Insure a motorcycle against accidents.
On June 5438+065438+ 10, 2006, the plaintiff Wang Xingming went to the insurance agency of an insurance company to insure the third party liability insurance according to the requirements of relevant departments. After Wang Xingming paid the insurance premium, Yao, the agent of the agency, handled the third party liability insurance for Wang Xingming's two-wheeled motorcycle. The agreed insurance amount was 50,000 yuan, and the insurance period was from May 2006 to April 30, 2007. But for some reason, Wang Xingming didn't sign the insurance column, and his agent Yao Dai Wang Xingming signed the insurance column. This insurance policy is stamped with the seal of the insurance company and the seal of the agency.
On June 5438+February 10, 2006, Wang Xingming drove an insured two-wheeled motorcycle and collided with human tricycles driven by a woman Chen Mou on the expressway in Hai 'an County. Chen Mou was injured and died after being rescued. After the traffic police brigade of Hai 'an County Public Security Bureau conducted an on-site inspection of the accident, it made an accident determination, and determined that Wang Xingming and Chen Mou were equally responsible for the accident. Under the mediation of the public security department, Wang Xingming compensated the relatives of the deceased for various losses of 1024 17.49 yuan, and the case was closed on June 5438+1October 5, 2007.
The insurance company refused to pay the claim.
Wang Xingming turned to the insurance company for compensation, demanding that the insurance company pay the insurance premium according to the insurance contract. However, the insurance company put forward that "Wang Xingming's driver's license has expired", which belongs to the exemption reason stipulated in the exemption clause of the insurance clause, and its claim for compensation is not within the scope of insurance liability, so Wang Xingming's claim was rejected. The two sides failed to reach an agreement on compensation, and Wang Xingming sued the insurance company in court with a complaint.
During the trial, both parties had no objection to the insurance situation, the occurrence of traffic accidents and the facts handled by the traffic police department. The focus of the dispute is whether the exemption clause of "the driver's license has expired and the insurer will not compensate" is applicable.
Explain that obligation is the key.
Wang Xingming, the plaintiff, claimed that according to the requirements of the relevant departments, I went to the insurance agency of the defendant's insurance company to handle the third-party liability insurance for second-wheel motorcycles and paid the insurance premium as required. However, when concluding the contract, the insurance agent did not explain the terms of the insurance contract to me according to law, and signed my name in the column of the applicant without my consent. Insurance contracts include application forms, insurance policies, approval forms, special agreements and insurance clauses. However, after the contract was established, the agent only delivered the insurance policy to me, but did not provide me with the insurance clauses as required. However, the insurance clauses include the rights, obligations and exemption clauses of the parties, which leads to the fact that I can't know the reasons for exemption afterwards. Although it is a fact that my driver's license expired at the time of the accident, the exemption clause is not binding on me because the insurance company failed to fulfill its obligation of explanation, and the insurance company's liability for compensation cannot be exempted according to law. I now request the court to decide that the defendant insurance company will compensate me for 50,000 yuan.
In order to support the litigation request, the plaintiff submitted the insurance policy, driver's license and driving license, traffic accident confirmation, mediation of traffic accident loss compensation, relevant bills and the defendant's notice of refusal to pay compensation to the court.
The defendant insurance company argued that when signing the contract, our company had explained the exemption clause to the plaintiff Wang Xingming; After the contract was established, the insurance clauses were also provided to it. When Wang Xingming had a traffic accident, his driver's license had expired. According to the exemption clause in the insurance clause, the accident does not belong to the insurance accident. Therefore, the plaintiff Wang Xingming claimed that the reason could not be established and requested the court to decide to dismiss his claim.
On April 16, 2007, the court issued a notice to the insurance company, ordering it to submit the relevant basis of its relationship with the above-mentioned agency to the court before April 20, 2007, but the insurance company has never provided it. In addition, the insurance company did not give a reasonable explanation for the official seal of the agency in the insurance contract. At the same time, the insurance company failed to provide sufficient evidence to prove that it had fulfilled its obligation to explain the exemption clauses to Wang Xingming, and there was no evidence to prove that it had provided insurance clauses to Wang Xingming.
Compensation for "expired driver's license"
After hearing the case, Hai 'an County Court held that although the insurance company did not provide evidence to prove the relationship between the insurance unit and the defendant insurance company, it can be concluded that there is an insurance agency relationship between the above-mentioned agent and the insurance company from the comprehensive judgment that the agent Yao holds a blank insurance policy with the official seal of the insurance company and the official seal of the agent on the policy. The agent is the insurance agent of this insurance contract, and Yao is the specific agent of this insurance contract. The behavior of insurance agents and specific agents shall be borne by insurance companies.
