1. Why did you commit suicide and be refused compensation two years after the contract came into effect?
Wang insured a whole life insurance for himself, and the effective date of the contract was 1 March 19971. Due to Wang's failure to pay the renewal fee on time, this insurance contract is valid until1May 2, 998. On May 1999 and 1 day, Wang repaid the insurance premium and interest owed. The effectiveness of this contract is restored through negotiation between both parties. 19991June 10, Wang committed suicide, and his beneficiary asked the insurance company to pay the insurance money. However, the insurance company believes that the "reinstatement date" should be the starting date when the contract takes effect, so it refuses to pay compensation on the grounds that the contract is less than two years old. Wang's beneficiary filed a public prosecution with the court.
Analysis: According to the relevant principles of contract law, the "suspension" of contract effectiveness is different from "termination", and "suspension" is only a temporary suspension of contract effectiveness, not a permanent loss of effectiveness. When the insured and the insurer reach an agreement and pay the premium and interest, the validity of the contract will be restored. Without special agreement, all original clauses, including suicide clauses, should be traced back to the original state (that is, the date of establishment of the contract), so it is unreasonable and obviously unfair to postpone the effective date of suicide clauses.
In this case, the effectiveness of the suicide clause in the insurance contract should be counted from the date of the establishment of the contract, which has expired for two years. The insurance company shall pay the insurance premium to Wang and his insurance beneficiary according to the contract.
2. China Life was awarded compensation for the "defects" in the exemption clause.
Recently, the Chaoyang District Court of Beijing concluded the case of Hu (1 1 year old) v. China Life Insurance Co., Ltd. Beijing Branch (hereinafter referred to as life insurance company) and ordered the life insurance company to compensate Hu for more than 7,000 yuan.
Hu is a student in Huairou District Town Central Primary School (hereinafter referred to as Town Primary School). 199 from September 17 to September 18, 2002, the primary school continuously insured "China life insurance for students and children" in the life insurance company. Additional risks are accidental injury medical insurance and hospitalization medical insurance. Hu is one of the insured and has paid the corresponding insurance premium.
On June 25th, 20001year, Hu was diagnosed as "left nephroblastoma" and was hospitalized. In July of the same year, she was discharged from the hospital on 0/9/KLOC. He was admitted to the hospital again on June 6th 165438+ and discharged on February 8th at 65438. According to Hu's claim, the life insurance company settled the expenses of two hospitalizations. Last September, 65438+May, Song Yang Town Primary School once again insured the students of the school with China Life Insurance and additional risks from the life insurance company through Beijing Jiaxin Insurance Agency Co., Ltd. Hu Qi is still among the insured and has paid the insurance premium of 50 yuan. The insurance period is from 0: 00 on September 5, 2003 to 24: 00 on September 4, 2004. In June 2004, Hu was hospitalized twice, but the life insurance company refused to settle the claim, so Hu took the life insurance company to court and asked the life insurance company to settle the claim of 9250.46 yuan.
The life insurance company argues that its exemption clause stipulates that "the insured has an incurable disease before insurance" and "the company is not responsible for paying insurance benefits", so it does not agree to claim compensation.
Analysis:
The court held through trial that the legal relationship between Hu and the life insurance company was legally established. According to Article 10 of the exemption conditions contained in the back clause of the insurance certificate issued by the life insurance company to the insured, "The insured suffers from an incurable disease, leading to death or disability, or treats or recovers the existing disease or disability", so the court makes an interpretation that is not conducive to the party providing the standard clause, that is, it makes an interpretation that is beneficial to the insured. Because the life insurance company confirmed that Hu's first insurance date was1September, 1999, he had not suffered from "left nephroblastoma" before that, and there was no case that "left nephroblastoma" was not cured. Hu suffered from the same disease during the insurance period of continuous insurance, which is not within the scope of the exemption clause of life insurance company. The life insurance company should bear the responsibility of paying insurance money, that is, compensating Hu for hospitalization medical insurance money of 7650.47 yuan. The life insurance company refused to pay compensation on the grounds of Item 6 of Article 4 of the Supplementary Hospitalization Medical Insurance Provisions for Students and Children of China Life Insurance issued by it: "Treatment and rehabilitation of incurable diseases and existing disabilities suffered by the insured before insurance". Because the life insurance company fails to provide the insured or the insured with relevant evidence of the above clause, the exemption clause recorded in this clause has no legal effect on the insured. The contract basis that is binding on both parties is the insurance certificate delivered by the life insurance company to Hu. Therefore, the defense of life insurance companies cannot be established.
