Study On The Problem Of Clearly Stating The Obligation Of Critical Illness Insurance Insurers

Commercial health insurance includes medical expense insurance,critical illness insurance,income loss insurance and long-term care insurance.Among them,serious disease insurance has attracted much attention.Serious disease is characterized by catastrophic,complex and high cost.Serious illness insurance transfers the risk to the insured who suffer from life-threatening serious illness and reduces their economic pressure to face high treatment costs.However,due to the legal system is still relatively imperfect,as well as in the judicial application of confusion,resulting in frequent disputes in the academic and judicial practice.In this article,through empirical study,the method of access to a number of related cases,found that heavy disease risk in the field of dispute focuses on the specified duty problem,typical case analysis,and then find a heavy disease risks specified duty system problems,namely the specified range is not clear for the implementation of the compulsory system,performance of the standard is not unified,unclear legal consequences,the performance of the subject is not standard.Analyze and solve the four problems in the system one by one.First of all,for the serious disease insurance with the most disputes,the scope of obligation performance is not clear,that is,it is difficult to determine the exemption of insurer liability clause,the introduction of reasonable expectation principle to determine the exemption clause.Reasonable expectation principle itself has introduced the necessity and legitimacy,which is the subjective socialist legal interpretation methods to perfect the legal interpretation system,the principle of legitimate expectation and specified duty system at the same time,due to the same standard and legislation purpose,and apply the logic of the relationship of cohesion,which has a natural fit.Therefore,introducing the exemption clause of reasonable expectation principle as a clear path is the only choice to solve the difficulty and confusion of identification.Second,it is necessary to comprehensively consider both substantive and formal standards,solve the problem of double standards dislocation in judicial practice,and unify the standards for clarifying the performance of obligations for serious disease insurance.Sort out the standard procedure of performing obligations: provide and prompt obligations as the premise of explaining obligations.Prompt includes oral prompt and written prompt.Orally,the applicant shall pay attention to the disclaimer clause,and the written notice shall be marked according to the legal requirements.The performance of the obligation of explicit description shall be mainly in written form and supplemented by oral form.Take the initiative to explain the main,supplementary questions and answers,at the same time set clear declaration requirements signature.Third,clear breach of serious disease insurance clear description obligation of legal consequences.The "invalidity" of the legal consequence of not fulfilling the obligation of explicit explanation of the exemption clause is correctly understood as the negation of the effect of the exemption or limitation of the liability of the insurer,rather than as the invalidity of the clause or not entering into the contract.Finally,the insurance company,the insurance agency company and the insurance broker company are the main body to fulfill the obligation of the serious disease insurance.Strengthen the construction of the talent team of the insurance industry and improve the industry mechanism,so as to enhance the professional quality of insurance agents and brokers,and provide a healthy industry ecology for the clear explanation of the obligation system.Through empirical research and literature analysis method,this paper focuses on the most controversial clarifying obligation system in the field of serious disease insurance,and selects typical cases to analyze and explore institutional problems.At the same time,it studies the views of academic circles on relevant institutional issues and explores the path to improve the system.