Entry-exit management of cyclists with sudden heart attack

Recently, I saw a post on the Internet that someone's uncle died of a sudden cerebral hemorrhage, and the family regretted why they didn't even buy an accident insurance.

But they don't know that even if they buy accident insurance, they can't get compensation for sudden cerebral hemorrhage. This also reflects a very common problem: the "accident" we understand is different from the "accident" covered by accident insurance.

What is an accident?

In our daily cognition, accident refers to unexpected and unexpected things.

However, in insurance, "accident" has a strict definition: an accident refers to an external, sudden, unintentional, non-disease objective event that causes harm to the body.

This may seem a bit verbose, but every element in it is very important:

External: refers to accidents caused by reasons other than the insured's body, such as car accidents, food poisoning, cat and dog bites, etc.

Suddenness: refers to the short time of the accident, such as drowning, electric shock, falling, etc. But occupational diseases are long-term and gradually formed, not accidental;

Unintentional: refers to accidents or irresistible accidents, such as accidents;

Non-diseases: sudden death, sudden cerebral hemorrhage, etc. Although it is sudden, it belongs to the insured's own physical problems;

Physical injury: that is, it must be a body part injury, and the prosthesis is not in the category.

If it does not meet any of the above points, it is not an "accident", and it is impossible to meet the claim requirements by buying accident insurance.

Several cases of accident insurance not paying compensation

die a sudden death

Case: Mr. A is a technician, who often works overtime until the early hours of the morning and goes back to the company to deal with problems on weekends to prevent emergencies. Due to overwork, I suddenly fainted while working overtime and stopped breathing on the way to the hospital. The doctor diagnosed it as "sudden death" His wife filed an accident insurance claim with the insurance company. The insurance company believes that sudden death is not an accident and refuses to settle the claim.

Interpretation: The definition of sudden death given by the World Health Organization is that a patient who is usually healthy or seemingly healthy suddenly dies of natural diseases in an unexpected short time.

As can be seen from the above definition, sudden death is actually related to its own disease, which does not meet the requirements of "non-disease" in accidents, so sudden death is not an accident.

PS: Due to the increasing number of sudden deaths, some accident insurances have added extra protection for sudden deaths. If Mr. A's accident insurance contains such protection responsibility, it can be paid.

Died of heatstroke

Case: On a hot summer day, Mr. B suddenly fainted from heatstroke when riding home at noon, and died after being rescued. Mr. B's daughter once bought accident insurance for her father and applied for compensation from the insurance company. The insurance company refused to pay compensation on the grounds that heatstroke was not an accident.

Interpretation: Heatstroke is an acute disease, which is closely related to people's physique and does not meet the requirements of accident insurance for "non-disease", so it is not an accident. A statement will also be given in the exemption clause of accident insurance.

altitude stress

Case: Aunt Zhang's family traveled to Tibet. During the trip, Aunt Zhang suddenly experienced altitude sickness, and later died because of ineffective treatment. Uncle Zhang applied to the insurance company for accident insurance claims, and the insurance company refused to pay compensation on the grounds that altitude sickness was not an accident.

Interpretation: On the one hand, altitude sickness is related to one's own physical factors, on the other hand, altitude sickness is predictable and does not meet the requirements of "sudden" in accidents, so altitude sickness is not an accident.

High-risk sports death

Case: Xiao Wang and his friends agreed to go rock climbing, but the safety measures were not in place. Xiao Wang unfortunately fell and died, and his parents' application for compensation from the insurance company was rejected, because the accident insurance indicated that accidents caused by high-risk sports were exempt from liability.

Interpretation: Many accident insurances are aimed at high-risk sports except. For example, an accident insurance is limited as follows:

If the insured is engaged in diving, skydiving, rock climbing, gliding or paragliding, adventure, wrestling, martial arts competitions, stunt performances, horse racing, car racing and other high-risk sports. If losses are caused to the insured, the insurer shall not be liable for the payment of insurance benefits.

If you have plans for high-risk sports, you must choose accident insurance for these projects.

commit suicide

Case: Xiao Li suffered from depression, had many self-mutilation behaviors, and finally committed suicide at home. Xiao Li's parents bought accident insurance for her, and then claimed compensation from the insurance company, and the result was rejected.

Interpretation: Suicide is the intentional behavior of the insured, which does not meet the requirements of accidents.

In accident insurance, suicide basically has exemption clauses:

The insured causes self-mutilation or suicide, unless the insured is a person without civil capacity at the time of suicide;

According to the General Principles of the Civil Law of People's Republic of China (PRC) and the national laws, a person without capacity for civil conduct refers to a minor under the age of 8 and a mentally ill adult who can't recognize his own behavior.

Except for people without civil capacity, other people's suicides are not compensated in accident insurance.

But suicide can be paid in life insurance, but it must be two years after the contract takes effect.

Fall due to illness

Case: When Mr. Li went downstairs, he had a heart attack and fell down the stairs. He was taken to the hospital for emergency treatment. Mr. Li Lao's daughter once bought him accident insurance and went to the insurance company to claim compensation. As a result, she was rejected because the doctor diagnosed that she died of a heart attack.

Interpretation: Although Mr. Li Lao did fall down the stairs, the cause came from a sudden heart attack, and the direct cause of death was also a heart attack, so this was a death caused by illness, and the accident insurance did not compensate.

Pregnancy/miscarriage/childbirth

Case: Ms. Zhao was pregnant for 3 months and bought herself an accident insurance for unexpected medical treatment. Unfortunately, she once tripped over a raised floor tile when she went out, and the mother and son were safe after being hospitalized. After leaving the hospital, Zhao Nvshi applied to the insurance company for reimbursement of medical expenses, but the result was rejected.

Interpretation: The insured's risk of pregnancy is higher than that of ordinary people, so many accident insurances include exemption clauses for pregnancy, abortion, childbirth and abortion.

How to do enough protection?

Here are some examples of accident insurance. I hope everyone can understand that the accident we understand is not exactly the same as the accident in insurance.

In fact, there are other situations where accident insurance is not guaranteed, so I won't list them here.

For consumers, it is necessary to understand insurance, read the terms clearly, and know which products they buy can be insured and which can't. The key point is the exemption clause.

Secondly, directional supplements, such as high-risk sports such as rock climbing, diving and skydiving, are not covered by general accident insurance. If you plan to participate in these activities, you can add a special outdoor sports insurance.

Of course, accident insurance is actually a supplement. Many situations that are not covered by accident insurance, such as sudden death, heatstroke, altitude sickness, high-risk exercise and suicide two years later, can be covered by term life insurance.

Therefore, for the pillar of the family, term life insurance should be the mainstay, and accident insurance can be used as a supplement.