Perspective | Employee Dormitory Sudden Death Compensation Rejected: Arbitration Details the Boundary of "Working Hours" and "Work Post" Determination in Employer's Liability Insurance
Published:
2025-08-04
In June 2023, a company insured 46 of its employees with employer's liability insurance from an insurance company (hereinafter referred to as "the insurance company"), with a death and disability liability limit of 400,000 yuan per person. On November 23, 2023, employee Wang Mou was found dead in the company dormitory by a coworker. The public security organs ruled out homicide, and the cause of death was myocardial infarction. On the same day, the company signed a "Settlement Agreement" with the deceased's family, paying compensation of 200,000 yuan and stating that Wang Mou "died suddenly of illness while resting in the dormitory at night." The company's claim to the insurance company was rejected on the grounds that the death occurred "outside of work hours and outside of the workplace," not meeting the compensation conditions stipulated in the insurance contract. The company disagreed and, based on the provisions of the insurance contract, filed an arbitration with the arbitration commission, requesting the insurance company to pay insurance compensation of 200,000 yuan.
In June 2023, a company insured 46 of its employees with an employer's liability insurance policy from an insurance company (hereinafter referred to as "the insurance company"), with a death and disability liability limit of 400,000 yuan per person. On November 23, 2023, employee Wang Mou was found dead in the company dormitory by a coworker. The public security authorities ruled out homicide, and the cause of death was myocardial infarction. The company signed a settlement agreement with the deceased's family on the same day, paying 200,000 yuan in compensation and stating that Wang Mou "died suddenly of illness while resting in the dormitory at night". The company's claim to the insurance company was rejected on the grounds that the death occurred "outside of work hours and outside of the workplace," not meeting the compensation conditions stipulated in the insurance contract. The company disagreed and, based on the provisions of the insurance contract, filed an arbitration case with the arbitration commission, requesting the insurance company to pay 200,000 yuan in insurance compensation.
Points of Contention
1. Did Wang Mou's death occur during "work hours" and at the "workplace"?
2. Is the exclusion clause valid, and should the insurance company bear the obligation to pay insurance compensation?
Established Facts
In June 2023, the company purchased insurance and paid the premiums, and the insurance company issued the policy; the contract was legally established and valid. At approximately 8:00 am on November 23, 2023, a coworker called Wang Mou for work in the dormitory but received no response, called 120, and medical personnel arrived at the scene and confirmed that Wang Mou had no vital signs. The public security authorities' "dispatch record" stated: Wang Mou "was resting in the dormitory after work the previous night and was found dead by a colleague at approximately 8:00 am the next day... the possibility of homicide is ruled out." The "Resident Death and Funeral Certificate" recorded the place of death as "home" (i.e., the dormitory), and the cause of death was myocardial infarction. The company reached a settlement agreement with the deceased's family, clearly stating that "on the night of November 22, 2023, Wang Mou died suddenly of illness while resting in the company dormitory." The certificate provided by the company to the insurance company stated that "Wang Mou died suddenly of illness in the employee dormitory at 7:40 am on November 23, 2023." The company claimed that Wang Mou "felt unwell during work hours on the 22nd and returned to the dormitory," but the submitted surveillance video did not directly prove that he had already fallen ill at that time, contradicting the above written evidence.
Case Analysis
1. Core Issue: Did the death occur during "work hours" and at the "workplace"?
(1) Determination of "Workplace"
The arbitration tribunal believes that the dormitory is a place for employees to live and rest, and its nature is different from that of a "workplace" where work duties are performed. The insurance contract does not include the dormitory within the scope of the "workplace".
(2) Determination of "Work Hours"
The public security authorities' "dispatch record," the company's settlement agreement, and certificate all consistently confirm that Wang Mou died "during the rest period after work." The company claims that the illness occurred "during work hours" but failed to provide effective evidence.
According to Article 67 of the "Civil Procedure Law of the People's Republic of China": Parties have the responsibility to provide evidence for their claims. As the claimant, the company failed to fulfill its burden of proof.
2. Does the exclusion clause have legal effect, and does the insurer bear insurance liability?
The company claims that the insurance company's agent did not explain the exclusion clause (actually insurance liability clause ) during the insurance process. The arbitration tribunal points out the key difference:
The insurance liability clause (Article 4 of the contract) defines what the insurer "covers," while the exclusion clause stipulates what is "not covered" within the scope of insurance liability. According to Article 17 of the "Insurance Law," the insurance company only has the obligation to explain the exclusion clause.
The arbitration tribunal believes that the company affixed its official seal to the "insurance application" and "insurance terms," which should be considered as acceptance of the contract content, including the agreement on the scope of insurance liability (work hours and workplace). As a civil entity with full capacity for civil conduct, affixing the official seal means that it is aware of and accepts its legal consequences. Therefore, its claim that the insurance company failed to fulfill its obligation to explain the scope of insurance liability lacks legal basis, and the insurance company should not bear insurance liability.
3. Conclusion
In this case, Wang Mou's death cannot be proven to fall within the scope of insurance liability. According to the provisions of Article 4 of the policy, insurance liability is limited to "sudden death or death after 48 hours of ineffective rescue due to illness during work hours and at the workplace." The existing evidence cannot prove that Wang Mou's death meets this situation. The obligation to explain the exclusion clause is also not triggered in this case; the disputed clause is the "insurance liability clause," not the "exclusion clause." The insurance application bears the official seal and states that "the exclusion clause has been clearly explained." As a commercial entity, the applicant should fulfill its duty of due diligence.
Judgment
1. The company's arbitration request is dismissed in its entirety;
2. The arbitration fees shall be borne by the company.
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