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患“原位癌”遭拒赔 太平洋保险未明示被判赔偿

2017-10-11 17:36:53   

中国消费者报哈尔滨讯(杨宝学 记者 刘传江)买保险就是防患于未然,然而消费者买了恶性肿瘤大病险,得了左乳癌却遭拒赔,原因竟是该疾病属于“原位癌”,并非恶性肿瘤,不在保险范围。日前,黑龙江省大兴安岭地区加格达奇区法院经审理判定,保险公司在订立保险合同时未尽如实告知义务,免责条款无效,应予以赔偿。

2016年6月2日,黑龙江省大兴安岭地区加格达奇区居民李先生为其母亲在中国太平洋人寿保险股份有限公司大兴安岭中心支公司(以下简称太平洋保险公司)购买了一份“银发安康恶性肿瘤疾病保险А款”大病保险,基本保险金额为5万元,每年需缴保费538元,10年缴清。

2016年12月,李先生的母亲在哈尔滨医科大学附属肿瘤医院被确诊患有左乳癌,进行了左乳切除手术。李先生向太平洋保险公司申请理赔时遭拒绝,理由是其母亲所患疾病是“原位癌”,不属于恶性肿瘤,不在保险条款责任范围内。

李先生不服太平洋保险公司的解释,认为癌症就应属于恶性肿瘤,投保时保险公司并没有告知“原位癌”不属于恶性肿瘤,不在保险范围内。

多次协商无果,李先生于今年5月将太平洋保险公司起诉至黑龙江省大兴安岭地区加格达奇区人民法院,请求法院判令保险公司给付赔偿金5万元。

庭审中,太平洋保险公司辩称,保险合同中已明确载明“原位癌”不属于恶性肿瘤,不在保险范围内,其已对保险合同条款尽到如实告知义务。

投保人李先生当庭出示的与太平洋保险公司保险业务员姜某的电话录音证明,姜某并未告知其“原位癌”不属于保险范围。姜某承认,她之前并不知道什么是“原位癌”以及“原位癌”不属于恶性肿瘤。

李先生代理律师李勇告诉记者,《保险法》明确规定,订立保险合同,采用保险人提供的格式条款的,保险人向投保人提供的投保单应当附格式条款,保险人应当向投保人说明合同的内容。对保险合同中免除保险人责任的条款,保险人在订立合同时应当在投保单、保险单或者其他保险凭证上作出足以引起投保人注意的提示,并对该条款的内容以书面或者口头形式向投保人作出明确说明。未作提示或者明确说明的,该条款不产生效力。

法院审理认为,双方签订的保险合同,符合法律规定合法有效,太平洋保险公司应按照诚实信用原则履行给付保险赔偿金的义务,在订立保险合同时,保险代理人未履行明确告知义务,故合同免责条款对投保人不产生法律效力,太平洋保险公司提出的拒赔理由不成立。

黑龙江省大兴安岭地区加格达奇区人民法院依据《合同法》《保险法》的规定判决,太平洋保险公司支公司给付保险赔偿款5万元。

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