March, 1. 200 1, Gong, a 45-year-old government official in a factory, was discharged from hospital after being hospitalized for gastric cancer (relatives were afraid of his emotional fluctuation and did not tell him the real condition) and took part in work normally. On August 24th, upon recommendation, Gong went to the insurance company to handle the simple life insurance for him and completed the relevant procedures. When filling out the insurance policy, he didn't declare the fact that he had cancer.
In May, 2002, Gong's old illness recurred, and he died after treatment. Gong's wife, as the designated beneficiary, went to the insurance company to ask for insurance money. When the insurance company checked and submitted relevant certificates, it was found that Gong's medical history stated that he had cancer and had an operation, so he refused to pay insurance money. Gong's wife argued that her husband didn't know what disease he had and didn't violate his obligation to inform, so the two sides had a dispute. What should the insurance company do?
A: In this case, Gong didn't know that he had stomach cancer. Just because he didn't declare that he had stomach cancer, he didn't violate his obligation to inform. But Gong couldn't be unaware of the fact that he was hospitalized and had an operation a few months ago (this fact is undoubtedly very important to the insurer), but he didn't explain it. This is the crux of the problem.
Because according to the general theory of insurance law, the content of disclosure obligation requires a statement of facts, not an accurate statement of opinions. It does not require that the applicant's information is completely accurate, as long as he fulfills this obligation as far as possible within the cognitive scope of the insured. That is to say, if the insured doesn't know what disease he is suffering from, and if he makes an emotional statement about his illness, although this statement may be inconsistent with the facts (for example, he has stomach cancer, and his family kindly tells him that he has stomach trouble, and he declares that he has stomach trouble), he is absolutely flawless in fulfilling his obligations, but if he conceals or lies about the facts about medical treatment or treatment, he commits the crime of not properly informing important facts and should bear the adverse consequences of violating the obligation of informing. Insurance companies have legitimate reasons to refuse compensation. Therefore, the insurer has the right of defense and refuses to pay the insurance money.
2. Xiongmou, an employee of a company in Hengyang City, insured his 59-year-old mother Wang for 8 major diseases whole life insurance through an insurance company salesman. I filled out the insurance policy without asking about Wang's physical condition. Afterwards, Wang was not asked to have a physical examination. In July 2002, Wang died unfortunately, and Xiong asked the insurance company to make a claim. The insurance company refused because it did not tell the insured truthfully that he was hospitalized for Parkinson's disease before taking out insurance.
Answer: According to Article 16 of the Insurance Law, if the insured intentionally conceals the facts, fails to perform the obligation of telling the truth, or fails to perform the obligation of telling the truth due to negligence, which is enough to affect the insurer's decision on whether to agree to underwrite or increase the insurance premium rate, the insurer has the right to terminate the contract. If the insured intentionally fails to perform the obligation of telling the truth, the insurer shall not be liable for compensation or payment for the insured accident that occurred before the termination of the insurance contract. The insurance premium is non-refundable However, this article also stipulates that 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.
Through the analysis of the above provisions, we can draw the conclusion that telling the truth is not initiative. In this case, the salesman Chen Mou filled in the medical history of the insured without asking the insured and the insured. Afterwards, the insured Wang was not required to have a physical examination. It cannot be concluded that the insured deliberately concealed the facts and failed to fulfill the obligation of telling the truth. So the insurance company should compensate.
Whether the applicant has fulfilled the obligation of telling the truth is related to the insurance company's claim decision. Although the insurance company finally paid the insurance premium in this case, for the majority of policyholders, don't take any chances when insuring. You should tell the truth as much as possible. Of course, if the insurance company does not ask, there is no need to take the initiative to inform.
3. One Spring Festival, Li bought fireworks and firecrackers worth 200 yuan for his son who just turned 8. One day, Mr. and Mrs. Li went out to visit. One of his sons was bored at home, so he dug out Li's hidden fireworks and firecrackers and played in the house, which inadvertently caused a fire, causing damage to clothes, bedding, home and furniture to varying degrees. The loss is about 30,000 yuan. Fortunately, Li bought a property insurance.
For such a fire, the insurance company believes that the fire was caused by the intentional behavior of Li's son, but according to the provisions of family property insurance, the property losses caused by the intentional behavior of the insured and his family members are excluded. The insurance company should not compensate. However, Li believes that the son's failure to intentionally set fire should not be regarded as the intentional behavior of the insured's family, and the insurance company should pay for it. The focus of this case lies in the identification of "intentional behavior".
