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說到購買保險,相信很多人第一時間都會想起人壽保險。這一節「長者法網智多聲」,就為大家說說人壽保險保甚麼,購買時有甚麼要注意。

人壽保險是保險公司與投保人訂立的合約,一旦投保人過身,保險公司就會根據仍然生效的保單,向指定的受益人支付特定金額。人壽保險亦可以附加其他保障項目,例如危疾或傷殘保險,亦可以有儲蓄成份。投保人需要定期付保費,好像是每個月、每季或每年支付。

香港有很多種類的人壽保險,例如定期壽險、終身壽險、儲蓄壽險、投資相連計劃、傷殘保障計劃和危疾保險等等。

與醫療保險一樣,人壽保險的保單,都會列明特定的不保事項,所以投保人一定要留意保單的條款和細則,了解一下有甚麼是不保的,亦要留意賠償限額。不保事項一些常見例子,包括重大失實陳述、自殺、欠交保費、參與危險活動等等。

如果想知道各種壽險的特點,以及還有甚麼常見的不保事項,可以到長者社區法網文字版參考,想再詳細了解,就要看清楚人壽保險公司提供的壽險內容了。

購買人壽保險之前,有很多東西要考慮的,好像是要衡量個人財政需要、目前是否有購買其他保險、保單合約期的長度、您可以負擔多少保費、以及保單有多少賠償、賠償種類等,還要看看如果退保或提早取回保費是否要罰款。如果經紀遊說您「轉保」,有甚麼潛在風險呢?

即使買了壽險,還有機會改變主意的,因為客戶會有冷靜期,可以在指定時限內,撤銷保單和取回保費。我們在長者社區法網文字版,列出一些購買壽險要注意的事,供大家參考。

無論購買甚麼保險,保險合約是建基於信任,投保人有責任向保險公司披露所有實情和交代所有資料,讓保險公司可以準確地評估風險,保險公司亦相信保單持有人會這樣做,這叫「至誠原則」。如果資料不齊全或有錯,又或是保單持有人沒有遵守保單條款,保單就可能無效了。

保險公司核保期間,如果懷疑投保人違反至誠原則,就有可能惹起爭議。這個情況下,投保人可以翻查保單是否包含「不可爭議條款」,即列明如漏報事實不涉及欺詐,只要投保人還在生,保險公司便不能在保單生效一段指定時間之後,例如保單生效兩年之後,才表示拒絕承保。不可爭議條款可以保障消費者,以免保險公司以受保人違反至誠原則為理由,逃避賠償責任。

除了人壽保險,醫療保險也是很常見的保險,我們在長者社區法網也有介紹,有興趣的老友記,可以到我們網頁了解。多謝大家收聽。

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Non-disclosure

Life insurance

As mentioned in the previous section, insurance contracts are based on trust. The nature of the subject matter of insurance and the circumstances pertaining to it are facts within the knowledge of the policyholders. Insurers, on the other hand, are not aware of these facts unless the policyholders tell them.  Therefore, policyholders must tell the whole truth.

Non-disclosure arises when an applicant for an insurance policy fails to disclose on the application form material facts within his/her actual or presumed knowledge. Clearly, the information given by an applicant in the application form can have a great impact on the insurer’s underwriting assessment. From the information given in the application form, the insurer can identify high-risk features and decide whether or not to take on the risk, and at what premium and terms.

It is important to note that the majority of non-disclosure disputes are related to the medical history of the policyholders. Non-disclosure can result in policy repudiation and claim rejection.

Although the majority of non-disclosure disputes arise from the policyholders’ failure to disclose their complete medical history, material information is restricted not only to medical records. Other information, such as history of past claims, average length of stay outside Hong Kong, smoking and drinking habits, previous traffic offences or occupations, may also affect an insurer’s decision in fixing the premium or determining whether or not to underwrite the risk.

If the non-disclosed information is material enough to have affected the underwriting decision of an insurer, it may be legitimate for the insurer to decline a claim even though the non-disclosed information is not related to the current illness because the non-disclosure would have prejudiced the insurer from making a fair and accurate underwriting assessment. This could provide justification for the insurer to repudiate the contract from inception.

You should not rely solely on your insurance agent in deciding whether or not a piece of information is material. In order to avoid unnecessary claims disputes, you should disclose all information and all material facts fully and accurately when filling in the application form.  If in doubt as to whether a fact is material, it is better to disclose it.