3. Can the murderer be the beneficiary?
1999 February Zheng, an employee of a factory in Changchun, beat his son for failing the exam. During the beating, his son was hit in the middle of the head and immediately fell into a coma. He died after being rescued. Forensic identification showed that the death was caused by external force. Soon, Zheng was detained in criminal detention. Zheng Zi, 14 years old, was insured by her school for student health and safety insurance. After the incident, Zheng's wife applied to the insurance company for compensation.
Analysis:
The focus of the dispute in this case is whether the murderer can be the beneficiary. Articles 27 and 64 of the Insurance Law clearly stipulate the scope of application of the clauses in which the insurance company terminates the insurance contract or does not assume the liability for compensation or payment, and the beneficiary loses the right to benefit. As the insured, the insured and the beneficiary, only by "deliberately creating an insured accident" will they lose their right to claim and benefit. Zheng's behavior has been identified as "negligence" rather than "intention", so Zheng has not lost his right to claim and benefit. The second opinion is the conclusion based on this. Therefore, the author agrees with the second view: Zheng has every right to be the beneficiary.
4. The child is insured with FPA, can he get compensation if he disappears for half a year?
Last year, Mr. Zhang insured 14-year-old son with a student safety insurance of 6,000 yuan a year. In the final exam that year, my son was flunked by the school because of his poor grades. When he came home that day, he was scolded and beaten by his father. The next day, Mr. Zhang came home from work and found that his son had disappeared and left home. He and his relatives searched everywhere, but there was still no news for half a year. In desperation, Mr. Zhang asked the people's court to declare him missing and demanded that the insurance money be paid by the court's missing certificate.
Analysis: Insurance is a profit-oriented economic activity. It does not assume the responsibility of playing the role of social charity or relief agency, and must be operated according to law. If the insured has been missing for four years, the people's court may declare him dead upon the application of his parents, and then pay the insurance money according to the declared death. However, if the insured reappears after the payment, Mr. Zhang still has the obligation to return the insurance money.
Because Mr. Zhang only holds the certificate of disappearance, and the insurance company can only pay the insurance money when he is declared dead, so the insurance company does not pay the death insurance money.
5. Does the victim suicide insurance company bear the responsibility after the traffic accident?
After the victim was injured in a traffic accident and committed suicide because of unbearable pain, whether there is a causal relationship between the traffic accident and the victim's suicide has triggered a lawsuit in Japan. Because this involves whether the insurance company should bear the insurance liability. With the increasing number of traffic accidents today, how to solve this problem fairly is of great social significance. Summary of the facts V.A. (the victim) went to the shopping mall in a private car driven by X 1 (the plaintiff, the victim's husband) and sat in the assistant seat. Under the command of the traffic management personnel of the mall, the vehicle turns on the turn signal and prepares to enter the parking lot of the mall. Suddenly hit by a truck driven by Y 1 (defendant, injurer) galloping from the front, causing optic nerve damage due to head trauma. After on-the-spot investigation by the traffic police, it was determined that X did not violate any rules during driving, and this accident was entirely the fault of Y 1. Therefore, Y 1 and Y2 (the defendant, the insurance company insured by Y 1) paid all the medical expenses and mental consolation money to A. After being injured in a traffic accident, A couldn't stand the pain of head trauma and suffered a great mental blow. 1 year after a traffic accident, he hanged himself at his residence. X 1 and X2 (the son of victim A) claim compensation for the death of A from Y 1 and Y2 (the defendant, the insurance company insured by Y 1). Y 1, Y2 refused to pay compensation on the grounds that there was no causal relationship between A's suicide and the traffic accident. X 1 and X2 brought a lawsuit to the court. The court found that there was a causal relationship between A's suicide and the traffic accident. Therefore, Y 1 and Y2 are judged to compensate the losses caused by A's death.
Analysis: From this case, we can know that the fault of Y 1 is 100%, which caused A's injury and left a very serious sequela after active treatment. A was tortured by illness and suffered a mental shock, which made A go on the road of no return after she could not bear the physical and mental pain. Judging from the result of A's suicide, the reason is twofold, that is, physical and mental pain, and the direct cause of this double pain is the traffic accident involved in this case. Therefore, according to the facts listed in the case, it can be inferred that there is a considerable causal relationship between suicide and traffic accidents.
