种牙选贵遭拒赔？法院：低价≠合理

Core Viewpoint - The court ruling emphasizes that the determination of reasonable medical expenses should consider the victim's specific injuries, actual needs, treatment necessity, and professional medical opinions, rather than solely focusing on cost comparisons [2][3]. Group 1: Court Ruling and Reasoning - The court ruled that the insurance company must fully compensate the victim for the medical expenses amounting to 13,000 yuan, as the chosen dental implant treatment was deemed reasonable given the victim's age and the nature of the injury [3]. - The court highlighted that the insurance company's argument regarding the cost exceeding basic medical insurance standards was insufficient, as they failed to provide evidence supporting their claim [2][3]. Group 2: Implications for Insurance Industry - The case challenges the traditional cost-control approach in insurance claims, suggesting that the definition of "reasonable expenses" should include personalized factors such as the victim's age, profession, and life needs, moving towards a higher standard of "healing well and living well" [4]. - Insurance companies are urged to strengthen their evidence requirements for denying claims, as they cannot rely solely on internal standards or market minimums to determine the reasonableness of expenses [4]. - The ruling calls for improved communication in product design and sales, emphasizing the need for clearer explanations of compensation ranges and standards, particularly for treatments outside the basic medical insurance catalog [4].