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原标题:上海市民购买“新冠”保险却屡遭拒赔?保险公司:上海没这个说法...
来源:上观新闻
“有了隔离险,隔离不花钱”
“只要9.9元,1天能领200元”
“隔离一天,躺赚千元”
…
去年以来
随着疫情的反复
不少保险公司也纷纷“与时俱进”
推出了不同版本的疫情保险产品
“新冠住院有津贴”“确诊即赔”
这些广告语吸引了众多消费者
那么
它到底值不?
最近
上海消费者购买“新冠”保险被拒赔
理由竟是上海没有中高风险地区
5月24日新闻坊报道,今年3月8日,沈女士花59元买了一份众安爱无忧保险,这款保险以“新冠”为主打卖点,条款中明确指出,如果被保险人成为新冠患者的密接,或因处于中高风险地区,而被集中隔离或居家隔离的,就可以获得隔离津贴,200元一天,6000元封顶。
可之后,沈女士因为所住小区长时间封控,去申请隔离津贴时,保险公司却几次三番拒绝赔付,理由是“这段时间内,上海并没有中高风险地区”的说法。
据报道,沈女士前后理赔了三次,只有一次得到了赔偿。
据沈女士介绍,第一、第二次是在3月19到21号期间,她居住的小区因为出现阳性感染者被封控。三天封了两次,沈女士因此申请隔离津贴理赔,刚开始众安保险拒绝理赔的,理由是因为上海不是中高风险地区。
不过,此后沈女士据理力争,最终双方经过协商,保险公司同意按三天标准理赔600元。
3月23日——4月28日,沈女士居住的小区一直处于封控状态。沈女士据此第三次申请隔离补贴,要求保险公司再赔付隔离津贴5400元,总金额达到6000元最高标准,又一次遭到保险公司拒绝。
这次,保险公司拒赔的理由仍然是:上海不是中高风险地区,拒绝理赔。
众安保险客服人员表示:“保单内容写得很清楚,一定要是中高风险地区,而他也未对三区管理政策,对应中高风险地区有任何关联对等性,其实是两套标准,所以封控区不能代表您处于中高风险地区。”
至于为何第一、第二次理赔成功,而这次却拒赔呢?客服人员给出了这样的解释:
“我们给到的是协议理赔,当时也是考虑到沈女士确实有隔离情况,所以我们给到理赔,但是协议理赔结果,不作为本次理赔的依据。”
同样因为小区里有阳性感染者,都是居家隔离,就因为一个叫“封控区”,一个叫“中高风险地区”,保险公司就可以拒赔吗?那第一、第二次的隔离情况,和这一次又有何不同呢?
记者注意到,在这款保险的附加条款中,对保险责任还有这样一条约定,被保险人因暴露于特定传染病病原体污染的环境中被隔离的,可以获得相应隔离津贴。
对此,法律界人士表示,封控小区,是否属于这种情况需要主管部门进一步界定:
“因为我是觉得如果她的楼栋,是有阳性患者,整个楼栋被封控的,这个很明确是处于特定的病原体污染环境中的,但是如果放大到一个封控小区,能不能被解释为处于这种环境中,可能会有一点争议。”
“还是要看银保监会,能不能对普遍情况,发一个相应的文,对它进行解释。
目前
市民沈女士称
众安保险已经主动与她取得联系
答应与她协议赔付
本文综合自:新闻坊、看看新闻
相关作者: 吴浩亮
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