On March 11, the Xicheng District People's Court of Beijing held a briefing on typical cases of consumer rights protection involving personal insurance disputes. Photo provided by Xicheng Court
3·15 Consumer rights protection day is coming soon. On the morning of March 11, the Xicheng District People's Court of Beijing (hereinafter referred to as "Xicheng Court") held a briefing on typical cases of consumer rights protection involving personal insurance disputes, introducing the dispute characteristics of personal insurance cases and publishing typical cases.
reporters learned from the press conference that in the past three years, the court has concluded a total of 292 personal insurance contract dispute cases, of which 223 were insured online, accounting for 76.3% of all cases. Among all cases, there were 245 cases in which the insured, as plaintiff, sued the insurance company for payment of insurance premiums, accounting for 83.9% of all cases. In addition, the focus of the dispute in more than half of the cases is related to the insurance company's refusal to file claims because the policyholder did not truthfully inform his health status and other content.
medical record shows that there is indeed a medical history. The insured informed him that he was refused compensation
At the press conference, Yang Chenglong, head of the People's Court of Financial Street, Xicheng Court, introduced several typical cases concluded by the court.
On May 9, 2018, Ms. Yan took out major disease insurance with her husband Mr. Li as the insured. In the insurance policy, Mr. Li had a history of drinking and smoking, and whether he had cardiovascular diseases such as hypertension, and Ms. Yan answered no. On March 20, 2019, Mr. Li was admitted to the hospital for treatment. Both the admission and discharge records were recorded. Mr. Li had a history of elevated blood pressure and migraine for more than 3 years, a history of hyperlipidemia and arteriosclerosis for 5 years, a history of hyperuricemia for more than 3 years, and a history of smoking and drinking for several years. After being discharged from the hospital, Mr. Li applied for a claim from the insurance company, and the insurance company terminated the insurance contract and refused to make a claim on the grounds of false notification. Later, Mr. Li sued the court and asked the insurance company to pay 40,000 yuan in insurance compensation.
After trial, the court held that the plaintiff's lawsuit was rejected because the policyholder Ms. Yan deliberately failed to fulfill the obligation to truthfully inform the insurance company, which was enough to affect the insurance company's underwriting decision.
Yang Chenglong introduced that the insured's obligation to truthfully inform is a legal obligation. The Insurance Law of the People's Republic of China stipulates that "If an insurance contract is concluded and the insured asks about the subject matter of the insurance or the relevant circumstances of the insured person, the insured shall truthfully inform you. If the insured intentionally fails to perform the obligation of truthful notification, or fails to perform the obligation of truthful notification due to gross negligence and has a serious impact on the occurrence of the insurance accident, the insurer shall not bear the liability for compensation or payment of insurance funds for the insurance accident that occurs before the contract is terminated."
In this case, according to Mr. Li's admission and discharge records, Mr. Li had suffered from hypertension, hyperlipidemia and arteriosclerosis before taking out insurance. Mr. Li's wife Ms. Yan, the profession of Mr. Li's wife, is a nurse and should be able to notice that Mr. Li, who lives with her, had already suffered from the above diseases when taking out insurance. However, when Ms. Yan took out insurance, she failed to truthfully inform the insurance company about the relevant inquiries of the insurance company, which was enough to affect the insurance company's underwriting decision. In the end, the court ruled to reject all of Mr. Li's lawsuit requests.
Yang Chenglong reminds insurance consumers that after the insurance claim dispute is filed in court, the medical history records of the insured before the insurance will also become an important basis for the court to find out the facts and determine liability. The insured should truthfully answer the insured company's inquiry.
failed to provide evidence of the online insurance process, and the insurance company was responsible for
On February 10, 2019, Mr. Shang took medical insurance through the online platform with his wife Ms. Zhang as the insured. After being diagnosed, Ms. Zhang suffered from malignant tumors and was hospitalized and outpatient for several times.
In February 2021, Ms. Zhang submitted a claim application to the insurance company online. The insurance company refused to file a claim on the grounds that Ms. Zhang had previous symptoms when she took out the insurance and was a disclaimer in the insurance terms. Ms. Zhang sued the insurance company in court.Ms. Zhang said that when she was insured, the system did not display the insurance terms, and the insurance company did not inform and inform the relevant terms, and required the insurance company to pay more than 130,000 yuan in insurance. During the trial, the insurance company failed to submit evidence of the 2019 insurance process, but demonstrated the real-time insurance process of the insurance product, including the options and content for reading the insurance terms before taking out the insurance.
After trial judgment, the insurance company showed that the insurance process displayed by the insurance company could not prove that it was the process when Mr. Shang took the insurance that year. It was determined that the insurance company had not fulfilled its obligation to provide instructions on the disclaimer clause, and finally ordered the insurance company to pay more than 40,000 yuan in insurance money to Ms. Zhang.
Yang Chenglong said that the Insurance Law of the People's Republic of China stipulates that "for the provisions in the insurance contract that exempt the insurer from liability, the insurer shall make sufficient reminders on the policyholder's attention when concluding the contract, and make clear explanations to the insured in writing or oral form of the content of the clause; if there is no prompt or clear explanation, the clause shall not arise Effectiveness. "According to this, if the insured or the insured agent authorized by the insured person can read the content of the concept, content and legal consequences of the relevant liability exemption clauses in accordance with the insurance process set by the insurer's website during the activation of the electronic policy, and click to confirm the "Agree to Accept the Terms" and confirm that "the insurer has fulfilled the clear explanation obligation" to the insurer during the insurance process.
In this case, the insurance company refused to pay compensation based on the exemption clause of the insurance contract. Although the insurance company demonstrated the online insurance process in court, the insurance company did not provide evidence whether the insurance process was consistent with the process when Mr. Shang took out insurance in 2019, and the insurance company was unable to provide relevant evidence of the insurance process that year, so it is not enough to prove that the insurance company has fulfilled its obligation to promptly explain the disclaimer clause.
More than 70% of cases are "online insurance"
Beijing News reporter learned from the press conference that in the past three years, Xicheng Court has concluded a total of 292 personal insurance contract dispute cases, including personal insurance contract disputes and health insurance contract disputes, life insurance contract disputes, accidental injury insurance contract disputes, etc. The plaintiffs in the cases involved in
are all policyholders or insured persons, and the defendant is an insurance company. Among them, 83.9% of the cases in which the insured, as the plaintiff, sued the insurance company for payment of insurance premiums. From the perspective of insurance methods, the proportion of 223 cases insured online is 76.3%. The insured online includes both the insured who actively purchases on the Internet, and the insured through the Internet after communicating with the insurance agent or insurance broker.
From the focus of the case dispute, 53.5% of insurance companies refused to pay claims because the policyholder did not truthfully inform his health status and other content, 26.7% of insurance liability scope such as the category of hospitals, and 32 cases involving the validity of standard terms and disclaimer terms, accounting for 27.6%. In addition, there are cases involving whether the subject is qualified, the determination of disability grade, insurance inheritance and transfer of rights and interests, and whether it exceeds the statute of limitations. Judge
introduced that in personal insurance contract dispute cases, the mediation and withdrawal rate of lawsuits accounted for 53.4% of such cases. Many cases are clear. After the lawsuit is filed in the court, the court will explain it to the court, and the parties can resolve the conflict on their own and achieve the substantive resolution of the conflict.
Beijing News reporter | Zhang Jingshu
editing | Liu Qian
proofreading | Li Lijun
