From China's point of view, with the increasing number of cars, auto insurance has become the main part of China's non-life insurance market and the largest property insurance. Then, in order to make you more aware of the concept of insurance claims, the following is a typical case analysis of motor vehicle insurance contract disputes compiled by me. Welcome to read and browse.
Su Mou v. an insurance company (case of property insurance contract dispute)
Main idea
The insurance company cannot prove that it has fulfilled its obligation to clearly explain the general exemption clause when concluding the insurance contract, and the exemption clause is invalid.
The facts of a legal case
On February 27th, 20 12, 65438, Su handled compulsory insurance and commercial insurance for all his motor vehicles from Company A, and the insurance period was from February 28th, 2000/2, 65438 to February 27th, 2003 13. The insurance clause stipulates that "in case of an accident, the insurer shall not be liable for compensation if the driver has one of the following circumstances: (9) driving under other circumstances that the insured vehicle is not allowed to be driven in accordance with laws and regulations or the relevant provisions of the traffic management department of the public security organ." Su applied for a driver's license for the first time on May 20th 1313. On June 22nd, 20 13, Su Mou was driving an insurance vehicle alone, and a rear-end traffic accident occurred in shenyang-haikou expressway, causing damage to the insurance vehicle and the third-party vehicle. Su is fully responsible for the accident. Later, Su applied for compensation from insurance company A.. Because insurance company A refused to pay compensation, Su sued the court and asked insurance company A to pay more than 320,000 yuan for vehicle maintenance and towing.
submit to trial
The court held that the driver Su Mou's behavior of driving a motor vehicle on the expressway alone during his internship violated the provisions in the Regulations on the Application and Use of Motor Vehicle Driving License that drivers should be accompanied when driving on the expressway during their internship, which belongs to the exemption clause of the insurance contract, but it does not belong to the prohibition provisions in laws and administrative regulations. For this exemption clause, although insurance company A reminds the insured to read it in the express notice column of the insurance policy, there is no evidence to prove that it has fulfilled the obligation of clear explanation, so this clause is not established and insurance company A should bear the insurance responsibility. The judgment supported Sue's claim.
point out
For all clauses in the insurance contract that exempt the insurer from liability, including some clauses of "exemption" or "exclusion of liability" in the insurance contract, as well as exemption clauses such as deductibles, percentage of deductibles and proportional compensation scattered in other parts of the insurance contract, the insurer shall prompt the applicant when concluding the contract. For general exemption clauses not prohibited by laws and administrative regulations, the insurer shall also prove that it has fulfilled its clearly stated obligations when concluding the contract, otherwise the clause will not take effect. The applicant or the insured can also ask the insurer to prompt and explain the exemption clause when concluding the contract, so as to understand and fully understand the exemption clause and avoid differences and disputes on whether it belongs to the scope of claims when an insurance accident occurs.
Zheng v an insurance company (case of property insurance contract dispute)
Main idea
If the insured lends a motor vehicle to a legal driver and a traffic accident occurs, the insurance company shall still bear the insurance liability.
The facts of a legal case
On September 8, 20 10, Zheng handled compulsory insurance, commercial third liability insurance and non-deductible third liability insurance for his motor vehicles. The third liability insurance clause stipulates: "If the insured motor vehicle or its licensed legal driver has an accident during use, resulting in personal injury or direct loss of property to a third party, the insurer shall compensate the insured according to the provisions of this insurance contract." 2010165438+10.8 On October 8, Zheng lent his insurance vehicle to his fellow countryman Pan Mou, who drove the insurance vehicle and forcibly collided with people outside the vehicle, causing damage to both vehicles. Pan Mou took full responsibility for the accident. On September 9, 20 1 1 traffic accident compensation case, it was ruled that Zheng had no fault in lending the vehicle and was not liable for compensation; Pan compensated Qiang for a vehicle loss of 6.5438+0.3 million yuan. After Pan fully fulfilled his obligations as determined in the traffic accident compensation case, the insured Zheng sued the court, requesting an insurance company to pay compensation of RMB 6,543,800+3,000.