According to the legal interpretation, "intentional" refers to the psychological state that the actor foresees that his behavior will cause certain harmful results, but still hopes that the results will happen or let them happen. Obviously, intention is always related to the "knowing" and "intention" of the actor.
The pedestrian in this case is only an 8-year-old child. According to the General Principles of the Civil Law of People's Republic of China (PRC), "/kloc-minors under 0/0 are persons without civil capacity." An 8-year-old child should be considered as a person without civil capacity. There is no intentional or unintentional problem, and he will not bear civil liability for the consequences of his actions. According to the General Principles of the Civil Law of People's Republic of China (PRC), "If a person without or with limited capacity for civil conduct causes damage to others, his guardian shall bear civil liability. If the guardian has fulfilled his civil liability, he may appropriately reduce his civil liability. " Mr. and Mrs. Li hid the fireworks before going out, which shows that he has done his duty, but leaving the underage children alone at home may have some unpredictable adverse consequences. Li and his wife should have thought of this, but due to negligence, they didn't. Even so, it can only be said that Mr. and Mrs. Li are at fault, not "intentionally." Conclusion: As the property loss in this case was not caused by the intentional behavior of the insured and his family, the insurance company should be liable for compensation.
4. In April, 2003, a township government took out family property insurance for its farmers in a local insurance company. The insurance premium is 2500 yuan per household in 7.5 yuan. In addition, it is specially agreed by both parties that the premium will be paid in two installments and in June. 165438+. The insurance company issued a policy to the township government and stamped it with the official seal. Later, the insurance company repeatedly urged the township government to pay premiums. In July of that year, it failed. A rare flood in history destroyed the flood levees in the township, flooded the farmland and houses in the township, and caused heavy losses to farmers. After the disaster, the township government quickly claimed compensation from the insurance company, and the insurance company refused to pay compensation on the grounds that the township did not pay the premium. Because it is of great importance, the township government sued the court, and how should the court finally decide?
The focus of the debate in this case is whether the insured pays the premium as agreed as a prerequisite for the insurer to bear the insurance liability. Property insurance contract is a promise contract. As long as the two parties express their true intentions and reach a written agreement, the insurance contract is established and the insurer begins to bear the insurance liability. However, if there are clear provisions in the law or special provisions in the contract, it must be implemented in accordance with the special provisions of the law or contract. Under normal circumstances, once an insurance contract is concluded, both parties to the contract have a specific relationship of rights and obligations, among which the most important thing is that the insured has the obligation to pay the insurance premium and the insurer has the obligation to compensate the loss of the subject matter insured. Article 13 of the Insurance Law stipulates that after the insurance contract is established, the insured shall pay the insurance premium as agreed; The insurer begins to assume the insurance liability according to the agreed time.
In this case, the insurance company issued a policy to the township government, and the insurance contract was established. The rights and obligations stipulated in the contract shall be protected by law. Township governments should pay premiums as agreed. If the insured defaults on the premium, the insurer can recover it through claims or lawsuits. However, the parties to this case did not make a special agreement on when the contract came into effect, that is, when the insurer began to assume the insurance liability. The insurance policy only states that the premium will be paid in two installments. 165438+ 10. Whether the hometown government pays the premium according to the agreement is not a prerequisite for the insurance company to assume the insurance liability, unless it is specifically stipulated in the policy that "the policy will take effect from the date of payment". In this way, even if the insured does not pay a penny, the insurer will bear the insurance responsibility. Therefore, when the insurance contract in this case is established, it shall be deemed as effective when the contract is signed, and the insurer begins to bear the insurance liability.
For example, Tian insured a life insurance for his wife Qian, with an insurance amount of 65,438+10,000 yuan, and Tian was the beneficiary. Half a year later, Tian divorced his wife. The day after the divorce, Qian died unexpectedly, and the beneficiary did not change before his death. Regarding the insurance premium of 654.38+10,000 yuan paid by the insurance company, Qian's parents suggested that Tian had divorced Qian and no longer had insurance interests, so the insurance premium should be collected by him as the heir. Do you think this statement is correct? Why?
Answer: ① When concluding a life insurance contract, the applicant is required to have the insured interest, but the insured interest is not pursued when an insurance accident occurs or when an insurance accident occurs. The reason is that the subject matter of life insurance is human life and body, and life insurance is savings. ② The insurance premium shall be the beneficiary's field.