For commercial insurance companies, accidental injuries generally need to meet four conditions, namely external, sudden, unintentional, and non-disease. Although sudden death meets the characteristics of sudden, sudden death Generally, it is because the physical reasons do not meet the characteristics of non-disease, so general accident insurance does not cover sudden death. At the same time, he revealed that although accident insurance does not cover sudden death, some critical illness insurance or some insurance products that cover diseases do.

In this regard, it is first necessary to determine whether the sudden death was an accident. If it was an accident, the insurance company's accident insurance should pay a claim. If it was not an accidental injury, then it should not pay a claim. He believes that in fact, the regulatory authorities only need to ask the relevant judicial agencies (or relevant government departments) to make an authoritative identification of sudden death, whether it is an accident, or whether it is an authoritative medical certification of sudden death, and under what circumstances it occurs. Sudden death is an accident, and under what circumstances is a sudden death not an accident? This way you can determine whether the insurance company should pay for the accident insurance.

Since people in the insurance industry believe that accident insurance should not cover "sudden death", is this clearly stated in the insurance contract? In order to find out whether insurance companies explicitly cover or deny coverage for "sudden death" in accident insurance, reporters conducted random checks on the accident insurance products of China Life, PICC Property & Casualty, Ping An of China and China Pacific Insurance.

Chapter A of China Life’s Tongtai Traffic Accident Insurance does not clearly state whether sudden death is an insurance liability or an excluded liability. At the same time, China Life’s additional Anxin accident insurance clauses also do not clearly state Indicate whether sudden death is an insurance liability or an exclusion. However, the customer service staff of China Life said that the sudden death was caused by illness and had nothing to do with the accident, so no compensation would be paid. Similarly, the terms of personal accident insurance for credit card holders of CPIC Property & Casualty Insurance Co., Ltd. do not specify whether “sudden death” claims will be covered. Taibao Life Insurance’s Taiping Ruyi Accident Insurance 2006 also does not specify whether sudden death is an insurance liability or an exclusion.

For accidental injuries, China Life (601628, SH) explains this in its insurance contract: Accidental injuries refer to direct injuries suffered from external, sudden, unintentional, non-disease objective events. causing physical harm.

However, in the Shunxin Insurance Clause A of the e-urban white-collar personal accident insurance of PICC Property & Casualty Insurance Company (02328, HK), the terms clearly include sudden death as an exclusion. The terms are based on the personal insurance policy of PICC Property & Casualty Insurance Company. According to the 2009 version of the accident insurance clauses, the exclusions of the insurance clauses state: "Illnesses, including but not limited to altitude sickness, heat stroke and sudden death." The company explains sudden death as follows: "Sudden death is the sudden and unexpected death of an apparently healthy person due to underlying disease or dysfunction." "Daily Economic News" reporters found that "sudden death" is also listed as an exclusion in the one-year comprehensive accident insurance adaptation clauses of Ping An of China (601318, SH).

The Insurance Regulatory Bureau clearly requires insurance companies to make it clear in the contract, which is of great benefit to avoid similar disputes. In the future, it does not rule out the possibility that some companies will include "sudden death" in insurance liability. If it is clear that no compensation will be paid Agents should also take the initiative to remind customers of "sudden death" during the sales process.