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The court held that the dispute insurance clause was a standard clause applied by insurance company A before the implementation of the Tort Liability Law in July 20 10. Before the implementation of the Tort Liability Law, in this case, the insured and his licensed legal driver were jointly and severally liable for repayment. After the implementation of Tort Liability Law, the way that the insured and its authorized legal drivers bear external liability has changed, and the insured only bears compensation liability when the damage is at fault. If the insurer still bears the insurance liability for the insured's tort liability according to the original insurance standard clauses, the scope of the insurer's liability and the amount of compensation will be greatly reduced. Based on the principle of good faith, the insurer has the obligation to prompt and explain the limitation of liability (that is, to exempt the corresponding liability), and should make corresponding adjustments in premium accounting. The parties to the contract have two interpretations of the above standard terms, and should make an interpretation in favor of the insured according to law. In this case, Pan recognized Zheng's prosecution and provided a strong receipt from the outsider, which proved that traffic accident compensation's liability for compensation had been fully fulfilled. Insurance company a should bear the liability for payment of commercial three-liability insurance. Therefore, the judgment supported Zheng's petition.
point out
In real life, it is very common to lend a vehicle to others to drive. At present, in China's vehicle insurance system, the insurance premium rate is mainly determined according to the situation of the vehicle, but has little correlation with the driver's own age, driving experience, driving habits, marital status and so on. Therefore, China's auto insurance embodies "car-following doctrine" rather than "follower doctrine". The principle of vehicle following covers the responsibility of the vehicle, not the external responsibility of a specific driver. In this case, if there is a traffic accident, the liability of the legal driver allowed by the insured should also be guaranteed by the third party liability insurance, so the insurance company cannot refuse to pay compensation.
Zhongmou v an insurance company.
Main idea
The insurance company can't be exempted from the responsibility for the road water accumulation caused by the rainstorm and the damage to the normal running vehicles, which is in line with the insurance contract.
The facts of a legal case
On October 8, 20 12, 165438/kloc-0, Zhongmou insured all his motor vehicles with insurance company A for one year. The insurance clause stipulates that during the insurance period, if the insured or its authorized legal driver uses the insured vehicle, the insurer shall be responsible for the loss of the insured vehicle caused by the rainstorm. The insurance company is not responsible for compensation for engine damage caused by flood or wading. 20 13, 1018 October, Zhong's normal motor vehicle was hit by a rainstorm, which caused the engine to stall and the vehicle to be damaged. After the vehicle was repaired, Zhongmou applied to insurance company A for compensation, and insurance company A refused to compensate for some losses of the engine. Zhongmou sued the court and demanded that the insurance company compensate the vehicle maintenance fee of more than 90,000 yuan.
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The court held that the engine damage of the insurance vehicle was caused by driving into the stagnant water area, and the reason for the formation of road stagnant water was the continuous rainstorm that day, so Zhong's loss was in line with the rainstorm insurance coverage agreed in the insurance clause. The road at the time of the insurance accident belongs to normal road conditions. Insurance company A has no evidence to prove that Zhongmou deliberately drove the car into the stagnant water, so Zhongmou did not have the subjective intention of wading. Although the insurance clause also stipulates that the engine damage caused by the insured vehicle wading does not fall within the scope of insurance liability, according to the law, if there are more than two interpretations of the format clause, the interpretation that is unfavorable to the party providing the format clause shall be made. Therefore, in the case that the insurance clause has stipulated that the rainstorm falls within the scope of insurance liability, insurance company A is not supported to claim exemption from compensation based on the exemption clause of engine damage caused by wading. Therefore, the judgment supported Zhong's petition.
point out
The road was flooded due to heavy rain, and the driver normally drove the insurance vehicle into the flooded area, resulting in engine damage. If the driver has no subjective intention, it should be considered that the rainstorm caused the loss of the insured vehicle, and the insured has the right to ask the insurance company to bear the insurance liability according to the insurance clauses. However, if the driver deliberately drives into a river, ditch, pond, etc. If the engine is damaged, the insurance company can of course invoke the exemption clause to refuse compensation.