When the plaintiff Wang Xingming signed an insurance contract with the defendant's insurance company, despite the defects such as signature, after a series of actions such as paying insurance premiums and receiving insurance policies, both parties' offers and commitments have been completed, and the contract should be declared to be established. At the same time, the contract is the true meaning of both parties, and its content does not violate the prohibition provisions of laws and regulations, and the contract is valid.
As a format contract, insurance contract has special legal requirements on how to embody the principle of good faith in the process of contract conclusion. According to China's Insurance Law, if there is an insurer's liability exemption clause in the insurance contract, the insurer shall clearly explain it to the applicant when concluding the contract. If it is not made clear, this clause will not take effect. Judging from the facts ascertained in this case, there is not enough evidence to show that the insurance agent and the specific agent have fulfilled the obligation to explain the exemption clause to Wang Xingming, and there is no evidence to show that the insurance clause has been provided, and the adverse consequences arising therefrom should be borne by the defendant insurance company. Therefore, the exemption clause in the insurance contract has no effect on Wang Xingming.
In this traffic accident, the plaintiff Wang Xingming was equally responsible for the accident. According to the contract, the deductible rate was 10%. Therefore, according to the relevant provisions of Article 2, Article 17 and Article 18 of the Insurance Law of People's Republic of China (PRC), the insurance company was judged to pay 45,000 yuan.
After the judgment of the first instance, the defendant's insurance company refused to accept the appeal. During the second trial of Nantong Intermediate People's Court, the appellant's insurance company applied to withdraw the appeal. Nantong Intermediate People's Court ruled that the appellant's insurance company was allowed to withdraw the appeal.
Comments: This case mainly involves how to fulfill the principle of utmost good faith and the obligation to explain the exemption clauses stipulated by law during the signing of insurance contracts.
The principle of utmost good faith is the embodiment of the function and function of the principle of good faith in insurance law. It is generally believed that the principle of good faith originated from Roman law and is called the principle of good faith, French civil law, German civil law and Japanese law. The principle of good faith requires that civil subjects should be honest and trustworthy, perform their obligations in good faith, and must not abuse their rights or evade their obligations stipulated by law or contract. People's Republic of China (PRC) Insurance Law also clearly stipulates the principle of good faith. Article 4 of the law stipulates: "The parties to an insurance contract shall follow the principle of good faith when exercising their rights and performing their obligations." At the same time, from the content of the specific provisions of the insurance law, the insurance contract not only requires the parties to follow the principle of good faith, but also to achieve the greatest integrity. The principle of utmost good faith is mainly embodied in the insurer's obligation to explain and the insured's obligation to tell the truth.
The insurer's obligation of explanation refers to the insurer's obligation to explain the terms of the insurance contract, especially the exemption clause, to the applicant when concluding the contract. The insurer's obligation of explanation is the obligation stipulated by law before the conclusion of the contract, which can be called the obligation before the contract. Paragraph 17 of the Insurance Law of People's Republic of China (PRC) stipulates: "When concluding an insurance contract, the insurer shall explain the terms of the insurance contract to the applicant, and may raise questions about the subject matter of insurance or the insured, and the applicant shall truthfully inform him." Article 18 of the law specifically stipulates: "If there is an insurer's exemption clause in the insurance contract, the insurer shall clearly explain it to the applicant when concluding the insurance contract. If it is not clearly stated, this clause will not take effect. " When determining whether to perform the obligation of explanation, subjective factors are not considered and the fault of the parties is not the premise. As long as the insurer fails to fulfill the obligation of explanation, it constitutes a violation of the obligation of explanation. The insurer's obligation to explain is a legal obligation, and it is not allowed for the insurer to limit or exempt it by means of contract terms. In any case, the insurer is obliged to explain the terms of the insurance contract in detail before concluding the insurance contract, and give a direct and true answer to the applicant's inquiry about the insurance contract. Without the applicant's inquiry or request, the insurer shall explain the contents of the terms of the insurance contract to the applicant, and the insurer shall take the initiative to explain.
The "clear explanation" of the exemption clause means that the insurer should not only remind the insured of the exemption clause, but also explain the concept, content and legal consequences of the exemption clause in written or oral form, so that the insured can understand the true meaning and legal consequences of the clause. Judging from the situation of this case, there is no evidence that the insurance company's agent and specific agent have "clearly stated" the exemption clause, so the exemption clause of "the driver's license has expired and the insurer will not compensate" has no legal effect on the plaintiff Wang Xingming.
This case reminds people that the principle of good faith should always be followed in civil activities; In insurance practice, insurance companies should perform the obligation of explanation in strict accordance with the provisions of the law, and the exemption clauses should be specially prompted and clearly stated. It is best for the insured to sign and recognize that the insurance company has fulfilled its obligations to clearly explain the terms of the insurance contract, so as to avoid the problem of difficulty in proving after the dispute over the insurance contract arises.