After taking out accidental injury insurance, a Nantong man Zhou Mou died while driving an electric bicycle while drunk, and the insurance company refused to pay compensation.
On January 21, The Paper (www.thepaper.cn) learned from the Rudong County Court in Nantong that since the insurance company did not deliver the insurance clauses, and did not inform or prompt the exemption clauses, the court determined that it should bear the responsibility for insurance claims and compensate for the insurance. 10,000 yuan in insurance for family members.
In July 2020, 59-year-old Zhou purchased accident insurance for motorcycle and tractor drivers from an insurance company in Rudong, with an insured amount of 10,000 yuan and a term of one year.
11 months later, Zhou was killed by driving an electric bicycle into a tree while drunk. His relatives applied to the insurance company for compensation and were rejected and sued to the court.
Relatives said that the insurance company only delivered an insurance policy to Zhou, but did not deliver the insurance clauses, and did not fulfill the obligation to remind and clearly state the exemption clause. It should be responsible for insurance claims for Zhou's death and pay insurance 10,000 yuan in gold.
The insurance company believes that Zhou was insured for accident insurance for motorcycle and tractor drivers, and he was driving an electric bicycle at the time of the accident, and the conditions for compensation were unreasonable.
The court held that although according to the insurance clause, Zhou's death was not covered by the insurance, the insurance company failed to provide evidence to prove that it served the insurance clause to the insured. rights and obligations among defendants.
The insurance policy involved in the case stated that the insurance liability is accidental injury death, accidental injury disability, accidental injury burn.
According to its standard terms, in the case of disputes between the two parties on the scope of insurance liability, whether it is based on common understanding or an explanation in favor of the insured, Zhou's death should fall within the scope of insurance liability.
The court held that although the insurance clauses involved in the case not only stated that the insured suffered an accidental injury not caused by driving a motorcycle or tractor, but also stated that the insured's intoxication and drunk driving were exempted matters, but the insurance company neither failed to do so. Evidence is provided to prove that it has served the insurance policy to the policyholder, and it cannot prove that it has fulfilled the obligation to remind and clearly explain the exemption clause to the policyholder. Therefore, the exemption clause has no effect, and the insurance company shall be liable for insurance claims.
The Paper reporter Qiu Haihong correspondent Wang LeiKeywords: