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Original documents mainly refer to documents with original legal benefits, especially documents with seals, including original files, original household registration documents, confidential documents, trademark originals, restricted documents, legal originals and other documents. As the basis for claims, insurance companies are required to provide originals when claiming claims. Recently, PICC Zhejiang Haiyan Branch made a ruling on an accident insurance case where the original claim documents could not be provided and the secondary treatment time exceeded the insurance extension period, and no compensation was awarded.
as early as April 14, 2012, in Haiyan Wuyuan Street, Beidang Jiayuan Community, a rural building construction worker accidentally fell. On August 17, 2011, the victim Chen applied for a one-year construction accident insurance to PICC Haiyan Branch Company. On the day of the accident, Chen reported the case to the company.
February 26, 2014, Chen applied for a claim to PICC Haiyan Branch Company and submitted the medical records, hospitalization list and medical invoices of the injured Wang. The adjusters found two doubts when reviewing the documents. First, all the medical records submitted by Chen were photocopies, and the invoices were not originals but printed copies issued by the hospital. Second, the injured Wang had been treated twice, and the second treatment time had exceeded 200 days after the expiration of the insurance period, which did not meet the relevant provisions of the insurance extension period.
It is understood that Wang's injury was a comminuted fracture of the left calcaneus. On April 14, 2012, he was treated in Haiyan Traditional Chinese Medicine Hospital for two days and then transferred to Fuyang Orthopedic Hospital for surgical treatment. He was discharged from the hospital on May 8 of the same year. Because he felt that there was still pain in the injured part, Wang was admitted to Fuyang Orthopedic Hospital again on April 22, 2013 for secondary surgical treatment. The two treatments cost a total of 28,000 yuan in medical expenses.
During the investigation, the adjuster asked Chen to provide the original medical records of the injured and the original medical invoice, and informed that even if the original had been used for financial reimbursement in other ways, he could also provide relevant reimbursement vouchers. When the adjuster clearly informed that compensation could not be made without providing original supporting materials, Chen still insisted on not revealing the whereabouts of the original.
At the same time, the adjuster confirmed that the treatment time was 248 days after the termination of the insurance liability stipulated in the policy contract through further verification of the second operation treatment time of the injured Wang, which did not meet the provisions of the accident insurance for construction workers. The insured is still hospitalized for treatment after the expiration of the insurance period, and the insurance period is extended for a maximum of 90 days.
According to the insurance terms and relevant provisions of the claim, PICC Property and Casualty Insurance Haiyan Branch made a decision not to compensate for the case. Chen accepted the decision and agreed to withdraw the case.
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