According to Japan's Law on the Protection of Liability for Automobile Damage Compensation, all motor vehicles must join the "Liability Insurance for Automobile Damage Compensation", which is a third-party liability insurance and a compulsory insurance. Y 1 owns its own van, so it is no exception. He had taken out the above insurance before the accident. According to the traffic accident site investigation, Y 1 should take full responsibility for driving the car and causing the accident. The local court made a judgment on the causal relationship between the traffic accident and A's suicide. According to the principle of damages in the provisions of the Automobile Damage Liability Insurance, the damages that should have been borne by Y 1 should be made up by the insurance company. In this regard, the author fully agrees with the court's decision.
6. Typical insurance cases
On April 20th, 1999, Anhui Branch of China Life Insurance Company approved to pay 200,000 yuan to Lu, the insured in Mengcheng County, Fuyang City, and the case was successfully concluded.
1 997165438+1On October 27th, Jiang, a salesman of China Life Mengcheng Branch, went to the west side of the county pagoda company to persuade him to take out insurance, but Lu reluctantly took out "Tomorrow Life Insurance" and "Sunset Increase Pension Insurance" for him, with the insurance amount of 654.38 million yuan each, but In order to promote this policy, but also for the benefit of Lu, salesman Jiang Wei paid the premium for Lu. Until the next spring, Jiang Conglu's home appliance business department took home appliances to pay the premium. Since the insurance company has signed the contract, the contract is valid. After the accidental casualties on land, the insurance company paid according to the contract, which can be described as a promise.
Analysis: None
7. Should the death insurance company pay the medical examination fee?
On April/KOOC-0//KOOC-0/day, 2002, Huang insured "Ping An Hongsheng" for Yan and paid the first premium/KOOC-0//KOOC-0/yuan in advance. The insurance company issued a "temporary receipt for personal insurance" to the plaintiff. Due to strict over-age, the insurance company issued a new contract notice to the insured on April 25, 2002, requiring the insured to have a physical examination. On April 26th, the salesman led the insured Yan to the hospital for medical examination. Yanmou had a disease before the medical examination began, and was hospitalized at that time. Diagnosed as (1) pulmonary septic shock; (2) rheumatic heart disease; (3) Heart failure, hospitalization and death on April 29th. The plaintiff Huang sued the court on June 5438+1October 265438+1October 2002, demanding compensation from the insurance company. After that, the two parties reached a settlement: the insurance company refunded the plaintiff's insurance premium 1 18 1 yuan; At the same time, pay according to the insurance liability of illness death within one year 1000 yuan; 230 yuan, who will bear the case acceptance fee; * * * 24 1 1 yuan. The plaintiff agrees to waive all rights such as litigation claim and insurance liability. After the agreement was fulfilled, the plaintiff sued again on February 20, 2002, 65438, demanding to be reported for compensation.
The court of first instance held that the plaintiff Huang and the insured Yan signed a life insurance policy in the insurance company and paid the first premium. Because Yan is over age, she needs a medical examination, and the contract can only be formally signed after passing the medical examination. Therefore, the original and the defendant did not formally sign an insurance contract. The plaintiff's claim is compensation for the accidental death of the insured, which is not supported because of insufficient evidence. In addition, the defendant has returned the first premium11yuan to the plaintiff as agreed by both parties, and the plaintiff has paid the humanitarian goods 1000 yuan * * 2 18 1 yuan. Therefore, the judgment rejected the plaintiff's claim, and the litigation expenses were borne by the plaintiff. After the judgment of the first instance, the plaintiff refused to accept it and appealed.
The court of second instance held that the insurance application submitted by the insured was an offer. The new contract notice issued by the insurance company does not clearly indicate whether to agree to underwrite, but requires the insured to have a medical examination. Therefore, this is not a promise, but a new proposal. The applicant agrees to the contents of the notice, carries out a medical examination according to the requirements of the insurance company, and provides the insurance company with a medical examination report on the health status of the insured, that is, the commitment to the new offer of the insurance company is completed, and the insurance contract between the applicant and the insurance company is established. In this case, the insured and the insured agreed to have a medical examination, but the insured fell ill and died during the medical examination and did not provide the medical examination report of the insured, so the insurance contract was not established. Therefore, on the grounds that the life insurance contracts of both parties have been established, the appellant's reason for asking the insurance company to bear the responsibility is not established. In addition, although it is stated in the temporary receipt of personal insurance that during the period from collecting the first premium to the insurance company agreeing to underwrite and issue the insurance policy, if the insured dies due to an accidental injury accident or according to the insurance contract applied by the applicant, the insurance company will pay the accidental death insurance premium according to the accidental death liability of the applicant or bear the corresponding medical death insurance premium exempted from medical examination according to the insurance contract applied for. In this case, the insured died of pulmonary septic shock, rheumatic heart disease and other diseases. The insurance company requires the insured to have a physical examination including physical examination, urine routine and electrocardiogram, and the insured agrees. Therefore, the death of the insured does not belong to accidental death, nor does it belong to the death of a disease exempted from medical examination. After the appellant filed a lawsuit with the people's court for the first time on June 5438+00,1October 2 1, 2002, both parties have reached an agreement on the disputed matters and have fulfilled it. The appellant filed a lawsuit based on the same facts and reasons, which violated the principle of good faith, and his claim lacked factual and legal basis, so the court refused to support it. The judgment dismissed the appeal and upheld the original judgment, and the acceptance fee for the second instance was borne by the appellant.
