[Key words] civil / personal insurance contract disputes / insurance liability scope / clause interpretation
[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.
[key points of judgment] motor vehicle drivers shall drive in accordance with the relevant provisions of the road traffic safety law, comply with the provisions of the road traffic safety laws and regulations, and drive safely according to the operation specifications. "Roads" in the road traffic safety law refers to roads, urban roads and places that are under the jurisdiction of the unit but allow social motor vehicles to pass, including squares, public parking lots and other places for public passage.
In case of any dispute between the insurer and the applicant, the insured or the beneficiary over the terms of an insurance contract concluded with the standard terms provided by the insurer, it shall be interpreted in accordance with the general understanding. If there are two or more interpretations of the contract terms, the interpretation shall be in favor of the insured and the beneficiary.
[basic case] on September 22, 2014, Li Hai, the father of Li, signed an insurance policy with the Shenyang Central Branch of a Life Insurance Co., Ltd. the applicant and the insured were Li Hai, and the beneficiary of the death was Li. The insurance type was "a certain two guarantee insurance" and "additional million years of accident injury insurance". The basic insurance amount was 200000 yuan. It is agreed in Item 1, paragraph 1, Article 6 of the insurance clauses that the death insurance premium is 5412 yuan (110%) × (1400+1060) × 2)。 In addition, the insurance premium for accidental death of private cars stipulated in Item 2 of Article 6 of the accident injury insurance clause for millions of years of driving is 2 million yuan (200000 yuan × 10) If the insured suffers from a traffic accident recognized by the public security traffic management department while driving or riding a private car in the people's Republic of China, and the insured dies due to the accident within 180 days from the date of the accident, the insured shall pay the private car accident death insurance benefits based on the balance of 10 times of the basic insurance amount of the additional contract at the time of the insured's death after deducting the paid private car accident disability insurance benefits, I.e. 2 million yuan (200000 yuan × 10); The third paragraph of Article 6 stipulates the insurance benefits for general accidental death, "If the insured suffers from an accidental injury and dies due to the accident within 180 days from the date of the accident, the general accidental death insurance benefits shall be paid according to the balance of the basic insurance amount of this additional contract after deducting the paid personal car accident disability insurance benefits at the time of the insured's death; the period when the insured drives or rides in a private car refers to the period from the time when the insured enters the private car to the time when he leaves the car; the defendant only pays The insurance liability of the main contract and this additional contract includes one of the expiration insurance premium, death insurance premium, private car accident death insurance premium and general accident death insurance premium ".
At about 17:00 on February 25, 2016, Li Hai drove three people of Liao a716xe jeep to enter the ice surface of Liaohe River from the Bank of Liaohe River in sanjianpao village, Sanmian boat, Faku County. When the ice surface in Liaohe River was broken, the jeep fell into Liaohe River. After fire rescue, two of them were rescued, and Li Haijing 120 drowned and died. The insurance company agreed to pay 200000 yuan of general accident insurance as agreed in the contract, while the beneficiary of the insured requested the insurance company to pay 2 million yuan (200000 yuan) of private car accident death insurance × 10) Therefore, a lawsuit was filed to the court.
[judgment result] i. the Shenyang Central Branch of an insurance Co., Ltd. paid an insurance benefit of 200000 yuan to Li within 10 days after the judgment came into effect;
2、 Other claims of Li were rejected. The case acceptance fee was 22843 yuan, of which 18543 yuan was borne by Li and 4300 yuan by Shenyang Central Branch of a Life Insurance Co., Ltd.
[reason for judgment] the court held that as a motor vehicle driver, Li Hai should drive in accordance with the relevant provisions of the road traffic safety law, comply with the provisions of the road traffic safety laws and regulations, and drive safely in accordance with the operating specifications. The "truth" in the traffic safety law refers to roads, urban roads and places that are under the jurisdiction of the unit but allow social motor vehicles to pass, including squares, public parking lots and other places for public passage; "Traffic accident" refers to the personal injury or death or property loss caused by the vehicle's fault or accident on the road. In this case, Li Hai drove a motor vehicle on the off-road "Liaohe ice surface". After the vehicle fell into the water, Li Hai drowned and died after the on-site rescue was ineffective. In the insurance contract signed by Li Hai and the Shenyang Central Branch of a Life Insurance Co., Ltd., it is agreed that if the insured is driving or riding a private car in the people's Republic of China and a traffic accident accident identified by the public security traffic management department occurs and within 180 days from the date of the accident, If the insured dies due to the accident, the insured shall pay the insurance benefits for accidental death of private car, i.e. 2 million yuan (200000 yuan) according to the balance of 10 times of the basic insurance amount of the additional contract at the time of the insured's death after deducting the paid insurance benefits for accidental disability of private car × 10)。 Obviously, Li Hai's behavior does not comply with the above legal provisions, so Li Hai's claim to pay insurance benefits for accidental death of private cars according to the claim is not supported. As for the defense of Shenyang Central Branch of a Life Insurance Co., Ltd., Li Hai's danger outside the vehicle does not belong to the scope of insurance liability, and his behavior belongs to the section of "engaging in or participating in exploration activities" in the liability exemption clause, and he does not bear the payment of death insurance benefits. The insurance law stipulates that for an insurance contract concluded with the standard terms provided by the insurer, if the insurer and the applicant, the insured or the beneficiary have disputes over the terms of the contract, they shall be interpreted in accordance with the general understanding. If there are more than two interpretations of the terms of the contract, they shall be interpreted in favor of the insured and the beneficiary. The insured in this case, Li Hai, was lucky and out of self-confidence. When encountering danger, he was bound to leave the carriage and save himself. Therefore, the defendant should pay the beneficiary's insurance benefits according to the provisions of "general accidental death insurance benefits" in the insurance contract, which is more beneficial to Li.
