Case 1: An accident occurred during recess.
Wang, a junior high school student in a middle school in Liaoning province, tripped and fell to the ground while running between classes, causing swelling and pain in his right elbow joint. After the incident, the school contacted the parents in time and sent Wang to a nearby hospital. After examination, it was a slight fracture of the elbow joint of the right hand.
Next, the students' parents sent their children for treatment, but three weeks later, the doctor told Wang that his right elbow was dislocated and he had to go to a big hospital for surgery.
Because it costs a lot to go to a big hospital for treatment, the parents of the students asked the school to pay most of these medical expenses first (because the students have accident insurance), but the two sides failed to reach an agreement on this issue. Later, after mediation by the judicial office, the school paid two-thirds of the medical expenses first, and the school paid half of the difference between the medical expenses of students.
Analysis:
In this case, student Wang's injury accident should be divided into two parts. Student Wang's fall at school only caused a slight fracture of his right elbow, which was a minor injury. He just needs to have a rest. Later, the dislocation of the right elbow joint was caused by hospital dressing or other reasons of Wang himself, and Wang should go to the hospital to solve it.
According to the fifth paragraph of Article 32 of the Regulations on School Safety Work, if a student violates the provisions of laws, regulations and rules, violates the rules and regulations of the school or disciplines, and commits an act that should be known to be dangerous or possibly harmful to others according to his age and cognitive ability, or if the student's behavior is dangerous, the school and teachers have warned and stopped it, but the student refuses to be dissuaded or corrected, the school will not be liable for compensation.
However, considering Wang's family situation and real life, the school promised to compensate Wang for the corresponding expenses, which is also a humanitarian act of the school.
Case 2: Parents with sudden illness at school claimed 65,438+10,000 yuan.
On the morning of June 5438+February 65438+July, 2006, Hu, a first-year pupil of a boarding private school in Ningbo, vomited after getting up.
In the process of taking Hu to the hospital, the school immediately informed Hu's parents in Shanghai. When his parents arrived at Ningbo Hospital, Hu was already in a coma. Hu received treatment in Ningbo for 3 days. During the treatment, out of concern for the students, the school sent teachers to accompany the parents.
Later, Hu was transferred to Shanghai by his parents for further treatment. When he was transferred to another hospital, the school also sent a special person to accompany him. Shanghai hospital further diagnosed cerebral hemorrhage caused by vascular rupture caused by congenital malformation of cerebral vessels, and made it clear that it was not caused by external forces.
In the meantime, the school sent people to visit many times. The school not only paid all the expenses of treatment in Ningbo for Hu's parents, but also mobilized all the faculty and staff to offer love to Hu and raised nearly 30,000 yuan to help Hu's parents. After surgery and nearly two months of treatment, Hu miraculously recovered.
After recovery, Hu's parents thought that their child had a sudden illness at school and almost lost his life. He spent more than 100 thousand to save the child, which delayed his work. Not only did he not agree to return the medical expenses of 6.5438+0.5 million yuan paid by the school, but he also proposed to compensate the medical expenses of nearly/kloc-0.0 million yuan paid by the insurance company.
Analysis:
According to the third paragraph of Article 12 of the Measures for Handling Student Injury Accidents issued by the Ministry of Education, students have special physique, special diseases or abnormal mental state, and schools do not know or find it difficult to know the student injury accidents caused. If the school has fulfilled its corresponding obligations, there is no misconduct and there is no legal responsibility.
After Hu vomited, the school sent Hu to the hospital for examination and treatment in time, and the measures taken were positive and effective. At the same time, the school immediately informed the parents when Hu was taken to the hospital.
These practices are enough to show that the school has fulfilled its corresponding responsibilities, and there is no misconduct and no legal responsibility.
Out of concern for Hu, the school paid his medical expenses, sent someone to take care of him, accompanied his parents to transfer Hu to Shanghai, visited Hu in Shanghai many times, and mobilized donations from faculty and staff. These practices are also in line with Article 26 of the Measures for Handling Student Injury Accidents: if the school has no responsibility, it can give appropriate help to the injured students according to the actual situation and on the principle of voluntariness and possibility.
