[introduction of the lawyer in this case] Wang Zhanping, senior partner of Liaoning Tongfang law firm, is good at legal management of insurance and wealth risk. Our clients are China Export Credit Insurance Corporation, Rongsheng Property Insurance Corporation, nearly 30 life insurance and property insurance Liaoning branches such as people's insurance, China Life Insurance, Ping An insurance, Taiping Insurance, Xinhua life insurance, and many insurance agent teams or insurance intermediary companies. We provide legal advice, legal advice, insurance contracts, insurance claims, insurance allocation of enterprises and individuals, due diligence, criminal cases involving insurance Litigation and non litigation legal services such as insurance fund utilization, insurance fund trust, Internet insurance, wealth inheritance, policy seizure, insurance recovery, litigation preservation, liability insurance risk review, Insurance Law Series training, etc.
[undertaking lawyers] Wang Zhanping, Wu Zhikuan
[Characteristics] in this case, the court of first instance did not support our claim. Although the court of second instance supported our claim, we believe that the reasons for the judgment of the court of second instance are not perfect.
[parties]
Plaintiff: Tang mou'an, male, born on September 2, 1989.
Plaintiff: Xia Mulan, female, born on March 29, 1966.
Plaintiff: Tang Mojiang, male, born on December 22, 1941.
Defendant: Dandong Branch of a Life Insurance Co., Ltd.
[brief introduction to the case]
The plaintiff Tang Mojiang is the father of the deceased Tang Mou Zhong, the plaintiff Xia Mou LAN is the wife of Tang Mou Zhong, and the plaintiff Tang Mou an is the son of Tang Mou Zhong. Tang was an employee of Dandong Pharmaceutical Machinery Co., Ltd. In August 2017, the company insured its employees with Guoshou comprehensive accident insurance at the defendant's office. Among them, Tang bought two copies of such insurance, both in card form. The policy numbers are: 51301140066 * * * *, 51302140066 * * * *, the insurance premium is 100 yuan each, which is paid by the unit, and the insurance premium is 70000 yuan each. The name of the insured is Tang Yizhong, and the beneficiary of the death is Tang Yizhong's legal heir. In the insurance policy, it is suggested in bold font that the company shall not be liable for paying insurance benefits in case of death, disability or medical expenses of the insured due to one of the following circumstances: the seventh item refers to the insured driving after drinking, driving without a valid driving license or driving a motor vehicle without a valid driving license. When the company applied for insurance, the salesman of the defendant's insurance company explained the exemption clauses of the insurance company to the person in charge of Tang Yizhong's unit. Liu Yizhi explained the exemption clauses to the employees many times in the company's general meeting. At about 7:00 on September 26, 2017, Tang Yizhong died on the spot in a traffic accident. According to the identification of the traffic police department, Tang Yizhong, who drove a motor vehicle on the road without obtaining a motor vehicle driver's license in accordance with the law and did not let a straight vehicle go first when turning, shall bear the same responsibility for the accident.
[referee] Liaoning Dandong intermediate people's court
[judgment result / content]
The court of first instance held that the insurer took the prohibited provisions in laws and administrative regulations as the reasons for exemption of the exemption clause of the insurance contract. After the insurer made a prompt for the clause, the applicant The people's court shall not support the claim of the insured or the beneficiary that the clause does not take effect on the ground that the insurer has not performed the obligation of clear explanation. Although the registered applicant of the insurance contract involved in this case is Tang Yizhong, the insurance company that signed the contract with the defendant and paid the premium is Dandong Pharmaceutical Machinery Co., Ltd., the unit where Tang Yizhong belongs. Therefore, the company is the actual applicant of the contract and Tang Yizhong is the insured. The behavior of the insured Tang Yizhong driving an unlicensed motor vehicle on the road violates the relevant provisions of the road traffic safety law. The insurance company has made a special prompt in the insurance certificate for the exemption, and has fulfilled the obligation of explanation to the applicant Dandong Pharmaceutical Machinery Co., Ltd. according to the contract and legal provisions, it can be exempted from the responsibility of paying insurance benefits. The plaintiff's claim for the insurance company to pay the insurance benefits has no factual and legal basis, and the court of first instance did not support it.
This case was appealed to Dandong intermediate people's court by the plaintiff in the original trial. The court of second instance held that Article 17 of the insurance law of the people's Republic of China stipulates that if the insurance contract is concluded with the standard terms provided by the insurer, the insurance policy provided by the insurer to the applicant shall be attached with the standard terms, and the insurer shall explain the contents of the contract to the applicant, When concluding the contract, the insurer shall make a prompt sufficient to attract the attention of the applicant on the application form, insurance policy or other insurance certificates, and make a clear explanation to the applicant in written or oral form of the contents of the clause; In the absence of prompt or explicit explanation, this clause shall not be effective. In this case, the activation card policy inquiry provided by the three Appellants in the second instance stated that the insured involved in the case was Tang Yizhong, so the life insurance company should perform the obligation of prompt to the applicant Tang Yizhong when signing the contract. The Dandong Branch of a certain life insurance company of the appellee, knowing that the insured involved in the case could only be natural persons, did not provide sufficient evidence to prove that when the insurance contract was concluded, it made a prompt to the applicant Tang Yizhong about the clauses in the insurance contract exempting the insurer from liability, which was sufficient to attract the attention of the applicant. Therefore, the insurance clause shall not be effective. The life insurance company shall pay the accidental injury insurance premium of 140000 yuan in total according to the insurance terms.