Analysis: 7. This case reveals a common problem in insurance contract disputes: when is the life insurance contract established when the insurance premium is prepaid?
According to the contract law, the conclusion of a contract needs to go through the process of "offer and acceptance". According to Article 13 of the Insurance Law, an insurance contract is established when the applicant requests insurance, the insurer agrees to underwrite and reaches an agreement on the terms of the contract. The applicant's insurance request is an offer to conclude an insurance contract, and the insurer's agreement to underwrite and reach an agreement on the terms of the contract is a promise. When this process is completed, the insurance contract is established.
The conclusion of life insurance contract also needs to go through the process of offer and acceptance. Taking the personal life insurance contract as an example, according to the current domestic sales model, the conclusion of the contract generally goes through the following steps: the salesman sends insurance sales information to potential policyholders through publicity and security planning (exhibition industry); Under the guidance of the salesman, the applicant fills in relevant documents, submits relevant materials and puts forward insurance requirements (insurance); The insurer conducts audit according to the applicant's situation and makes an audit decision; After the applicant confirms the audit decision, the insurance company prints the policy and delivers it to the applicant (underwriting). From the legal point of view, this process can be summarized into three stages: invitation to offer (exhibition), offer (insurance) and commitment (underwriting). In this process, the insurer's audit decision varies according to the risk status of the subject matter insured. According to the different types of audit decisions, the time of commitment and the subject of commitment will be different, which will lead to the difference in the time of contract establishment:
1. The decision to extend the underwriting is essentially to change the conclusion time of the contract, which belongs to the new offer made by the insurer to the insured. Its purpose is to show the insured that the contract will be concluded at some time in the future. If the applicant has no objection, both parties reach an appointment (contract). This case does not involve the establishment of this contract.
2. For additional conditional underwriting (that is, additional premium underwriting or additional special agreement besides underwriting), the consideration clause or insurance liability clause in the offer made by the insurer to the applicant has changed, which constitutes a new offer in nature. This new quotation is only applicable to the conclusion of this insurance contract. According to the contract law, if an offer is not effectively revoked after it is issued, the offeror shall be bound by the contents of the offer, and once the offer is accepted by the other party, it constitutes an acceptance. In this case, the subject of the promise is the applicant, and the contract is established when the applicant accepts the additional underwriting conditions.
3. In the case that the insurer requires the applicant to complete the insurance materials, accept medical examination or re-designate the beneficiary, the essence is only to ask the offeror to improve the contents of the offer, which does not constitute a change in the contents of the offer, so it does not constitute a new offer. In this case, when the contract is established is determined according to the above rules after the insurer's audit decision is made.
This case belongs to the third case mentioned above. After the insurance company examines the application for insurance, it issues a new contract notice, requiring the insured to have a physical examination. From the content, the notice does not specify whether to agree to the insurance, but requires the insured to provide further information such as physical examination and health status. Therefore, the notice is neither a promise to accept insurance nor a new offer. Therefore, the act of the insured signing the notice and conducting a medical examination according to the requirements of the notice does not indicate that the insurance contract has been established.
On the other hand, because the cause of death of the insured is disease death, it does not meet the definition of "accidental death" in the insurance clause, and at the same time, the insured's situation does not belong to the disease death without medical examination as stipulated in the temporary receipt. Therefore, it is naturally impossible for the insured to obtain compensation from the insurance company according to the agreement of "temporary collection" if he dies during the medical examination before the establishment of the insurance contract.
Further reading: How to buy insurance, which is good, and teach you how to avoid these "pits" of insurance.