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Every month, we regularly update claim case studies to document real-life incidents, convey the goodwill of insurance, and share practical insurance insights and tips. Today, we’d like to share a claim case study involving a “car accident,” where two insurance policies combined paid out 280,000. Below is the claim summary: Now, let’s dive into the detailed claim process. 1. 72-Hour Coma After Car Accident: Two Policies Paid 280,000 in Total In June 2022, with the assistance of a Shenlanbao planner, Ms. Z purchased a Super Mary 6 critical illness insurance policy from Hetai Life for her husband, Mr. L, with a basic coverage of 300,000. At the same time, she also purchased a Dahu Jia 3 adult accident insurance policy from PICC for Mr. L, which included 1 million in accidental death/disability coverage and 100,000 in accidental medical coverage. Unexpectedly, in August of the same year, Mr. L was involved in a car accident, fell into a coma, and was admitted to the ICU. The traffic police had determined that Mr. L was partially responsible for the accident, and his wife, Ms. Z, was engaged in a lawsuit with the auto insurance provider. Upon learning about the situation, the Shenlanbao planner actively monitored the progress of the case. As soon as the lawsuit concluded this year, they immediately assisted Ms. Z in filing a claim for the Dahu Jia 3 adult accident insurance policy under Mr. L’s name. Additionally, while reviewing the medical records, the Shenlanbao planner noticed that Mr. L’s condition might qualify for the intermediate illness benefit under the critical illness insurance and proactively offered to assist with the Super Mary 6 claim. With the help of Shenlanbao’s planners and claims experts, Ms. Z prepared all necessary medical records and formally filed claims with both insurance companies. In June of this year, both claims were approved. The Dahu Jia 3 accident insurance reimbursed 100,000 in medical expenses, while the Super Mary 6 critical illness insurance paid out a lump sum of 180,000 for the intermediate illness benefit, waived future premiums, and kept the critical illness coverage intact. As a reminder, if any of our clients unfortunately experience an insured event, there’s no need to panic. Our professional claims team provides end-to-end assistance throughout the claims process. In the event of a claim, contact us immediately. Our claims specialists will guide you through any challenges to ensure a smooth settlement.Click the card below to schedule an appointment with our professional planners for customized insurance solutions.
For claim assistance, follow the “Shenlanbao Professional Insurance Broker” WeChat official account and proceed with the following steps. 2. What lessons can we learn from this claim case? We have repeatedly emphasized that adults need four essential types of insurance: million-yuan medical insurance, accident insurance, critical illness insurance, and term life insurance. However, many still ask: Why buy accident insurance if you already have million-yuan medical insurance? Why buy critical illness insurance if you have accident insurance? And so on. In reality, each insurance type serves a unique purpose: As shown in the diagram, each insurance type only covers risks within its specific scope. For example, accident insurance only covers risks caused by accidents, not illnesses. It also provides unique coverage for accidental disabilities (grades 1-10), offering a lump-sum payout. Relying on only one or two types of insurance leaves gaps in coverage. Therefore, comprehensive protection for adults lies in the interconnectedness of these four insurance types. When combined, these four insurance types complement each other in case of claims, ensuring financial stability even in extreme situations. In the case above, Mr. L was in a coma for 72 hours due to a car accident. This qualifies as an accident, so accident insurance covered his medical expenses. Additionally, his condition met the criteria for intermediate severity, so critical illness insurance also provided a payout for income loss and rehabilitation costs. Can multiple insurance policies pay out simultaneously for the same claim? Compensation-based policies (e.g., critical illness insurance, term life insurance, and accidental death coverage) can pay out simultaneously. Reimbursement-based policies (e.g., medical insurance or accident medical coverage) only reimburse actual expenses and do not allow duplicate claims. 3. Final Thoughts Every time a claim case arises, our feelings are mixed. It means someone has suffered a loss, facing not only health concerns but also the discomfort of treatment, along with significant psychological and financial stress for themselves and their families. During such times, the Shenlanbao team stands firmly behind our clients, providing immediate assistance from professional claims experts. This includes guidance on required documents, potential issues, and real-time updates on claim progress, ensuring a smooth payout process.
