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2002年11月24日,李先生为本人投保太平人寿保险公司“太平无忧长期健康保险”10万元,“太平真爱附加健康保险”计划2,该合同核保通过后于2002年11月25日生效。 2003年1月15日,李先生因“十二指肠溃疡、消化道出血”在空军总医院住院治疗,经治疗好转出院。此次共计发生医疗费用4798.2元,出院后李先生向保险公司提出索赔申请。公司经审核,对承保后不足2月便因“溃疡性结肠炎”住院提出疑义,对该案件提起调查。通过调查发现,李先生在投保前有慢性腹泻病史10余年,严重时每日多达15余次,曾在2001年10月因“慢性结肠炎”在二炮总医院住院治疗,并行“肠息肉”切除手术。而鼻塞、流清涕等鼻中隔偏曲症状存在5年余。经过复核投保资料,公司认定李先生未就“溃疡性结肠炎”在投保书中如实告知,而“鼻中隔偏曲”系既往症,属于条款的除外责任,因而对该案件作拒付处理,并就主险提请总公司作二次核保。
On November 24, 2002, Mr. Li himself insured 100,000 yuan of “Taiping worry-free long-term health insurance” and “Taipingzhen love additional health insurance” plan of Taiping Life Insurance Company 2. After the agreement was approved by the Ministry of Health and Insurance on November 25, 2002 Day effective. January 15, 2003, Lee because of “duodenal ulcer, gastrointestinal bleeding” hospitalized in the Air Force General Hospital, after treatment was discharged. The total cost of medical expenses 4798.2 yuan, after discharge, Mr. Lee filed a claim to the insurance company. The company audited less than 2 months after underwriting due to “ulcerative colitis” hospital doubt, the investigation of the case. Through the survey found that Mr. Lee had a history of chronic diarrhea before the insured for more than 10 years, up to 15 times a day in severe cases, in October 2001 for “chronic colitis” in the Second Artillery General Hospital hospital, parallel “intestinal polyps ”Surgery. The nasal congestion, runny nose and other nasal septum deviation exists for more than 5 years. After checking the insured materials, the company found that Mr. Lee did not “ulcerative colitis” in the insurance book truthfully informed, and “nasal septum deviation” is a pre-extinction, is the exception of the terms of the responsibility, so the case for protest, and The main insurance company to make a second request for underwriting.