I bought accident insurance from China Life Insurance Company and fell. How to settle claims?

1. Contact the agent who originally sold you accident insurance, and he will tell you the documents needed for the claim settlement procedure.

2. If you can't get in touch, call China Life Customer Service at 955 19, and then transfer to manual service to report the loss and claim compensation.

Don't lose all the documents issued by the hospital. Accident insurance is a reimbursement system, and claims cannot be settled without documents.

Accident insurance:

1. Unexpected medical treatment: reimbursement of expenses incurred due to unexpected outpatient service or hospitalization;

2. Accidental injury: compensation can only be made if the accident leads to disability or death. First of all, see if you have bought accident medical care. If yes, submit a copy of my ID card, outpatient medical record or discharge summary, original invoice, expense list (hospitalization only), accident certificate (issued by traffic police, other minor work units or neighborhood committees), and passbook or card for opening an account in my name. Do it.

Case study:

On June 6th, 20001year, a city public security bureau insured its employees with "Group personal accident insurance". According to the policy, the main insurance amount for each employee of the insured unit is 200,000 yuan, and the additional accidental medical insurance amount is 6,543,800 yuan.

On February 23, 2002, the insured Xie Mou suffered a severe head injury in a hotel due to an unexpected situation. On February 24, he was taken to the hospital for emergency treatment, and died of his injuries on March 22. Since then, Xie's mother, as the beneficiary, has applied to the insurance company for compensation of 200,000 yuan for accidental death.

After investigation, the claim adjuster of the insurance company found that the column of current medical history of the insured recorded that "the patient fell on his head after drinking about 10 hours ago", and the confession was more reliable. In addition, in the hospital discharge summary, it was once again recorded that "the patient died of severe brain injury due to falling after drinking". Because the insured fell down after drinking, which belongs to the scope of liability exemption in the policy, the insurance company refused to pay. The beneficiary refused to accept this and appealed to the court.

In the practice of life insurance claims, in many cases, the medical records of medical institutions are the only basis for claims. However, due to the particularity of medical records, especially the identification of the probative force and evidence effect of the chief complaint, current medical history and past history in medical records, there is a great controversy in actual handling and insurance dispute litigation. Here, the author tries to express his personal views from the perspective of evidence rules through a typical insurance dispute litigation case.

Opinions of both parties

The plaintiff (beneficiary) has no objection to this clause, but thinks that the expression of the current medical history in the medical history is not what Xie himself said, but is fabricated by others and cannot be used as evidence.

The defendant (insurance company) believes that although the description of the insured's fall after drinking in the medical history comes from others, the situation at that time was that the insured was unconscious when he was taken to the hospital, and it was obviously unrealistic to ask him to dictate his illness to the doctor when he was admitted to the hospital, and the doctor specially noted in the medical history record that the medical history was reliable; On the other hand, all the records of the hospital show that it was a trauma caused by a drunken fall, so the defendant thinks that although the records of the hospital are relayed, according to the above situation, it can be judged that the records of the hospital are true and objective and can reflect the real situation at that time, so the evidence has probative force, and the insured's situation belongs to the scope of liability exemption in the policy.