In this case, it is unreasonable for Hu's parents not to return the medical expenses of 10.5 million yuan paid by the school, but also to ask the school to compensate nearly10 million yuan.
Case 3 The school will be fined 300 yuan for damaging the school chandelier.
Ma, a junior 3 student in a school in Shandong Province, attended ... >>
Question 2: When people encounter an accident or misfortune and fail to buy insurance in advance: 30 points, 3,000 yuan, and at the same time, it is necessary to ensure that the insurance amount is not too high. Order is the first, buy insurance for children and minors, mainly choose to buy commercial insurance, Xue Ping insurance, accidental injury comprehensive insurance,
Question 3: Case analysis of personal accident insurance claims: What to pay and what not to pay is too general! Key points for judging accident insurance claims when the application materials are complete: 1, and whether the accident time is within the insurance period; 2. Whether the insured accident belongs to accidental liability, the definition of accident in Insurance Law is "external, sudden, unintentional, non-disease and objective events that cause harm to the body", and pay attention to "non-disease" here! 3. Whether the insured accident belongs to the "exemption" in the insurance clause; Based on the above, you can judge whether you can pay.
Question 4: We need a case about the principle of insurance proximate cause. . On the principle of proximate cause in insurance law
[Huang Yixin]-(August 29th, 2005)/Read 2 1 182 times.
On the principle of proximate cause in insurance law
Huang Yixin
The principle of proximate cause is the first basic principle of determining causality established by British marine insurance law. After long-term practice and development, it has been adopted by the insurance laws of many countries. Insurance companies in China often refuse to pay compensation on the grounds of non-proximate cause when insurance accidents occur. However, due to the lack of clear provisions in China's insurance legislation, local courts are generally unfamiliar with this imported product, and judges will not or dare not apply it in judgment documents, resulting in some difficult or unclear insurance disputes from time to time. In order to improve China's insurance legislation and connect with international insurance practices, China should confirm the principle of proximate cause in legislation and judicature as soon as possible. This paper attempts to elaborate on this in order to attract more attention.
First, the meaning of the principle of proximate cause
Causation, which means "the closest, approximate and immediate" in English (in time, place or order), is difficult to find a completely corresponding word in Chinese, such as "direct cause" (corresponding to direct cause), which cannot fully cover its connotation, so it is simply translated into "proximate cause" now. The introduction of this exotic product is not only fashionable, but also timely, and will be a mature legal rule system for adjusting causality in Anglo-American law. The principle of proximate cause, in short, means that the insurer's liability should be limited to the losses caused by the insurance risk as proximate cause. Although China's current Insurance Law and Maritime Law do not stipulate the principle of causation, the principle of proximate cause is generally applied in foreign-related relations such as marine insurance, and the Interpretation on Several Issues Concerning the Trial of Insurance Disputes (Draft for Comment) promulgated by the Supreme Court in February 2003 also adopted this concept. Article 19 of the exposure draft clearly stipulates: "If the insurer claims to bear the liability for compensation by taking the loss caused by the insured risk as the proximate cause, the people's court shall support it."
