Viewpoint... An analysis of whether death due to heat stroke should be recognized as an accident of commercial insurance.
Published:
2024-04-02
Nowadays, commercial insurance has become a kind of insurance closely related to social life and citizens' interests. The purpose of buying commercial insurance is to be able to get a compensatory property protection when an accident comes. However, in practice, insurance companies will strictly define "accidents" and refuse to identify accidents containing sick words such as heat stroke, thereby narrowing the scope of compensation.
Abstract
Nowadays, commercial insurance has become a kind of insurance closely related to social life and citizens' interests. The purpose of buying commercial insurance is to be able to get a compensatory property protection when an accident comes. However, in practice, insurance companies will strictly define "accidents" and refuse to identify accidents containing sick words such as heat stroke, thereby narrowing the scope of compensation.
(I) accidents covered by motor vehicle commercial insurance
What is an accident in commercial insurance? China's Insurance Law does not specify the meaning of accident, the connotation of "accident" and the allocation of the burden of proof of "accident", which leads to disputes over accidental injury in judicial practice. Although there is no clear definition in the Insurance Law, the definition of compensation for personal accident insurance is quite clear and strict. According to the "essentials" of the mainstream personal accident insurance compensation in our country, personal accident insurance compensation must have four conditions, namely, foreign, sudden, unintentional, and non-disease. Four elements must be present at the same time to constitute an accidental injury, one of which is indispensable. In actual claims, the requirement of personal accident insurance claims is that the four elements exist at the same time, which greatly improves the conditions of claims and reduces the scope of claims.
The meaning of accident, in which "accident" is the core content, is simply "unexpected", unintentional and unforeseen. The definition and constituent elements of "accident" commonly used in my country's current insurance industry are derived from the "Announcement on the Guiding Provisions of the Air Passenger Accidental Injury Insurance Industry" issued by the Insurance Regulatory Commission. Although the announcement has been abolished, my country's insurance industry is concerned. The connotation of "accident" has been commonly used so far, that is, an accident is an objective event that causes harm to the body due to external, sudden, unintentional, and non-disease.
Whether (II) death due to heat stroke is an accident
Before defining whether the death of heat stroke is an accident, we should first understand what is heat stroke? Heat stroke refers to the dysfunction of body temperature regulation caused by high temperature, excessive accumulation of heat in the body, resulting in damage to nerve organs. It can be seen that heat stroke is caused by the external high temperature environment, combined with the aforementioned requirements of China's insurance industry on the elements of "accident", that is, external, sudden, unintentional, non-disease to analyze whether heat stroke is an accident one by one.
1. Extrinsic issues about heat stroke.Heat stroke is a case of severe heatstroke caused by external high temperature. The occurrence of the disease originates from the body, but the root cause of the disease is the influence of the external high temperature environment, which causes changes in body function, which is an external factor.
2. Whether there is a sudden problem with heat stroke.Heat stroke is not an ordinary heat stroke. In the classification of heat stroke, it is a fatal disease with high mortality. It is characterized by acute onset, rapid progression of the disease, sudden loss of the ability to move, and naturally no ability to save themselves. The onset of heat stroke is sudden.
3. The question of whether it is unintended.The view of insurance companies is usually: as an adult, the victim is familiar with the change of the four seasons and the development process of temperature, coupled with the current level of meteorological science and technology, has been fully able to accurately forecast high temperature weather. at the same time, high temperature weather can cause personal injury is also the basic common sense that ordinary people should know, and it is entirely possible to prevent and avoid the harm caused by high temperature weather to the body by effective means. However, as we all know, heat stroke is a kind of severe heatstroke caused by external high temperature. The National Health Commission cautiously described the cause of heat stroke as "high temperature and high humidity climate factors and high-intensity physical activity are the most important risk factors for heat stroke. Classic heat stroke is mainly caused by high temperature and (or) high humidity environmental factors, usually without strenuous physical activity. The exertional heat stroke is mainly due to the imbalance of heat production and heat dissipation caused by high-intensity physical activity.". Although the high temperature weather is predictable, the high temperature weather is the most important risk factor for heat stroke, even if the measures of heat prevention and sun protection are taken, heatstroke may occur. Therefore, the predictability of high temperature has nothing to do with the predictability of the onset of heat stroke, which is unpredictable. Therefore, the onset of heat stroke is unintended.
4. The question of whether heat stroke is a non-disease.The view of insurance companies is usually that "heat stroke is the most serious heat stroke. If the temperature rises, you will get heat stroke, and if the temperature drops, you will catch a cold. This is a disease caused by weather changes." Thus, insurance companies also believe that heat stroke is caused by changes in the weather. At the same time, insurance companies will consider heat stroke to be a disease according to medical norms, but not non-disease. In response to this controversy, it is necessary to first clarify what is a disease? A disease is usually the damage caused by the onset of a disease that already exists within a person. The occurrence of the accident involved was not caused by the victim Zhu's own original disease, but physical injury caused by external high temperature or high humidity weather, which was not spontaneous or old disease. In such cases, the disease should be explained in a narrow way. Therefore, heat stroke, a disease caused by the external environment, should not be a "disease" in the interpretation of insurance terms, but a non-disease.
In summary, heat stroke has the characteristics of foreign, sudden, unintentional, and non-disease, which is fully in line with the current insurance industry's "accident" composition conditions. Injuries (deaths) caused by heat stroke are accidents and therefore should be recognized as accidents in commercial insurance claims.
Key words:
Related News
Zhongcheng Qingtai Jinan Region
Address: Floor 55-57, Jinan China Resources Center, 11111 Jingshi Road, Lixia District, Jinan City, Shandong Province
