每经记者|涂颖浩 每经编辑|黄博文 重疾险本是应对大病的"救命钱""缓冲垫"，然而，买的时候流程简单，真要理赔时却被各种理由拒赔，对于这种情形，保险消费者最 为担心。 《每日经济新闻》记者注意到，北京市西城区人民法院近日发布的《涉重疾险纠纷审判白皮书（2021~2024）》显示，大多数重疾险拒 赔案件中，保险公司拒赔理由相似，主要集中在健康询问环节、理赔环节和免责条款效力认定等方面。值得关注的是，"投保人未履行 如实告知义务"是保险公司排位第一的主要抗辩理由。 每经媒资库图 对于"未告知既往症""等待期"这些保险术语，不少消费者感到困惑："自己并不了解它们代表的确切内容，如果因此被拒赔了该怎么 办？" 《每日经济新闻》记者注意到，在法院判决中，这些情况都能赔。 案例1：应赔付 概括性条款不能视为明确询问，投保人未作答不构成违反如实告知义务 重疾险理赔纠纷中，"如实告知义务"界定常成争议焦点。北京市西城区人民法院审理的一起重疾险案件明确裁判规则：保险公司以"身 体的其他感觉异常或活动障碍"等概括性条款主张投保人未履行如实告知义务的，法院不予支持。 2019年11月19日，秦某通过线上方式投保某保险公司重疾险。 ...

Core Viewpoint - The importance of "full disclosure" in insurance contracts is emphasized, as it is crucial for the validity of policies and the smooth processing of claims [1][2]. Group 1: Importance of Full Disclosure - "Full disclosure" is a fundamental legal obligation for policyholders, directly affecting the validity of the insurance policy and future claims [1]. - Insurance operates on the principle of utmost good faith, where insurers rely on the information provided by policyholders to assess risk and determine premiums [2]. - Failure to disclose relevant health information can lead to the cancellation of the contract and denial of claims, as stipulated by the Insurance Law of the People's Republic of China [2]. Group 2: Common Misconceptions - Misconception 1: "If the health check is normal, there is no need to disclose." This is incorrect, as health inquiries cover more than just the results of a health check [3]. - Misconception 2: "The agent said there is no need to disclose." Oral promises from agents are legally invalid; the policyholder is ultimately responsible [3]. - Misconception 3: "If two years pass, claims will definitely be paid." This is a misunderstanding of the "two-year incontestability clause," which requires good faith in the application process [3].

Group 1 - The core issue revolves around the rejection of a claim for the "Health·Foshan Insurance" policy purchased by a resident who did not meet the eligibility criteria, despite successfully obtaining a policy [1][2] - The insurance policy was marketed as having flexible eligibility requirements, stating that individuals only needed to meet one of seven conditions to enroll, with no restrictions on age, occupation, medical history, or residency [3][9] - The policy's promotional materials indicated that individuals could enroll without submitting any proof of eligibility, relying instead on a self-declaration process [9][12] Group 2 - The insurance company confirmed that the underwriting process did not require the submission of supporting documents, which raises questions about the adequacy of the verification process [12][14] - Legal experts noted that while the insurance company provided information about eligibility conditions, the lack of a thorough verification process at the time of enrollment could lead to disputes regarding the validity of the policy [13][14] - The "Health·Foshan Insurance" is a government-guided commercial health insurance product, with a significant number of policies issued and claims processed in recent years, indicating its popularity and the potential for similar issues to arise [12][14]