新华保险赔付件数501万件，日均赔付1.4万件；赔付金额147亿元，日均赔付4029万元；全部案件申请 至结案平均时效0.77天。 中小险企势头同样强劲，理赔服务能力稳步攀升。2025年，中邮保险服务客户数超249万次，同比增长 超370%；赔付金额32亿元，同比增长超90%；理赔线上化率超99%，理赔服务时效1.1天。 理赔，是消费者选购保险产品时最关心的问题之一，也是保险保障功能和服务温度的核心体现。 据《国际金融报》记者不完全统计，截至目前，中国人寿、平安人寿、新华保险、泰康人寿、中宏保 险、中邮保险、招商信诺人寿、农银人寿等多家险企已陆续披露2025年度理赔报告。 总体来看，各家险企的理赔件数与理赔金额均呈上升趋势；获赔率持续保持高位水平，普遍稳定在99% 以上；医疗险依然是赔付件数最多的险种，重疾险赔付金额虽然稳居首位，但保障仍存在较大缺口。 理赔时效提速至秒级 根据国家金融监督管理总局披露的数据，2025年前11个月，保险业原保险保费收入5.76万亿元，同比增 长7.56%；赔付支出2.21万亿元，同比增长5.95%。 从各家险企的表现来看，2025年，寿险"头雁"中国人寿理赔总件数超过6224万 ...

Core Viewpoint - The article highlights the challenges faced by critical illness insurance, particularly regarding the complexity of contracts and difficulties in claims processing, which have led to a trust crisis in the industry [2][3]. Group 1: Issues in Critical Illness Insurance - Critical illness insurance is intended to protect families from financial risks associated with serious illnesses, but it often features complicated contracts that hinder claims [2]. - Many insurance policies appear to cover a wide range of diseases, yet the actual claims process is fraught with obstacles, leading to a perception of claims being akin to a "blind box" [2]. - The definition of critical illnesses in insurance contracts often includes restrictive conditions, resulting in frequent disputes over claims as many illnesses understood by the public are not recognized by insurers [2][3]. Group 2: Industry Response and Recommendations - The article suggests that the "single-win" mentality of some insurance companies, which focuses on profit maximization by limiting payouts, is unsustainable [3]. - To resolve these issues, the industry should adopt a "win-win" approach, prioritizing the interests of policyholders to ensure the sustainable development of critical illness insurance [3]. - Recommendations include updating disease definitions in line with medical advancements, streamlining claims processes, and shifting from restrictive practices to proactive service [3][4]. Group 3: Role of Innovation and Regulation - Insurance companies can reduce claims costs by innovating service models, such as incorporating health management services like regular check-ups and chronic disease interventions [4]. - The involvement of regulatory bodies is crucial to clarify the medical rationale behind critical illness definitions and to regulate ambiguous contract terms to prevent misleading practices [4]. - Enhancing consumer awareness and encouraging policyholders to thoroughly review contract terms and assert their rights in case of unreasonable claim denials is also essential [4].