Travel insurance, why is it difficult to settle claims?

In recent years, with the emergence of tourism boom, some disputes caused by accidental injuries during the journey have also surfaced. Insurance disputes not only occur between tourists and insurance companies, but also travel agencies as third parties. Travel agencies handle accident insurance for tourists. What role does the travel agency play after tourists are in danger? How do tourists defend their rights? The behavior of part-time agents in travel agencies has gradually surfaced.

Case replay: Who moved my claim?

At the beginning of 2004, Mr. Li participated in a new Matai tour organized by a travel agency. The travel agency has insured the outbound travel insurance of an insurance company in this city for each tourist, and the insurance premium has been deducted from the tour fare. Mr. Li suffered an accidental injury on the mountain while traveling, which was identified as within the scope of insurance liability.

After returning home, Mr. Li went to the travel agency to collect money, which was rejected by the travel agency. The travel agency asked to sign an agreement with Mr. Li not to ask for compensation from the travel agency after accepting compensation from the insurance company, but Mr. Li refused. As the two sides failed to reach an agreement, the court ruled that the travel agency would compensate most of the medical expenses, and Mr. Li himself would bear a small part. Although the lawsuit is over, Mr. Li still wants to know where his claim money has gone.

Later, after many inquiries, Mr. Li learned about the insurance company that bears his own insurance and went to the insurance company, hoping to receive the compensation directly. However, Mr. Li's request was rejected. The handling personnel think that the travel agency is the insured, and all problems are only handled by insurance companies and travel agencies. It is suggested that Mr. Li negotiate with the travel agency and refuse to provide the insurance certificate, insurance contract and insurance clauses issued by the insurance company.

Mr. Li Can just came to the customer service center of the insurance company to make a written report and provide relevant agreement materials. The agreement was signed by the travel agency and Mr. Li, which stated that the travel expenses were 3,400 yuan (one person), including: Insurance premium, which proves that Mr. Li paid the insurance premium, but the insurance company bought a travel accident insurance through the travel agency, and the insurance company was only a part-time agent. Mr. Li strongly urged the insurance company to stop the infringement of the travel agency and let it receive the claims as soon as possible.

At the end of 2004, the customer service center of the insurance company wrote to Mr. Li, saying that he could collect insurance money at the counter of the insurance company. But when Mr. Li contacted the customer service center to get the insurance money, the insurance company said: the travel agency did not return the money to the insurance company, and the travel agency said that it had already given the money to Mr. Li. I didn't get the insurance money again, and Mr. Li was puzzled about it. Who put forward his request?

The hotline feeds back the compensation paid by the insurance company.

In response to Mr. Li's query, the insurance company explained itself: In February 2004, a travel agency came forward to insure our travel accident insurance for 36 tourists visiting Xinmatai. In March, the travel agency filed a claim with our company from the customer Mr. Li, and our company paid the claim according to the terms and conditions, and has transferred the claim to the travel agency account, asking the travel agency to transfer it to the insurance beneficiary.

Later, Mr. Li came to our company's customer service center, claiming that he could directly come to the insurance company to collect it because he had a lawsuit with the travel agency. The company replied that he could take the relevant documents to the counter to collect them. But when I contacted the travel agency later, the travel agency said that it had paid the customer. So our customer service center contacted Mr. Li immediately, but Mr. Li denied receiving the claim. At present, the company has asked the travel agency to provide the basis for customers to claim compensation, and will handle it as appropriate.

The focus of the dispute is whether tourists are insured.

The focus of the dispute in this case is actually whether the applicant of this travel accident insurance is Mr. Li, a tourist, or a travel agency, which will directly determine who has the right to receive this claim.

Experts believe that in this case, the travel agency, as an insurance company, insured travel accident insurance for passengers, and the travel agency is essentially an insurance agent. Article 126 of the Insurance Law stipulates that an insurance agent is a unit or individual who collects agency fees from the insurer according to the insurer's entrustment and handles insurance business on behalf of the insurer within the scope authorized by the insurer. ? Insurance agents include professional insurance agents, part-time insurance agents and individual insurance agents.

As a part-time insurance agent, the travel agency's insurance, claims and other behaviors belong to insurance agency behavior, and it is invalid to detain Mr. Li's claims beyond the agency authority. In addition, insurance companies should earnestly fulfill the provisions of insurance contracts and pay insurance benefits to beneficiaries who have the right to claim insurance benefits to avoid unnecessary disputes.

It can be said that in this case, the agreement with the travel agency presented by Mr. Li when he went to the customer service center of the insurance company is very important. This agreement directly proves that Mr. Li is both the insured and the insured, and the travel agency is only an insurance agency, that is, an insurance concurrent agent. Here, I also remind the vast number of policyholders that in order to effectively safeguard their legitimate rights and interests, they must obtain and read the insurance contract in time and keep it properly.

