本期双语案例推送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等有关保险纠纷类案例。目录Contents1.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HuachiBranchofPICCPropertyandCasualtyCompanyLimitedv.ZhangLili(appealcaseofdisputeoveranaccidentalinjuryinsurancecontract)2.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ShandongBranchofAEGON-CNOOCLifeInsuranceCo.,Ltd.v.WangZhansheng(appealcaseofdisputeoveralifeinsurancecontract)3.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ChenCongluv.CentralHuai'anSub-BranchofPingAnPropertyandCasualtyInsuranceCompanyofChina,Ltd.(caseregardingdisputeoverinsuranceclaimsettlement)
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
HuachiBranchofPICCPropertyandCasualtyCompanyLimitedv.ZhangLili(appealcaseofdisputeoveranaccidentalinjuryinsurancecontract)
【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。
[JudgmentAbstract]
Generally,theinsurerprovidesitsstandardclauseswhenconcludinganinsurancecontract,andtheexceptionsthereofarebeneficialtotheinsurer.Therefore,theinsurershouldperformthereasonabledutyofremindingupontheexecutionofaninsurancecontractwiththeinsured.Inanyofthefollowingcircumstances,theinsurerisdeemedtohavefailedtoprovideevidenceonitsfulfillmentofthedutyofreminding:1)theinsuredhasnotsignedthepolicyforconfirmation;or2)there'snoremarkablecontentthatisenoughtoattracttheattentionoftheinsured;or3)it'simpossibletodeterminewhethertheinsuranceclausesaredeliveredtogetherwiththeinsurancepolicy.Hence,theexceptionsoftheinsurancecontractshouldbedeemedinvalid,totheextentthattheinsurershouldassumelegalconsequencesarisingfromitsinabilitytoprovideevidence.
【法宝引证码】CLI.C.8076097
[CLICode]CLI.C.8076097(EN)
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
ShandongBranchofAEGON-CNOOCLifeInsuranceCo.,Ltd.v.WangZhansheng(appealcaseofdisputeoveralifeinsurancecontract)
【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。
Inacaseregardingdisputeoveradditionalmedicalinsurance,wheretwosetsofmedicalrecordssubmittedbytheinsuredarecontradictoryintheprivateprosecutioncontent,withoutobviousdifferenceintheprobativeforce,sothatitisdifficulttodeterminethedisputedfactsthroughmedicalrecords,theinsurancecompanyshallbeartheburdenofproofonthefactsthattheinsuredhasalreadydevelopedthediseasebeforehospitalization.Iftheinsurancecompanyisunabletoprovidesuchevidence,itshallbearadverselegalconsequencesandpayinsurancebenefitstotheinsuredinaccordancewiththeinsurancecontract.
【法宝引证码】CLI.C.3354248
[CLICode]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
ChenCongluv.CentralHuai'anSub-BranchofPingAnPropertyandCasualtyInsuranceCompanyofChina,Ltd.(caseregardingdisputeoverinsuranceclaimsettlement)
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。
AccordingtotheInsuranceLaw,liabilityinsurancereferstoatypeofinsurancewhichtakestheinsured'slegalliabilityforindemnitytoathirdpartyasthesubjectmatterinsured.Moreover,Article8oftheTortLawofthePeople'sRepublicofChinaalsostipulatesthat,wheretwoormorepersonsjointlycommitatort,causingharmtoanotherperson,theyshallbeliablejointlyandseverally.Therefore,wherethecontributorynegligenceoftwoormoreactorsresultsinatrafficaccidentandcausesadamagetoanotherperson,theactorsshallbejointlyandseverallyliableforthevictim'sdamage.Ifsomeoftheinsuredhasfulfilledallofthecompensationobligations,thentheinsurershallsettlealltheclaimstotheinsuredwithintheliabilitylimit.Theinsurerisnotallowedtoclaimforbearinginsuranceliabilityonlywithintheproportionofliabilitiesthatshouldbeassumedbytheinsured,whereasitmayrecovertheexcesspartaftertheclaimsettlement.