Zhang Mei lawyer's team of Furong Law Firm successfully acted for a personal insurance contract disp

[Lawyer in Charge]  Zhang Mei Lawyer's Team

[Cause]  Personal Insurance Contract Dispute

[Trial Authority]  Wuhan Intermediate People's Court

[Defendant]  Pacific Property Insurance Wuhan Branch

[Facts and Situation]  The insured died accidentally, and the insurance company issued a "Notice of Refusal of Claim" on the grounds that the insured was an employee of XX Company and died accidentally in the process of performing his work duties, which did not fall within the scope of the "travel period" stipulated in the insurance liability, and was within the scope of liability exemption, so no compensation was paid.

[First Instance Judgment]  The first instance court ruled to dismiss all the plaintiff's claims because the insured's accident occurred during work, so the insured's death due to the case did not fall within the scope of the agreed insurance liability.

[Commission Process]   After comparing with many law firms and communicating with Zhang Mei, the head of Zhang Mei's lawyer team, the family decided to entrust Zhang Mei's lawyer team to represent the case in the second instance, and Zhang Mei personally took the lead in handling it. After several discussions with senior lawyers in the team, a second instance appeal plan was issued.

【Second trial process】  During the second trial, the attorney seized three major arguments: 1. The insurance clauses were not delivered, and the delivery of the insurance clauses is an important basic fact for determining whether the objection to the validity of the insurance liability clauses can be cited and applied. The burden of proof of the delivery of the insurance clauses lies with the insurance company. The exemption clauses in the insurance clauses did not fulfill the obligation to clearly explain, and the exemption clauses were invalid; 2. The insured did not die accidentally during work, but was in a cooperative relationship with the clubs, not a labor relationship, and the fact of accidental death at work cannot be established; 3. After verification by our side, the company that the insured worked for as claimed by the insurance company in the first trial did not exist at all, which means that the company entity on which the insured's labor relationship relied did not exist (based on this, the insurance company's claim that the accident occurred at work was overturned. We used a trick, that is, we did not emphasize this fact in the appeal, and directly asked questions to the other party during the trial, and verified with the other party on the spot, confirming that the company did not exist). At the same time, to confirm the labor relationship, the labor contract, salary payment evidence, and whether the insured accepted the work-related content arranged by XX Company in this accident, all of which were evidenced by the insurance company.

[Judgment Result] The Wuhan Intermediate People's Court of the second instance fully adopted the defense opinions of Zhang Mei's lawyer team. According to Article 5, Article 17, Article 30, and Article 42 of the Insurance Law of the People's Republic of China; Article 9, paragraph 1 of the Judicial Interpretation of the Insurance Law II; Article 67, paragraph 1, and Article 77, paragraph 1, paragraph 2 of the Civil Procedure Law, the judgment is as follows: 1. The civil judgment No. XXXX of the Jianghan District People's Court of Wuhan City, Hubei Province is revoked; 2. The Wuhan Branch of Pacific Property Insurance Company shall pay the appellant 600,000 yuan in accident insurance and 15,000 yuan in funeral insurance. The above two items total 615,000 yuan.

Main legal provisions: Insurance Law

Article 5 The parties to insurance activities shall exercise their rights and perform their obligations in accordance with the principle of honesty and trustworthiness.

Article 17 When concluding an insurance contract and adopting the standard terms provided by the insurer, the insurance application form provided by the insurer to the insured shall be attached with the standard terms, and the insurer shall explain the contents of the contract to the insured.

For clauses in the insurance contract that exempt the insurer from liability, the insurer shall make a reminder sufficient to attract the attention of the insured on the application form, insurance policy or other insurance certificates when concluding the contract, and shall make a clear explanation of the content of the clause to the insured in written or oral form; if no reminder or clear explanation is made, the clause shall not take effect.

Article 30 If the insurer and the insured, the insured or the beneficiary have disputes over the terms of the insurance contract concluded using the standard terms provided by the insurer, they shall be interpreted according to the usual understanding. If there are more than two interpretations of the contract terms, the people's court or arbitration institution shall make an interpretation that is favorable to the insured and the beneficiary.

Article 42 After the death of the insured, if any of the following circumstances occurs, the insurance money shall be regarded as the insured's estate, and the insurer shall perform the obligation to pay the insurance money in accordance with the provisions of the "Inheritance Law of the People's Republic of China":

(1) No beneficiary is designated, or the beneficiary designation is unclear and cannot be determined;

(2) The beneficiary dies before the insured, and there is no other beneficiary;

(3) The beneficiary loses the right to benefit or waives the right to benefit according to law, and there is no other beneficiary.

If the beneficiary and the insured die in the same incident and the order of death cannot be determined, it is presumed that the beneficiary died first.