险人向投保人提供的投保单应当附格式条款，保险人应当向投保人说明合同的内容。也就是说，消费者在填写投保单的同时可以看到自己所投保产品的具体条款。

　　免责条款需向投保人做出明确说明

　　根据新《保险法》规定，对保险合同中免除保险人责任的条款，保险人在订立合同时应当在投保单、保险单或者其他保险凭证上做出足以引起投保人注意的提示，并对该条款的内容以书面或者口头形式向投保人做出明确说明。未作提示或者明确说明的，该条款不产生效力。

　　在此之前，中国保险行业协会为适应新《保险法》的要求，出台了《人身保险产品条款部分条目示范写法》，在该《示范写法》中，只有7种情形被列为寿险公司的责任免除事项，而以往被列为除外责任的“被保险人感染艾滋病病毒或患艾滋病”则被删除。

　　新规举例

　　◆对被保险人吸食或注射毒品增加了“主动”行为的范围认定。

　　◆对酒后驾驶、无合法有效驾驶证驾驶，或驾驶无有效行驶证的机动车等增加了具体的释义，以防止保险公司随意理解延伸。

　　理赔程序和时限被进一步细化和明确

　　记者从新《保险法》中看到，保险公司的理赔程序和时限被进一步细化和明确。首先，保险公司如果认为客户资料不齐全，要求客户补充有关证明和资料应当“及时一次性通知”。这就意味着保险公司不能以此为理由要求投保人多次往返递交索赔资料，延误理赔时间。

　　保险人理赔审核时间不应超过30日，除非合同另有约定。而在达成赔偿或给付保险金协议后10日内，保险公司要履行赔偿或给付保险金义务。此外，核定不属于保险责任的，应当自核定之日起3日内发出拒赔通知书并说明理由。

　　险企解除合同有限制

　　业内人士告诉记者，在新法实施后，保险公司行使合同解除权的门槛被抬高。根据新《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，足以影响保险人决定是否同意承保或者提高保险费率的，保险人有权解除合同。值得注意的是，在投保人因过失造成保险公司解除合同的情形中，其过失必须是“重大过失”，这在一定程度上保护了投保人因“过失”而非“重大过失”导致被拒赔的可能。但对于“重大过失”目前还缺乏具体的法律判决案例界定。

　　此外，对保险公司解除权的行使期限也有所限制。根据新法，保险公司在合同订立时，已经知道投保人存在解除情形，但仍然订立合同，不得解除合同。而在合同成立日起2年内，保险公司了解有解除事由，则必须在30天内决定是否解除合同。如果超过2年，保险公司即失去合同的解除权。
【作者：纪晨璐】（责任编辑：卢珊）
The new Insurance Act, "11" 30 days of domestic demand since the implementation of the completion of claims audit
At 17:17 on October 2, 2009 Source: The Phoenix Network

Along with the new "Insurance Law" was implemented deadline approaches, the insurers to adjust the terms and modify the products have entered the final moment of tackling. Italian Life Youxiang reporter yesterday sent a statement, saying the company due to the internal adjustment of product strategy, will be 25th of this month to suspend sales of individual product marketing channels, "Italian creativity in mid-fiscal-linked insurance."

Reporter learned from a number of life insurance companies, all companies in terms of product adaptation, while also marketing personnel have been trained. Journalists in the new "Insurance Law" specifically found that the revised terms, the new law will be implemented in a number of aspects of efforts to improve protection of the interests of policy holders.

No longer "fog concept of Flowers" signature that is aware of specific provisions

Currently consumers to buy insurance rather "smoke and mirrors" flavor, even in the moment of signing the insured does not know the specific provisions of insurance products to buy. Reporters had received a number of public complaints, reflecting the sale of the insurance companies too "high-handed", the insured must sign the contract to see the detailed insurance terms. There are life insurance company staff told reporters that this provision does have some reasonable, but so do companies essentially operate. In the new "Insurance Law" after the implementation of this approach will no longer apply.

According to the new "Insurance Law" stipulates that contracts for insurance, using the format provided by the insurance provisions, the insurance coverage provided to the insured shall be attached to form a single clause, the insurer shall explain to the insured the contents of the contract. In other words, consumers fill out a single insured at the same time we can see their own specific provisions of the insurance products.

Disclaimer required to make a clear statement of policy holders

According to the new "Insurance Law" stipulates that the insurance contract, the terms of exemption from liability insurance, the insurance contract should be in the insurance bills, insurance or other insurance on the certificate and make enough to cause the prompt attention of the insured, and the terms of the contents of the written or oral form to the insured to make a clear explanation. Have not been prompted or explicitly stated, the provision is not effective.

Prior to this, China's insurance industry associations to adapt to the new "Insurance Law" requirements, issued a "personal insurance products, parts of the articles written for the Model" in the "Model formulation", only seven kinds of cases are classified as life insurance companies the responsibility of exemption issue, and was previously listed as exclusion of "insured person infected with HIV or suffering from AIDS" have been deleted.

For example, new regulations

◆ on the insured person or smoking or injecting drug users increased by "active" range of behavior found.

◆ on drink driving, driving without valid driver's license, or driving without a valid driving license and motor vehicles increased by a specific interpretation in order to prevent insurance companies from arbitrarily extending understanding.

Claims procedures and time limits have been further refined and clear

Reporters from the new "Insurance Law" to see the insurance company's claims procedure and time limits have been further refined and clear. First of all, the insurance company, if that customer data is not complete, requiring customers to supplement the evidence and information should be "timely one-time notification." This means that insurance companies can not take this as reason to require policyholders to submit claims for multiple-entry data, the time delay claims.

Insurers Claims Processing time should not exceed 30 days, unless the contract agree otherwise. In reaching an agreement for compensation or insurance payment within 10 days after the insurance company to fulfill its obligation of indemnity or insurance payments. In addition, the approval does not belong to insurance liabilities, they shall be approved within 3 days from the date of a notice issued by exclusions and explain the reasons.

Cancel the contract there are restrictions on enterprise risk

Industry sources have told reporters after the implementation of the new law, the insurance company exercised its contractual right of cancellation of the threshold was elevated. According to the new "Insurance Law" stipulates that the insured intentionally or due to gross negligence failure to fulfill obligations to truthfully informed enough to affect the insurer decide whether they agree or raise insurance premium rates, insurers have the right to cancel the contract. It is noteworthy that the insured caused by negligence in the case of insurance companies cancel the contract, its negligence must be "gross negligence", which to some extent, protect the insured for "negligence" instead of "gross negligence" led to rejection lose possible. However, for "gross negligence" is still a lack of a specific case definition of legal judgments.

In addition, the exercise of right of cancellation of insurance companies there are restrictions on the period. Under the new law, the insurance company in the contract, I knew there policyholders to lift the case, it is still a contract, shall not terminate the contract. In the two years from the date of conclusion of the contract, the insurance company know about the subject to lift, you must decide whether to cancel the contract within 30 days. If more than 2 years, the insurance company loses the contract right of cancellation.
【Author: Ji Chen Lu】 (Editor: Shan Lu)