The principle of proximate cause originates from the British Marine Insurance Act (1906). Article 55 of the Law (1) stipulates: "According to the provisions of this Law, unless otherwise stipulated in the insurance policy, the insurer shall be liable for losses caused by the insured peril as the proximate cause, but not for losses caused by the insured peril as the proximate cause." (1) This is because the marine insurance contract is a strict "limited compensation contract", and the scope of the insurer's liability for compensation cannot be the total loss of the subject matter insured, but the partial loss caused by dangerous reasons within a certain range (so-called "insured loss"). Therefore, marine insurance claims should apply the special principle of causality, that is, the so-called "principle of proximate cause" in common law. This principle requires that there must be a causal relationship between the occurrence of insurance risks and the damage to the subject matter insured, which conforms to the provisions of the marine insurance law. This principle has been gradually extended to the whole insurance law and even tort law (even a part of contract law) by judges and scholars in common law system. At present, the insurance legislation of many countries in the world mostly determines the principle of proximate cause as the basic principle of insurance law. ①
However, because the Anglo-American legal system emphasizes case analysis and ignores abstract induction, the meaning of proximate cause is not completely clear so far. For example, prosser, a famous professor of tort law in the United States, thinks that the word Proximate means the nearest in time and space. Blake's legal dictionary said: "The so-called recency here is not necessarily the recency in time or space, but the recency of a causal relationship. The proximate cause of damage is the main cause or motive or effective cause. " Nevertheless, in the long-term trial practice, the judges of the two legal systems have established three basic rules for judging proximate cause through precedents and theories: first, proximate cause is a substantial, significant and positive factor leading to damage results; Second, this factor works naturally and continuously, which does not involve other factors that affect the occurrence of results and cause the interruption of causality; Third, based on the concept and policy analysis of fairness and justice. ② This time, the Supreme Court also defined proximate cause in the second paragraph of Article 19 of the Judicial Interpretation of Insurance (Draft for Comment): "proximate cause refers to the decisive and effective reason for underwriting loss". However, the meanings of "decisive" and "effective" are obviously too vague and lack of maneuverability, so it still needs to be individualized and concrete in the form of judicial practice.
Second, the specific identification of proximate cause
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Question 5: Case analysis of personal accident insurance A. The proximate cause of death is a car accident, which belongs to insurance liability and the insurance company should compensate; The direct cause of a B's death is heart disease, which belongs to the exclusion liability. Insurance companies do not bear the responsibility of death payment, but should bear the responsibility of compensation for fractures caused by car accidents.
Question 6: Claims for insurance compensation? In fact, in this matter, it depends on who the designated beneficiary is.
However, there are special reasons for this. According to the insurance law, the beneficiary of the policy must be the immediate blood relatives or legal partners of the insured!
In this case, because Hu and Wang had divorced and claimed first, Wang was only disabled. According to the insurance law, the indemnity is collected by Wang himself.
The second part, after Wang's death, the identity of this beneficiary has changed, and Wang's parents have reason to propose insurance payment.
In this case, since Wang and Hu have divorced and the beneficiary is still Hu, it may lead to an investigation and confirm that Wang's death has nothing to do with Hu before continuing the claim settlement procedure!
Question 7: 30-year-old accident insurance claim case Mr. Li insured himself with a "sincere protection" protection plan, with a basic coverage of 500,000 yuan, a monthly premium of 1.548 yuan, a 25-year protection of 10 year, and a * * premium of 1.86 million yuan. From the first payment, he can.
1, death insurance:
If Mr. Li dies unfortunately within the validity period of the contract, the beneficiary of his death can get the highest death insurance18.6×118% = 219000 yuan, and the main supplementary insurance contract is terminated.
2. Accidental death insurance:
If Mr. Li dies unexpectedly within the validity period of the contract, the beneficiary of his death can get the following amount of death insurance money, and the main supplementary insurance contract is terminated.
Aviation accidental death: 50× 20 =100000 yuan.
Traffic accident death: 50×10 = 5 million yuan.
Death in a self-driving accident: 50× 2 = 1 10,000 yuan.
Ordinary accidental death: 500,000 yuan
All the above shall be paid at the same time, accounting for 1 18% of the accumulated premium.
3. Accident disability insurance:
If Mr. Li is unfortunately disabled due to accidents during the validity of this contract, he can get the following amount of accidental disability insurance:
Aviation accident disability: 6,543,800 yuan × disability rate.
Traffic accident disability: 5 million yuan × disability ratio.
Disability in self-driving accident: 6.5438+0 million yuan × disability ratio.
Ordinary accidental disability: 500,000 yuan × disability ratio
4. Accidental hospitalization allowance insurance:
If Mr. Li has an accident before he is 80 years old and needs hospitalization, we will pay the accidental hospitalization allowance insurance according to the actual hospitalization days of the insured ×250 yuan/day.
5. Overdue insurance premium:
If Mr. Li is alive at the expiration of this contract, he can get the maturity insurance premium of 265,438 yuan +0.9 million yuan, and the main supplementary insurance contract is terminated.
Question 8: It's not an accident that insurance claims are not paid, although we think it happened by accident.