[lawyer's opinion]
The court of first instance held that although the registered applicant of the insurance contract involved in this case was Tang Yizhong, the insurance company that signed the contract with the defendant and paid the premium was Dandong Pharmaceutical Machinery Co., Ltd., the unit where Tang Yizhong worked, so the company was the actual applicant of the contract. The fact finding was wrong, and the determination of the applicant should be based on the insurance policy. The applicant can entrust a third person to pay the premium on behalf of him. Therefore, the applicant is not the person who actually paid the premium, But the policyholder determined by the insurance policy. In addition, the reasons for the judgment of the court of second instance did not involve the interpretation of the insurance clauses involved in the case. According to the cognition of ordinary people, the electric vehicle could not be registered and objectively could not obtain the motor vehicle number plate and license plate. Although the electric vehicle in the case was identified as a motor vehicle, there was a dispute over whether it belonged to the motor vehicle agreed in the terms of the insurance contract. According to the bulletin cases of the Supreme People's court - Cao Liancheng, Hu Guilan, Cao Xinjian Cao Xianzhong v. Minsheng Life Insurance Co., Ltd. Jiangsu branch insurance contract dispute case, Summary of the judgment of the case: "in the absence of provisions on the identification standard of motor vehicles in the insurer's liability exemption clause and the interpretation of the insurance clause, based on the product specification and product inspection certificate of the moped manufacturer (both show that the vehicle is a moped) And the fact that the insured is unable to obtain the motor vehicle license plate objectively, the explanation that the vehicle involved in the case does not belong to the motor vehicle specified in the insurer's exemption clause conforms to the cognitive standard of an ordinary vehicle purchaser and user, and the explanation should be made in favor of the insured. The vehicle involved in the case should be deemed not to belong to the motor vehicle specified in the insurer's exemption clause. At this time, if the insured drives the above vehicle without a driver's license, it does not belong to driving without a license as stipulated in the exemption clause. " Similar to this case, although China is not a case law country, the communique case of the Supreme Court represents the mainstream judicial view of the Supreme Court and has important guiding significance for the trial practice.
[reason for recommendation]
The solution of the two major focus issues in this case has universal significance for the correct application of laws in judicial practice. First, how to determine the insured; 2、 This case is a personal insurance contract dispute, but the particularity of this case lies in whether the electric vehicle is identified as a motor vehicle is applicable to the exemption of driving without a license as stipulated in the exemption clauses of the insurance contract. This situation generally exists in motor vehicle traffic accident liability dispute cases. However, the court of second instance of this case did not clearly explain the terms involved in this case because of the lack of judgment reasons.
[undertaking lawyers] Wang Zhanping, Wu Zhikuan
[Characteristics] in this case, the court of first instance did not support our claim. Although the court of second instance supported our claim, we believe that the reasons for the judgment of the court of second instance are not perfect.
[parties]
Plaintiff: Tang mou'an, male, born on September 2, 1989.
Plaintiff: Xia Mulan, female, born on March 29, 1966.
Plaintiff: Tang Mojiang, male, born on December 22, 1941.
Defendant: Dandong Branch of a Life Insurance Co., Ltd.
[brief introduction to the case]
The plaintiff Tang Mojiang is the father of the deceased Tang Mou Zhong, the plaintiff Xia Mou LAN is the wife of Tang Mou Zhong, and the plaintiff Tang Mou an is the son of Tang Mou Zhong. Tang was an employee of Dandong Pharmaceutical Machinery Co., Ltd. In August 2017, the company insured its employees with Guoshou comprehensive accident insurance at the defendant's office. Among them, Tang bought two copies of such insurance, both in card form. The policy numbers are: 51301140066 * * * *, 51302140066 * * * *, the insurance premium is 100 yuan each, which is paid by the unit, and the insurance premium is 70000 yuan each. The name of the insured is Tang Yizhong, and the beneficiary of the death is Tang Yizhong's legal heir. In the insurance policy, it is suggested in bold font that the company shall not be liable for paying insurance benefits in case of death, disability or medical expenses of the insured due to one of the following circumstances: the seventh item refers to the insured driving after drinking, driving without a valid driving license or driving a motor vehicle without a valid driving license. When the company applied for insurance, the salesman of the defendant's insurance company explained the exemption clauses of the insurance company to the person in charge of Tang Yizhong's unit. Liu Yizhi explained the exemption clauses to the employees many times in the company's general meeting. At about 7:00 on September 26, 2017, Tang Yizhong died on the spot in a traffic accident. According to the identification of the traffic police department, Tang Yizhong, who drove a motor vehicle on the road without obtaining a motor vehicle driver's license in accordance with the law and did not let a straight vehicle go first when turning, shall bear the same responsibility for the accident.