Editor's comments

Distinguish between travel agency liability insurance and travel accident insurance

There is another point in this case that deserves our attention. When Mr. Li came to the insurance company for the first time and wanted to receive compensation directly, he was rejected. The handling personnel think that the travel agency is the insured, and all problems are only handled by the insurance company and the travel agency. It is suggested that Mr. Li negotiate with the travel agency and refuse to provide the insurance certificate, insurance contract and insurance clauses issued by the insurance company. This statement is obviously wrong, probably? Travel agency liability insurance? And then what? Travel accident insurance? Confused.

? Travel agency liability insurance? And then what? Travel accident insurance? It's different. Mr. Li bought travel accident insurance through a travel agency. Mr. Li is both the insured, the beneficiary and the insured. Travel agencies only handle insurance formalities for tourists. As a part-time insurance agent, the insurance and claims settlement of travel agencies is only an insurance agency. It is certainly invalid to detain Mr. Li's claim.

What if Mr. Li bought it? Travel agency liability insurance? Things are different. According to the travel agency liability insurance regulations, Travel agency liability insurance? The insured is the travel agency itself, and the insured, the insured and the beneficiary are all travel agencies. Once a tourist suffers personal and property losses due to the responsibility of the travel agency, the insurance company will be liable for compensation.

Generally speaking, travel agencies must insure passengers? Travel agency liability insurance? , but? Travel accident insurance? Tourists buy it voluntarily, so it is very important to distinguish between the insured and the beneficiary of these two kinds of insurance.

Part-time insurance agents surfaced.

With the comprehensive deepening of the insurance industry, the term part-time insurance agent has attracted more and more attention. The travel agency in this case is a part-time agent, which is a kind of insurance agent. Insurance agents include professional insurance agents, part-time insurance agents and individual insurance agents.

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The Interim Measures for the Administration of Part-time Insurance Agents stipulates that part-time insurance agents refer to units entrusted by insurers to handle insurance business for insurers while engaging in self-operated business. The insurer shall bear the legal liabilities arising from the insurance agency business conducted by part-time insurance agents within the scope authorized by the insurer.

In order to further standardize the behavior of part-time insurance agents, maintain the order of the insurance market, and protect the interests of the insured, the China Insurance Regulatory Commission stipulates that part-time insurance agents must carry out insurance agency business within the scope authorized by the agency contract in strict accordance with the approved types of insurance, and shall not change the insurance clauses, raise or lower the insurance rates without authorization.

When dealing with part-time agents, we should pay attention to the insurance part-time agency contract, which should specify the agent type, agency authority, charging standard and payment method, premium transfer period and so on. A part-time insurance agent shall, in accordance with the provisions of the part-time insurance agency contract, settle the premium with the insurance company on time and hand over the relevant documents. The settlement time of the premium shall not exceed one month at the longest, and the agency fee shall not be deducted by the premium.

Tips for Friendship Link Travel Insurance

In the face of various situations of tourists, travel agencies also have their own views. They feel that many tourists are confused about the insurance clauses.

Because travel agencies now have travel agency liability insurance, tourists think that since they are insured, they don't have to buy another one. But in fact, the coverage of travel agency liability insurance is very small, and in most cases it still belongs to the category of personal travel accident insurance; There are still many tourists who have distrust of insurance companies, feel that the insurance clauses are too vague and the claim settlement procedures are complicated, and simply refuse to take out insurance.

In addition, many tourists are disgusted with insurance and think that accidents will not happen to them, thus limiting the sales of travel insurance. According to people in the insurance industry, there are usually three misunderstandings for ordinary tourists to buy travel insurance.

Myth 1: Simply relying on travel agencies, thinking that travel insurance sent by travel agencies includes accident insurance. But in fact, the travel agency buys compulsory travel agency liability insurance, which refers to the behavior that the domestic and foreign tourists it receives suffer economic losses because of the negligence or fault of the travel agency in tourism business activities, and the insurance company should bear the responsibility of the travel agency and be liable for compensation for the insurance money. When the accident has nothing to do with the travel agency, tourists can't get any protection from this kind of travel agency liability insurance.

Myth 2: General personal accident insurance includes all accidents, but in fact, general personal accident insurance does not include high-risk activities. If you want to engage in high-risk activities such as bungee jumping, rock climbing, mountaineering and skiing, it is very likely that you will not get compensation after the accident.

Myth 3: If you buy ordinary vehicle insurance, you don't need to buy other insurance. Now that go on road trip has become a fashion, even if you buy ordinary vehicle insurance, you should buy other insurance before you go out. Generally, the insurance on the car is third party liability insurance and vehicle loss insurance, but it can't guarantee the safety of passengers on the car. Therefore, before going out, we should fully consider possible accidents and take some insurance, such as passenger insurance on the car, as needed, so that drivers and passengers on the same car can get more effective protection.