Insurers Have Authority to Reject Application Before Policy Issued: FSC 防疫險拒重複保? 金管會:核保階段有權拒保

Insurance companies are tightening regulations for claiming disease prevention compensation, which has led to numerous disputes and complaints.


Kuo Kuo-wen, Legislator (DPP): “The Financial Supervisory Commission's explanation makes you think they're throwing the game.”

Claims for disease prevention insurance compensation have surged since the epidemic began wreaking havoc across Taiwan, along with the controversies surrounding double, or even multiple insurances. The Financial Supervisory Commission's Insurance Bureau said insurance companies have the authority to reject an application before the policy is issued.

Chen Ching-yuan, Director, Non-Life Insurance Supervision Div., IB: “We respect the choice of companies to issue two insurance policies based on their overall risk appetite.”

Fubon Insurance was the first to stipulate that it would not pay out to people with multiple policies, and many insurance companies have followed suit. Cathay Century Insurance's website has an explanation on how claims are processed. It said it has made conditions stricter as the number of policy applications has exceeded its risk appetite capacity, and the limit is one policy. However, there are cases when companies have refused to insure people who have already paid premiums and are only waiting for a guarantee slip and have refunded them.

Chen Ching-yuan, Director, Non-Life Insurance Supervision Div., IB: “If there are individual disputes, then we will ask the policyholder to file a complaint or mediate. There will be so-called emergency relief in the follow-up.”

Legislators have received complaints from parents who had to stay home with their quarantining children after their classmates tested positive. The FSC believes these parents are "voluntarily quarantining" and are not eligible to apply for claims. The Centers for Disease Control says home quarantine notices are administrative sanctions and not quarantine certificates.

Lin Chiung-fang, Section Director, Acute Infectious Diseases Div., CDC: “Those who need to be administratively sanctioned are given a written certificate. In principle, it's the result of disease prevention investigations or risk assessments.”

Chen Ching-yuan, Director, Non-Life Insurance Supervision Div., IB: “If policies are opened (legally), then insurance companies will of course have to settle claims based on contracts.”

The FSC says it has met with insurance companies to make sure they know what documents are needed to process disease prevention insurance claims and that there is consistency. The Non-Life Insurance Association is expected to publish an explanation soon.

 

 

民進黨立委郭國文說:「金管會這樣的解釋,老實講,有放水的嫌疑啦!」

防疫險理賠爭議不斷,針對重複保險拒保,金管會保險局表示,若在核保階段,保險公司有權利這麼做。

金管會保險局產險監理組組長陳清源指出:「同一家公司已經保了兩張了,它基於整個風險胃納等等,這部分我們是尊重公司的一個做法。」

富邦產險基於損害填補原則,開出複保險拒保第一槍後,陸續多家產險公司跟進。打開國泰產險官網,就會跳出防疫險核保作業說明,強調因投保案件暴增,已超過風險胃納量,承保條件更嚴苛,以一件為限。不過出現爭議的是,保戶已扣款,只差一紙保單,也遭退費拒保。

保險局產險監理組組長陳清源解釋:「如果有個案爭議的部分,這個部分我們會請保戶來做申訴或做調解,後續都有一些所謂的救濟的行為。」

另外有不少民眾向立委投訴,因小孩同班同學確診,需陪同隔離,但金管會認為,家長自願隔離不予理賠,民眾認為不合理。但疾管署說明,居家隔離通知書屬於行政處分,非隔離證明。

衛福部疾管署急性傳染病組科長林瓊芳指出:「需要給予一些行政上處分的人,開立的一個書面證明,原則上都是經過疫調,或者是風險評估的結果。」

保險局產險監理組組長陳清源表示:「有(依法)開立這個部分,保險公司當然就要依約去做理賠。」

金管會表示,近期已和各家產險業者開會,針對防疫險理賠需準備哪些文件,並訂出一致性,產險公會近期就會公告說明。 
 

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