In the case of the case, the insurance company has not exercised the right to terminate the contract within the statutory time limit, and may not refuse compensation on the basis of the policyholder's failure to perform the obligation of truthful notification.
Published:
2021-12-03
[brief case]] In June 2017, Liu purchased personal accident insurance from a property insurance company through online insurance, which covers 1-3 categories. When Liu filled in the insurance information, he chose the occupation of being an expatriate (belonging to category 2). After the successful payment of the insurance, a property insurance company issued an insurance policy. The insurance period recorded in the policy is from June 18, 2017 to June 17, 2018. The coverage includes: accidental injury death disability insurance amount of 500000 yuan, accidental injury medical expenses insurance amount of 30000 yuan, hospitalization living allowance insurance amount of 36000 yuan, each accident accidental injury medical expenses without deductible, according to the proportion of 100 compensation, hospitalization living allowance only protects the insured due to accidental injury caused by hospitalization, does not protect the insured due to illness caused by hospitalization, there is no deductible for each accident hospitalization living allowance, and the daily compensation is 200 yuan. During the insurance period, the number of days of each compensation shall not exceed 90 days, and the total accumulated number of days of compensation shall not exceed 180 days. At the end of January 2018, Liu was accidentally injured at work, and was diagnosed as 1. Avulsion of the left forearm was completely severed; 2. Open fracture and dislocation of the left elbow joint. From January 31, 2018 to March 31, 2018, Liu was hospitalized in the hospital and spent 163474.44 yuan on medical expenses. On February 1, 2018, a property insurance company investigated Liu's work with Liu's colleague, who said that he and Liu were both drilling pile operators in a mechanical and electrical decoration engineering company. Later, a property insurance company refused to settle the claim on the grounds that the occupation informed by Liu when he was insured did not match the actual occupation. focus of controversy] Whether the insurance company should be liable for insurance claims. The court of first instance held that] According to the provisions of Article 16 of the the People's Republic of China Insurance Law: "If an insurance contract is concluded and the insurer makes inquiries about the subject matter of the insurance or the relevant circumstances of the insured, the applicant shall truthfully inform him. If the applicant intentionally or due to gross negligence fails to perform the obligation of truthful disclosure stipulated in the preceding paragraph, which is sufficient to affect the insurer's decision whether to agree to underwrite or increase the insurance premium rate, the insurer shall have the right to terminate the contract. The right to rescind a contract provided for in the preceding paragraph shall be extinguished without exercise for more than 30 days from the date on which the insurer becomes aware of the cause of rescission. If more than two years have passed since the date of the establishment of the contract, the insurer shall not terminate the contract; if an insurance accident occurs, the insurer shall bear the responsibility for compensation or payment of insurance benefits. ......" In this case, a property insurance company on February 1, 2018, after knowing that Liu's insured occupation was inconsistent with the actual occupation, it did not exercise the right of discharge within 30 days, which did not meet the exemption of the above-mentioned legal provisions, and this defense of a property insurance company could not be established. A property insurance company shall bear the insurance liability in this case. According to the insurance policy and insurance terms, combined with Liu's disability grade and hospitalization medical situation, the judgment supports Liu's claim, that is, a property insurance company shall pay Liu 250000 yuan for accidental disability compensation, 30000 yuan for accidental injury medical expenses and 11600 yuan for hospitalization living allowance. The court of second instance held that] According to the facts found by the court of first instance, a property insurance company knew that Liu's insured occupation was inconsistent with his actual occupation when investigating Liu's work on February 1, 2018, but a property insurance company did not exercise the right of discharge within 30 days, the court of first instance found that a property insurance company's defense of not assuming insurance liability on the grounds that Liu did not truthfully inform the profession did not conform to the exemption situation stipulated in Article 16 of the the People's Republic of China Insurance Law, which had a factual basis, and the court maintained it. At present, it takes longer for a property insurance company to appeal and explain its follow-up investigation and approval process in the trial, which is not enough to be the reason for it to exercise the right of discharge beyond the legal time limit. The appeal of a property insurance company could not be established and the Court rejected it. Lawyer Advice] In the course of insurance business, it is inevitable that the policyholder fails to truthfully inform the insurance company about the subject matter of the insurance or the insured, in which case the insurance company has the right to unilaterally terminate the insurance contract, but the right of termination must be exercised within the statutory time limit. Through this case, it is recommended that insurance companies carry out regular business training on the Insurance Law and other relevant laws and regulations and common risks and precautions in business practice, so as to avoid failure to fulfill legal obligations, exceeding the legal time limit, etc., resulting in the inability to refuse compensation in accordance with the law and the trial. The adverse consequences of the inability to effectively defend.
