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中国人寿保险公司《理赔手册》第二篇理赔程序第四节调查中,明确阐述其调查的主要方法之一是需要证明就诊事实、住院情况,应到就诊医院摘抄或核实病历等相关资料。调查报告可为保险责任的认定及理算提供可靠依据。为准确、全面、真实、客观的做好这一工作,既有效防范诈保、骗保的存在,又保护投保人、被保险人和受益人的合法权益,做到既不惜赔,也不滥赔,切实维护公司信誉。就要很好掌握病案资料在保险理赔调查中的使用要点。
In the fourth investigation of the claims settlement procedure of China Life Insurance Company’s Claim Manual, one of the main methods of clearly explaining the investigation is the need to prove the facts of the visit and the hospitalization, and should go to the hospital for medical records or verify the medical records and other related materials. The investigation report can provide a reliable basis for the identification and calculation of insurance liability. To accurately, completely, truthfully and objectively do a good job in this work, we not only effectively prevent frauds and deceptions, but also protect the lawful rights and interests of policyholders, insureds and beneficiaries so that we can neither lose compensation nor abuse Pay, effectively protect the company’s credibility. It is necessary to have a good grasp of the use of medical records in insurance claims investigation.