[relevant laws] Contract Law of the people's Republic of China
Article 44 effectiveness of contract a legally established contract shall become effective upon its establishment. Where laws and administrative regulations provide that approval, registration and other formalities shall be handled to take effect, such provisions shall apply.
Article 60 the parties shall fully perform their obligations in accordance with the contract. The parties shall abide by the principle of good faith and perform the obligations of notification, assistance and confidentiality according to the nature, purpose and trading habits of the contract.
Article 107 If a party liable for breach of contract fails to perform its contractual obligations or fails to perform its contractual obligations in accordance with the contract, it shall bear the liability for breach of contract such as continuing to perform, taking remedial measures or compensating for losses.
Insurance law of the people's Republic of China
Article 30 for an insurance contract concluded with the standard terms provided by the insurer, if the insurer disputes the terms of the contract with the applicant, the insured or the beneficiary, it shall be interpreted in accordance with the usual understanding. If there are two or more interpretations of the contract terms, the people's court or arbitration institution shall make an interpretation in favor of the insured and the beneficiary.
[lawyer's opinion] the lawyer believes that the accident in this case does not belong to the traffic accident stipulated in the insurance contract for the death insurance of private car accident, According to Clause 2 of Article 6 of the insurance liability of accident injury insurance clauses for additional one million years of driving, the insurance benefits for accidental death of private cars are agreed as follows: "if the insured is within the territory of the people's Republic of China (excluding Hong Kong, Macao and the Gulf region) If a traffic accident injury accident recognized by the public security traffic management department occurs during driving or riding a private car, and the insured dies due to the accident within 180 days from the date of the accident, we will pay the private car accident death insurance benefits in the following manner, and this additional contract will be terminated. "
It can be seen that the private car accident death insurance fund (2 million) requires that the accident needs to be recognized by the public security traffic management department. However, the traffic police department in this case has not issued a certificate of responsibility for the accident or an accident certificate to prove that the accident belongs to a traffic accident. The traffic management department does not only issue an accident certificate for the traffic accident, but can also issue an accident certificate, that is, if the accident liability cannot be recognized, the accident certificate will be issued, However, the traffic management department that does not comply with the traffic accident is unable to issue the accident identification certificate or accident certificate. Furthermore, the insured in this case did not die on the spot after the vehicle involved fell into the water, but died in the process of rescuing others in the water outside the vehicle after the accident. That is to say, even if there is a traffic accident, the insured in this case is not killed in the traffic accident.
In addition, Article 6 of the insurance clause stipulates that "the period during which the insured drives or takes a private car refers to the period from the time when the insured enters the private car to the time when he gets out of the car." It is obvious that no matter whether the insured leaves the car actively or passively, it is no longer covered by the insurance for accidental death of private car after leaving the car. That is to say, if the insured leaves the car while driving the private car and is outside the vehicle, and is collided and drowned by other vehicles, it is not covered by this insurance. In fact, when the insurance company agreed on this clause, according to the big data principle in the insurance industry, it was based on the data of traffic accidents in China rather than all accidents. In addition, the insurance premium paid was 10 times of the insurance amount, and the risk it assumed was limited to the traffic accidents of private cars. Therefore, the scope of protection should be strictly limited. The two conditions of private cars and traffic accidents exist at the same time, Of course, sometimes there will be vehicles registered in the name of the company and owned by individuals, which will also lead to disputes after the occurrence of insurance accidents, and the insurance company needs to further explain the terms design. The people's court should also fully respect the insurance company's explanation in the terms of the insurance coverage, because this is the agreement on the scope of insurance liability, not the exemption clause. In practice, many judges have made mistakes in identifying the insurance liability clauses and the exemption clauses of the insurer, and the insurance liability clauses are not prompted and clearly explained due to the identification errors, so that the insurance liability is artificially expanded, Affecting the development of the entire insurance industry.