保险纠纷案例汇编 | 法宝双语案例

一、中国人民财产保险股份有限公司华池支公司与张丽丽意外伤害保险合同纠纷上诉案

【裁判要旨】

订立保险合同，一般采用保险人提供的格式条款，合同中的免责条款一般是有利于保险人的，因此在签订保险合同时，保险人应尽到合理的提醒义务。在保险单上无投保人签字确认、无足以引起投保人注意的提示内容、保险条款是否与该保险单一同送达也无法判断等情形的，可以认定保险人无法提供证据证明其履行了对投保人提请注意的义务。因此保险合同中的“免责条款”不产生效力，保险人应承担举证不能的法律后果。

[Judgment Abstract] 

Generally, the insurer provides its standard clauses when concluding an insurance contract, and the exceptions thereof are beneficial to the insurer. Therefore, the insurer should perform the reasonable duty of reminding upon the execution of an insurance contract with the insured. In any of the following circumstances, the insurer is deemed to have failed to provide evidence on its fulfillment of the duty of reminding: 1) the insured has not signed the policy for confirmation; or 2) there's no remarkable content that is enough to attract the attention of the insured; or 3) it's impossible to determine whether the insurance clauses are delivered together with the insurance policy. Hence, the exceptions of the insurance contract should be deemed invalid, to the extent that the insurer should assume legal consequences arising from its inability to provide evidence.

【法宝引证码】CLI.C.8076097

二、海康人寿保险有限公司山东分公司与王占胜人身保险合同纠纷上诉案

Shandong Branch of AEGON-CNOOC Life Insurance Co., Ltd. v. Wang Zhansheng (appeal case of dispute over a life insurance contract)

【裁判摘要】

在附加医疗保险纠纷中，被保险人提交病历中的自诉内容相互矛盾，两份病历的证明力并无明显差别的情况下，该病历证明的争议事实难以认定，保险公司应承担举证责任，证实被保险人在该次住院之前即已发病。若保险公司无法提供证据证明该事实，则应承担不利的法律后果，按照保险合同的约定向被保险人支付保险金。

[Judgment Abstract]

In a case regarding dispute over additional medical insurance, where two sets of medical records submitted by the insured are contradictory in the private prosecution content, without obvious difference in the probative force, so that it is difficult to determine the disputed facts through medical records, the insurance company shall bear the burden of proof on the facts that the insured has already developed the disease before hospitalization. If the insurance company is unable to provide such evidence, it shall bear adverse legal consequences and pay insurance benefits to the insured in accordance with the insurance contract.

【法宝引证码】CLI.C.3354248

[CLI Code] CLI.C. 3354248 (EN)

三、陈从禄因副驾位乘员开车门致人损害共同侵权承担连带责任赔付后诉中国平安财产保险股份有限公司淮安中心支公司保险理赔纠纷案

Chen Conglu v. Central Huai'an Sub-Branch of Ping An Property and Casualty Insurance Company of China, Ltd. (case regarding dispute over insurance claim settlement)

【裁判要旨】

保险法规定责任保险是指以被保险人对第三者依法应负的赔偿责任为保险标的的保险。根据《中华人民共和国侵权责任法》第八条的规定，二人以上共同实施侵权行为，造成他人损害的，应该承担连带责任。因此，两个以上行为主体因共同过错发生交通事故致他人损害的，行为人应对受害人的损失承担连带赔偿责任。其中部分被保险人已履行了全部赔偿义务的，则保险人应在保险限额内向被保险人全部理赔，保险人不能主张只在被保险人应负责任比例范围内承担保险责任，其可以在理赔后就连带超额部分实施追偿。

[Judgment Abstract]

According to the Insurance Law, liability insurance refers to a type of insurance which takes the insured's legal liability for indemnity to a third party as the subject matter insured. Moreover, Article 8 of the Tort Law of the People's Republic of China also stipulates that, where two or more persons jointly commit a tort, causing harm to another person, they shall be liable jointly and severally. Therefore, where the contributory negligence of two or more actors results in a traffic accident and causes a damage to another person, the actors shall be jointly and severally liable for the victim's damage. If some of the insured has fulfilled all of the compensation obligations, then the insurer shall settle all the claims to the insured within the liability limit. The insurer is not allowed to claim for bearing insurance liability only within the proportion of liabilities that should be assumed by the insured, whereas it may recover the excess part after the claim settlement.

【法宝引证码】CLI.C.4104533

[CLI Code] CLI.C. 4104533 (EN)