Fan sued an insurance company for property insurance contract dispute.
Main idea
After the insurance accident, the insured is too lazy to apply for compensation, and the accident victim can directly claim compensation from the insurance company.
The facts of a legal case
A transportation company insured its heavy-duty semi-trailer tractor with a commercial three-liability insurance company. During the insurance period, Yan was injured in an accident while driving an insurance vehicle, and Yan was fully responsible for the accident. Subsequently, Fan took Yan, a transportation company and an insurance company to court and demanded compensation. The court ruled that an insurance company paid more than 240 thousand yuan in compulsory insurance, Yan paid Fan a loss of more than 280 thousand yuan, and a transportation company assumed supplementary liability for compensation. After the judgment came into effect, Yan and A transportation company failed to fulfill their obligations, and insurance company A did not assist in the implementation. Fan sued the court and demanded that the insurance company compensate the three liability insurance premiums for more than 220,000 yuan.
submit to trial
The court held that according to the law, if the insured of liability insurance causes damage to a third party and the insured fails to compensate the third party, the insurer will not compensate the insured's insurance money. If the insured of liability insurance causes damage to a third party, and the insured's liability for compensation to the third party is determined, and the insured's request is slow, the third party has the right to directly request compensation from the insurer for the part that should be compensated. The effective judgment has confirmed the insured's liability for compensation to the third party, namely Fan, and the insured's request is slow, so Fan has the right to directly request compensation from insurance company A. Therefore, the judgment supports Fan's claim.
point out
After a road traffic accident causes damage to a third party, the insured, as the infringer, should actively negotiate with the insurance company, apply to the insurance company for compulsory insurance and commercial insurance claims, and compensate the accident victims in time. If the insured neither applies to the insurance company for compensation, nor actively compensates the accident victims, or conceals or evades the liability for compensation for the accident, the accident victims can directly ask the insurance company to pay the third party liability insurance premium to safeguard their own rights and interests.
Xu v a property insurance contract dispute of an insurance company.
Main idea
Once a car accident happens, if the insurance company or the insured unilaterally entrusts the loss, it is easy to cause disputes.
The facts of a legal case
On June 20 14, Xu handled compulsory insurance and motor vehicle insurance for all motor vehicles in Company A for one year. On July 20th, 20 14, a bicycle accident occurred when Shen, a driver allowed by Xu, was driving an insurance vehicle. The traffic police department determined that Shen was fully responsible for the traffic accident. After the accident, Xu reported the case to A insurance company in time and negotiated with the insurance company for car damage maintenance many times. Due to unsuccessful negotiation, Xu entrusted an appraisal company to evaluate the repair cost of the damaged vehicle on August 1 2065. Xu paid the appraisal fee and repaired the insured vehicle according to the appraisal price. Subsequently, Xu applied to insurance company A for compensation, and insurance company A refused compensation on the grounds that the difference between the evaluation price and the fixed loss price was too great. Xu sued the court, demanding that the insurance company be ordered to pay more than 50,000 yuan for vehicle repair.
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The court held that the price appraisal report provided by Xu was made by a qualified appraisal institution according to law, while insurance company A only provided the insurance vehicle loss assessment report in the lawsuit. The damage assessment report has neither the date and basis of damage assessment, nor the signatures of insurance companies, surveyors and the insured, nor any materials such as photos of car damage. In terms of evidence validity, the price assessment report provided by Xu was higher than the loss assessment report of insurance company A. Insurance company A failed to provide evidence to prove that the price assessment report was wrong in procedure or entity, and the court adopted the conclusion of vehicle damage assessment. Therefore, the judgment supports Xu's claim.
point out
In the event of a car accident, the insurance company should arrive at the scene of the accident in time after receiving the report and determine the damage. If there is a dispute between the insurance company and the insured on the fixed loss price, they should try their best to settle it through consultation and should not shirk each other. If negotiation fails, when the insurance company or the insured entrusts the assessment unilaterally, they should consciously abide by the good faith, promptly notify the other party to check the vehicle situation and obtain the original data, so as to ensure the corresponding rights of both parties in the assessment process and improve the objectivity of the assessment report and the recognition of both parties.
