Persuade the designated insurance company to refuse to pay compensation.
On the evening of September 22nd, 2007, Wu Yuan, a released prisoner, saw his ex-girlfriend hugging a man while playing in a coffee shop in xipu town. Wu Yuan cut the man's right leg and face with a knife. The man's classmate Xiao Zhang stepped forward to dissuade him and was scratched by the other side with a knife. Appraised by the Forensic Medicine and Judicial Appraisal Center, Xiao Zhang's disability level is 9. His medical expenses cost 83,835.92 yuan. On September 9, 2008, Xiao Zhang asked a property insurance company to pay 4,000 yuan for disability insurance and 60,000 yuan for medical insurance according to the student safety insurance contract he bought when he entered school, but the other party issued a notice of refusal, claiming that the case was exempted.
Insurance cards cannot "guarantee" that family members will not be prosecuted.
The adjuster of the property insurance company said that Article 4 "Exemption Clause" 14 of the insurance contract stipulates: "The company shall not be liable for the part of the medical and medical expenses paid by the insured that should be borne by a third party according to law." In other words, Xiao Zhang's medical expenses should be borne by Wu Yuan, and the property insurance company has no responsibility.
Holding their son's "student ID card", Mr. and Mrs. Zhang said angrily, "If you buy insurance, you can't get compensation. What else can you buy?" Subsequently, Mr. Zhang took the property insurance company to court.
Defendant's agent: You have to pay for the misunderstanding.
"It should be compensated, but Wu Yuan must appear in court as a third person." Zhang Chi, the agent of the property insurance company, told reporters before the court session yesterday afternoon. Zhang Chi is a staff member of the legal affairs department of the defendant company. He believes that the reason why the two parties went to court is because the company's claim adjusters don't know enough about the insurance clauses. He said that after the property insurance company pays compensation, it will exercise the "right of recourse on its behalf" and ask Wu Yuan to compensate the property insurance company.
"Your request fundamentally violates the insurance law!" During the trial, Chen Feiji, the plaintiff's attorney, refuted the request of the defendant's agent. Lawyer Chen said that according to Article 68 of the Insurance Law, even if the property insurance company makes compensation, there is no "right of recourse", and it is illegal to ask Wu Yuan to appear in court as a third party.
After the trial, the defendant's agent agreed to pay compensation. Both the original defendant and the defendant expressed their willingness to mediate the specific compensation amount within one week.
Focus dispute
The exemption clause violates the insurance law.
Why is there an exemption clause that conflicts with Article 68 of the Insurance Law in Ping An Insurance sold by property insurance companies to students? Zhang Chi, the defendant's agent, explained that all exemption clauses are expressly stipulated by the CIRC, and property insurance companies have no right to change them privately.
If a case like Xiao Zhang reappears, can the insured get compensation smoothly? "I can't promise." Zhang Chi said that every adjuster has a different understanding of the legal provisions, and it is inevitable that such misunderstandings will occur. The plaintiff's attorney believes that the exemption clause of the property insurance company obviously violates the law.
Focus adjustment
Article 68 of the Insurance Law: If the insured of life insurance has an insurance accident such as death, disability or illness due to the behavior of a third party, the insurer has no right to claim compensation from the third party after paying the insurance money to the insured or beneficiary, but the insured or beneficiary has the right to claim compensation from the third party.