[referee] Liaoning Dandong intermediate people's court
[judgment result / content]
The court of first instance held that the insurer took the prohibited provisions in laws and administrative regulations as the reasons for exemption of the exemption clause of the insurance contract. After the insurer made a prompt for the clause, the applicant The people's court shall not support the claim of the insured or the beneficiary that the clause does not take effect on the ground that the insurer has not performed the obligation of clear explanation. Although the registered applicant of the insurance contract involved in this case is Tang Yizhong, the insurance company that signed the contract with the defendant and paid the premium is Dandong Pharmaceutical Machinery Co., Ltd., the unit where Tang Yizhong belongs. Therefore, the company is the actual applicant of the contract and Tang Yizhong is the insured. The behavior of the insured Tang Yizhong driving an unlicensed motor vehicle on the road violates the relevant provisions of the road traffic safety law. The insurance company has made a special prompt in the insurance certificate for the exemption, and has fulfilled the obligation of explanation to the applicant Dandong Pharmaceutical Machinery Co., Ltd. according to the contract and legal provisions, it can be exempted from the responsibility of paying insurance benefits. The plaintiff's claim for the insurance company to pay the insurance benefits has no factual and legal basis, and the court of first instance did not support it.
This case was appealed to Dandong intermediate people's court by the plaintiff in the original trial. The court of second instance held that Article 17 of the insurance law of the people's Republic of China stipulates that if the insurance contract is concluded with the standard terms provided by the insurer, the insurance policy provided by the insurer to the applicant shall be attached with the standard terms, and the insurer shall explain the contents of the contract to the applicant, When concluding the contract, the insurer shall make a prompt sufficient to attract the attention of the applicant on the application form, insurance policy or other insurance certificates, and make a clear explanation to the applicant in written or oral form of the contents of the clause; In the absence of prompt or explicit explanation, this clause shall not be effective. In this case, the activation card policy inquiry provided by the three Appellants in the second instance stated that the insured involved in the case was Tang Yizhong, so the life insurance company should perform the obligation of prompt to the applicant Tang Yizhong when signing the contract. The Dandong Branch of a certain life insurance company of the appellee, knowing that the insured involved in the case could only be natural persons, did not provide sufficient evidence to prove that when the insurance contract was concluded, it made a prompt to the applicant Tang Yizhong about the clauses in the insurance contract exempting the insurer from liability, which was sufficient to attract the attention of the applicant. Therefore, the insurance clause shall not be effective. The life insurance company shall pay the accidental injury insurance premium of 140000 yuan in total according to the insurance terms.
[lawyer's opinion]
The court of first instance held that although the registered applicant of the insurance contract involved in this case was Tang Yizhong, the insurance company that signed the contract with the defendant and paid the premium was Dandong Pharmaceutical Machinery Co., Ltd., the unit where Tang Yizhong worked, so the company was the actual applicant of the contract. The fact finding was wrong, and the determination of the applicant should be based on the insurance policy. The applicant can entrust a third person to pay the premium on behalf of him. Therefore, the applicant is not the person who actually paid the premium, But the policyholder determined by the insurance policy. In addition, the reasons for the judgment of the court of second instance did not involve the interpretation of the insurance clauses involved in the case. According to the cognition of ordinary people, the electric vehicle could not be registered and objectively could not obtain the motor vehicle number plate and license plate. Although the electric vehicle in the case was identified as a motor vehicle, there was a dispute over whether it belonged to the motor vehicle agreed in the terms of the insurance contract. According to the bulletin cases of the Supreme People's court - Cao Liancheng, Hu Guilan, Cao Xinjian Cao Xianzhong v. Minsheng Life Insurance Co., Ltd. Jiangsu branch insurance contract dispute case, Summary of the judgment of the case: "in the absence of provisions on the identification standard of motor vehicles in the insurer's liability exemption clause and the interpretation of the insurance clause, based on the product specification and product inspection certificate of the moped manufacturer (both show that the vehicle is a moped) And the fact that the insured is unable to obtain the motor vehicle license plate objectively, the explanation that the vehicle involved in the case does not belong to the motor vehicle specified in the insurer's exemption clause conforms to the cognitive standard of an ordinary vehicle purchaser and user, and the explanation should be made in favor of the insured. The vehicle involved in the case should be deemed not to belong to the motor vehicle specified in the insurer's exemption clause. At this time, if the insured drives the above vehicle without a driver's license, it does not belong to driving without a license as stipulated in the exemption clause. " Similar to this case, although China is not a case law country, the communique case of the Supreme Court represents the mainstream judicial view of the Supreme Court and has important guiding significance for the trial practice.
[reason for recommendation]
The solution of the two major focus issues in this case has universal significance for the correct application of laws in judicial practice. First, how to determine the insured; 2、 This case is a personal insurance contract dispute, but the particularity of this case lies in whether the electric vehicle is identified as a motor vehicle is applicable to the exemption of driving without a license as stipulated in the exemption clauses of the insurance contract. This situation generally exists in motor vehicle traffic accident liability dispute cases. However, the court of second instance of this case did not clearly explain the terms involved in this case because of the lack of judgment reasons.
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