Company A v. Insurance Company B (dispute over property insurance contract)
Main idea
After a traffic accident, the injured and the insured should be cautious about the involvement of professional claims agents (commonly known as "injured scalpers") in compensation matters.
The facts of a legal case
On October 20111year1month, Company A insured its motor vehicle with Company B for compulsory insurance and commercial liability insurance. During the insurance period, the driver of Company A collided with the motorcycle driven by Shen, causing Shen and motorcycle passenger Sun to be injured, and the vehicle was damaged. The driver of Company A was responsible for the accident. On August 28th, 20 12, Company A reached a mediation agreement with Shen and Sun under the auspices of the traffic police department, and Company A compensated Shen with 65,438+million yuan and Sun with 5,000 yuan. Company A applied for compensation from insurance company B, and insurance company B refused to pay compensation on the grounds that Shen did not actually receive the compensation. Company A appealed to the court, requesting to order insurance company B to pay the compensation paid by company A to Shen for more than 6,543,800 yuan.
submit to trial
The court found through trial that the compensation had been collected by Dong, the agent entrusted by Shen. Dong appealed to the court, claiming that he had paid compensation of 90,000 yuan to Shen and provided a receipt of 90,000 yuan. After verification, Shen only received a compensation of 24,000 yuan from Dong and issued a receipt. Dong tampered with the receipt himself. Because Dong made a false statement and forged evidence, the court punished Dong for 10 days in judicial custody according to the relevant provisions of the Civil Procedure Law. In this case, on the basis of Dong's refund of 60,000 yuan to Shen, Company A and Insurance Company B reached a mediation agreement.
point out
In the road traffic accident compensation treatment, there are a large number of professional claim settlement agents, commonly known as "human injury scalpers", who take advantage of the weakness of accident victims' lack of professional legal knowledge to provide one-stop claim settlement services and obtain illegitimate interests from them. For example, in this case, forging receipts and embezzling the creditor's rights of the injured have greatly damaged the legitimate rights and interests of the parties and should be punished by law. Therefore, in the handling of traffic accident compensation, the injured and the insured should be cautious about the intervention of "injured scalpers" in compensation matters and safeguard their rights and interests according to law.
Chen v. a property insurance contract dispute of an insurance company.
Main idea
After a traffic accident, if the driver leaves the scene of the accident without justifiable reasons, the insurance company shall be exempted from liability.
The facts of a legal case
On 20 1 1, Chen Mou insured his private car with insurance company A, and the insurance period was from 20 1 1 to February 20 12/4. The insurance clause stipulates that after the accident, if the insured or his permitted driver drives the insured motor vehicle or abandons the insured motor vehicle to escape from the scene of the accident and fails to take measures according to law, the insurer is not responsible for compensation. 2011September 2 at 4: 3 1 5 seconds, the command center of Shanghai Public Security Bureau 1 10 police station received a report that a car rolled over at G50 (westbound) A30 (jinshanwei direction), and the traffic impact was not significant. At 5: 54, the son of the driver Chen Mou also reported that he overturned and no one was injured. He went to the hospital by himself. Later, Chen Mou applied to insurance company A for compensation, and insurance company A refused to pay compensation on the grounds that the accident met the exemption clause in the insurance contract. Chen Mou subsequently sued the court, demanding that the insurance company be ordered to compensate for the loss of vehicles of more than 500,000 yuan.