[brief case]]
In June 2017, Liu purchased personal accident insurance from a property insurance company through online insurance,The range of occupations covered by this insurance is 1-3 categories. The occupation Liu chose when filling in the insurance information was an alien (belonging to category 2)After the successful payment of the insurance, a property insurance company issued a policy.The insurance period recorded in the policy is from June 18, 2017 to June 17, 2018; The coverage includes: 500000 yuan for accidental death and disability insurance, 30000 yuan for accidental injury medical expenses, and 36000 yuan for hospitalization living allowance. There is no deductible for medical expenses for each accident and accidental injury, which is paid according to the proportion of 100. The hospitalization living allowance only covers the hospitalization of the insured due to accidental injury, and does not cover the hospitalization of the insured due to illness. The hospitalization living allowance for each accident has no deductible, and 200 yuan is paid daily, during the insurance period, the number of days of each payment shall not exceed 90 days, and the total cumulative number of days of payment shall not exceed 180 days.
At the end of January 2018, Liu was accidentally injured at work, and was diagnosed as 1. Avulsion of the left forearm was completely severed; 2. Open fracture and dislocation of the left elbow joint. From January 31, 2018 to March 31, 2018, Liu was hospitalized in the hospital and spent 163474.44 yuan on medical expenses. On February 1, 2018, a property insurance company investigated Liu's work with Liu's colleague, who said that he and LiuAre in a mechanical and electrical decoration engineering Co., Ltd. as a drill pile operator. Later, a property insurance company refused to settle the claim on the grounds that the occupation informed by Liu when he was insured did not match the actual occupation.
focus of controversy]
Whether the insurance company should be liable for insurance claims.
The court of first instance held that]
According to the provisions of Article 16 of the the People's Republic of China Insurance Law: "If an insurance contract is concluded and the insurer makes inquiries about the subject matter of the insurance or the relevant circumstances of the insured, the applicant shall truthfully inform him.If the applicant intentionally or due to gross negligence fails to perform the obligation of truthful disclosure stipulated in the preceding paragraph, which is sufficient to affect the insurer's decision whether to agree to underwrite or increase the insurance premium rate, the insurer shall have the right to terminate the contract. The right to rescind a contract provided for in the preceding paragraph shall be extinguished without exercise for more than 30 days from the date on which the insurer becomes aware of the cause of rescission. If more than two years have passed since the date of the establishment of the contract, the insurer shall not terminate the contract; if an insurance accident occurs, the insurer shall bear the responsibility for compensation or payment of insurance benefits. ......"In this case, after a property insurance company knew that Liu's insured occupation was inconsistent with the actual occupation on February 1, 2018, it did not exercise the right of discharge within 30 days, which did not meet the exemption circumstances stipulated by the above law. This defense of a property insurance company cannot be established. A property insurance company shall bear the insurance liability in this case. According to the insurance policy and insurance terms, combined with Liu's disability grade and hospitalization medical situation, the judgment supports Liu's claim, that is, a property insurance company shall pay Liu 250000 yuan for accidental disability compensation, 30000 yuan for accidental injury medical expenses and 11600 yuan for hospitalization living allowance.
The court of second instance held that]
According to the facts found by the court of first instance, a property insurance company knew that Liu's insured occupation was inconsistent with his actual occupation when investigating Liu's work on February 1, 2018, but a property insurance company did not exercise the right of discharge within 30 days, the court of first instance found that a property insurance company's defense of not assuming insurance liability on the grounds that Liu did not truthfully inform the profession did not conform to the exemption situation stipulated in Article 16 of the the People's Republic of China Insurance Law, which had a factual basis, and the court maintained it. Now a property insurance company appeals and explains in the trial.The follow-up investigation and approval process takes longer, which is not enough to justify the exercise of the right of release beyond the statutory time limit.The appeal of a property insurance company could not be established and the Court rejected it.
Lawyer Advice]
In the course of insurance business, it is inevitable that the policyholder fails to truthfully inform the insurance company about the subject matter of the insurance or the insured, in which case the insurance company has the right to unilaterally terminate the insurance contract, but the right of termination must be exercised within the statutory time limit. Through this case, it is recommended that insurance companies carry out regular business training on the Insurance Law and other relevant laws and regulations and common risks and precautions in business practice, so as to avoid failure to fulfill legal obligations, exceeding the legal time limit, etc., resulting in the inability to refuse compensation in accordance with the law and the trial. The adverse consequences of the inability to effectively defend.
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