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The court held that Chen Mou's son did not call the police until passers-by called the police nearly three hours after the rollover, and left the scene on the grounds of seeking medical treatment. Chen Mou's son claimed that he was in a coma for two hours before calling the police, but it was found that he made 14 phone calls during this period, so there were loopholes in his statement, which violated his integrity. In addition, the accident only caused minor injuries to Chen Mou's son, and his reasons for leaving the scene for medical treatment were not sufficient without affecting his life safety. Therefore, it is unreasonable and necessary for Chen Mou's son to leave the scene of the accident, that is to say, he fled the scene, and the insurance company's exemption was established. Therefore, it was decided not to support all applications from Chen Mou.
point out
If a traffic accident causes casualties or property losses, the driver shall protect the scene and call the police immediately, and shall not leave the scene of the accident. But when life is dying or other emergencies need to be dealt with in time, it is reasonable and necessary to leave the scene, because the right to life is higher than the property right, and if it is not rescued in time, it may endanger life. In this case, the insurance company should not be hard on the driver. However, this does not mean that once the driver is hurt or feels hurt, he can leave the scene on his own. Without the on-site handling by the police, it is impossible to confirm whether the driver was drunk driving or taking drugs. Therefore, if the driver leaves the scene without justifiable reasons, the legal consequences of exemption from insurance liability will occur when the exemption clause takes effect.
Insurance Company A v. Insurance Company B (dispute over property insurance contract)
Main idea
After the insurance company advances the rescue expenses in advance within the scope of compulsory insurance liability, it can recover from the drunk driver or his unit.
The facts of a legal case
Company B insured the motor vehicles under its name in Company A for compulsory insurance. During the insurance period, Xu, an employee of Company B, was drunk driving the vehicle involved to go out to deal with the company's affairs, causing Fu to be injured. Xu was fully responsible for the accident and assumed criminal responsibility. After the accident, Fu filed a lawsuit, demanding that Company A should be liable for its losses within the compulsory insurance limit, and Company B should be liable for the shortfall. After hearing the case, the court made a judgment that Company A compensated a certain 65438+ 10,000 yuan within the compulsory insurance limit, and Company B compensated a certain 8 600 yuan. After paying the insurance premium to Fu, Company A sued the court and demanded that Company B pay compensation of 6,543,800 yuan and interest.
submit to trial
The court held that Xu drunk driving a motor vehicle caused personal injury to a third person, and insurance company A was liable for paying compensation for the compulsory insurance in another lawsuit filed by the third person, and could recover compensation from the infringer who caused the accident according to law. The vehicle involved is owned by Company B, and Xu is an employee of Company B. If a traffic accident occurs in the course of performing duties and causes damage to a third party, Company B shall be liable for compensation. Therefore, the judgment supports the claim of insurance company A that requires company B to compensate related expenses and pay interest losses.
point out
For drunk drivers, not only will they be convicted and sentenced for drunk driving, but the insurance company will be exempted from the liability of compulsory insurance and commercial insurance, and the drunk driver himself will bear the civil liability for personal injury or property loss of the accident victim. If drunk driving causes personal injury to a third person, the insurance company has the right to recover from the drunk driving actor after paying the rescue expenses in advance. If the drunk driver's behavior belongs to the performance of his duties, the insurance company may claim compensation from his unit. Therefore, vehicle units and drivers should abide by traffic laws and regulations, prohibit drunk driving and maintain normal traffic order.
Wang v an insurance company (dispute over property insurance contract)
Main idea
If the driver's license is deducted 12 points, the insurance company will be exempted from liability for compensation.
The facts of a legal case
On may 20 1 1, Wang handled compulsory insurance and special insurance for telephone sales of motor vehicles in company a. The insurance period is from May 28th, 20 1 1 year to May 27th, 20 12. According to the insurance clause, if the driver still drives the motor vehicle when the driver's license is lost, damaged, expired, detained according to law, or the score reaches 12, the insurer will not be liable for compensation. On May 20 12 1 1 day, the driver allowed by Wang collided with the vehicle driven by Zuo, an outsider, causing damage to both vehicles, and Ning took full responsibility for the accident. After paying compensation to the left, Wang applied for compensation from an insurance company. Insurance company A thinks that Ning's driver's license deduction has reached 12, which is in line with the exemption clause of the insurance contract, so it refuses to pay. Wang sued the court and asked the insurance company to compensate the car damage fee and other expenses 1 1 more than ten thousand yuan. It is also found that during the scoring period of 2011to 20 12 1.29, the driver of the accident Ning scored 12 points, but on May 2012,65433 points.
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The court held that the "Regulations on the Implementation of the Road Traffic Safety Law" stipulates that a motor vehicle driver may not drive a motor vehicle if his motor vehicle driving license is lost, damaged, expired, or detained, temporarily detained or scored 12. Therefore, the exemption reasons in the dispute exemption clause belong to the prohibitive provisions in administrative regulations and should be known and followed. Moreover, the insurance company has written this clause in black font and reminded the insured to read it on the front of the insurance policy. Wang argued that the exemption clause was invalid on the grounds that insurance company A did not clearly state its obligations and did not support it. Ning still drives a motor vehicle after the driver's license deduction reaches 12, which not only violates the prohibition provisions in laws and administrative regulations, but also conforms to the exemption reasons stipulated in the insurance contract, so insurance company A does not have to bear the insurance liability.
point out
When the driver's license score reaches 12, you should accept the relevant training and examination organized by the traffic police department and re-obtain the driver's license. During this period, you are not allowed to drive a motor vehicle. If a driver illegally drives a motor vehicle and has a traffic accident, the exemption clause will be effective as long as the insurance company regards this "situation prohibited by laws and administrative regulations" as the exemption reason of the insurance contract and gives a prompt. Once the driver violates the insurance clauses exempted from prohibitive clauses in laws and administrative regulations, the insured claims compensation on the grounds that the insurance company only gives tips but does not clearly state its obligations, and its requirements are not supported.
Zhu v an insurance company (dispute over property insurance contract)
Main idea
Insurance companies are exempted from liability for driving unregistered and expired motor vehicles.
The facts of a legal case
On April 20 12, Zhu Weiqi handled compulsory insurance and vehicle insurance in Company A for one year. The insurance clause stipulates that "the insurer shall not be liable for compensation in any of the following circumstances: (1) Unless otherwise agreed, there is no valid driving license or license plate or temporary license plate or temporary mobile license plate issued by the traffic management department of the public security organ at the time of the insured accident." On May 2012 13, Zhu had a traffic accident driving a BMW and a bicycle, which caused car damage and road property loss, and incurred rescue expenses. Zhu takes full responsibility for the accident. The vehicle number recorded in the road traffic accident certificate is "Shanghai HG8537 (Pro) ended on May 9". After the accident, Zhu applied to insurance company A for compensation, and insurance company A made a written notice of refusal. Zhu Sui appealed to the court, requesting the insurance company to compensate the vehicle repair fee and road property loss of 465.438 million yuan.
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The court held that the insurance vehicle driven by Zhu had not been registered at the time of the accident, and the temporary number plate he held had expired. Insurance company A had the right to refuse compensation within the scope of commercial insurance. Regarding the exemption clauses, Company A specially reminds the insured to read the insurance clauses carefully, especially the exemption clauses in the express notice column of the policy. Moreover, the law prohibits motor vehicles from driving on the road without being registered by the traffic management department of the public security organ. This legal provision has been publicized and does not object to understanding, and anyone must abide by it. Therefore, Zhu's claim that the above exemption clause is invalid because insurance company A fails to fulfill its obligation of timely and clear explanation cannot be established, and his application should be rejected.
point out
Before buying a new car without a formal license, car owners often rely on temporary driving licenses, but some car owners ignore the use period of temporary driving licenses. If you drive a temporary license plate that exceeds the time limit on the road, once a traffic accident causes personal injury and car damage, according to the insurance clauses, the commercial insurance company will not pay compensation. Therefore, car owners should pay attention to the service life of the temporary license plate, replace the temporary license plate in time and apply for a formal license plate to avoid losing insurance protection.
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