Insurance Law Case Analysis and Answers

1. In March 2001, Gong, a 45-year-old cadre of a certain factory, suffered from gastric cancer (relatives did not tell him the true condition because they were afraid of his mood swings) ) was hospitalized and discharged from the hospital after surgery, and returned to work normally. On August 24, Gong was recommended by Wu and went to the insurance company to apply for simple life insurance with him and completed the relevant procedures. When filling out the insurance policy, he did not declare that he was suffering from cancer. Facts.

In May 2002, Gong's old illness relapsed and he died after ineffective treatment. Gong's wife went to the insurance company as the designated beneficiary to request insurance benefits. The insurance company submitted relevant documents for review. When obtaining the certificate, it was discovered that Gong’s medical history stated that he had suffered from cancer and had undergone surgery, so he refused to pay the insurance. Gong’s wife argued that her husband did not know what kind of disease she had and had not violated the obligation to disclose it. As a result, the two parties had a dispute. Dispute. How should the insurance company handle it?

2. Xiong, an employee of a company in Hengyang City, purchased 8 life-long critical illness insurance policies for his 59-year-old mother Wang through Chen, an insurance company salesman. Chen did not respond After asking about Wang's physical condition, he filled out the insurance policy. Afterwards, Chen did not ask Wang for a physical examination. In July 2002, Wang unfortunately died of illness, and Xiong asked the insurance company to settle the claim. The insurance company complained that the defendant was not truthfully informed when taking out the insurance. The insurance company refused to pay the claim due to the fact that he was hospitalized for "Parkinson's syndrome" before taking out the insurance. Xiong appealed to the court and asked for an insurance payment of 240,000 yuan. What was the verdict?

3. A certain year During the Spring Festival, Li bought fireworks and firecrackers worth 200 yuan for his son who had just turned 8 years old. One day, Li and his wife went out to visit. His son felt bored at home alone, so he dug out the fireworks and firecrackers that Li had hidden and put them behind him. Playing in the house, he accidentally caused a fire, causing varying degrees of damage to clothes, bedding, furniture, etc. The loss was about 30,000 yuan. Fortunately, Li had purchased home property insurance and made a claim to the insurance company. The insurance company Whether to pay compensation

4. In April 2003, a certain township government purchased home property insurance from a local insurance company for farmers in the township. The insurance premium was 7.5 yuan per household, and the insured amount was 2,500 yuan per household. Both parties to the insurance Special agreement: the premium was paid in two installments and was paid in full in November. The insurance company then issued the policy to the township government and stamped its official seal. Later, the insurance company repeatedly pressed the township government for premiums but failed. In July of that year, a historical incident occurred A rare and severe flood destroyed the flood control embankment of the township and submerged farmland and houses in the entire township. Farmers suffered heavy losses. After the disaster, the township government quickly filed a claim with the insurance company, and the insurance company claimed that the township had not paid premiums. Refusal to compensate. Because the matter was so important, the township government appealed to the court to see how the court would ultimately rule.

Reference answers:

1. In this case, Gong did not know that he had the disease Gastric cancer. From the perspective that he did not declare that he had gastric cancer, it does not constitute a violation of the obligation to disclose. However, Gong’s fact that he had been hospitalized and had surgery a few months ago (this fact is undoubtedly for the insurance company) It is impossible not to know), but he did not explain it. The key to the problem is precisely here.

Because according to the general theory of insurance law, the obligation to disclose requires that the content of the disclosure be a statement of facts. rather than accurately stating a point of view. It does not strictly require that the policy holder’s disclosure is completely accurate, as long as he fulfills this obligation to the greatest extent possible within the policy holder’s knowledge. In other words, in the case of the insured, When he is not sure what kind of disease he has, if he makes a perceptual statement about his disease, even though this statement may not be consistent with the facts (for example, if he suffers from gastric cancer and his family members tell him in good faith that he has stomach disease, he will (Declaring to have suffered from stomach trouble) He is absolutely flawless in the performance of his obligations, but if he conceals or falsely states the facts regarding medical treatment or treatment, he is guilty of failing to properly inform important facts and shall bear the disadvantage of violating the obligation to disclose. Consequences.

The insurance company has legitimate reasons for refusing to compensate. The insurance company therefore obtains the right of defense and refuses to pay the insurance money.

2. According to Article 16 of the Insurance Law: The policyholder If the facts are deliberately concealed and the obligation of truthful disclosure is not performed, or the failure to perform the obligation of truthful disclosure due to negligence is enough to affect the insurer's decision whether to agree to underwrite or increase the insurance rate, the insurer has the right to terminate the contract. If the policyholder intentionally fails to perform the obligation of truthful disclosure, The insurer is not liable for compensation or payment for insured accidents that occur before the insurance contract is terminated, and will not refund the insurance premium. But the same article stipulates: When entering into an insurance contract,

The insurer shall explain the terms of the insurance contract to the policy holder, and may make inquiries about the subject matter of insurance or the insured, and the policy holder shall truthfully inform the applicant.

Analysis of the above provisions can be concluded that: truthfully inform and It was not a proactive notification. In this case, the salesperson Chen filled in the policy’s medical history information without asking the insured or the policy holder. Afterwards, Chen did not ask the insured Wang to do a physical examination. It cannot be done. It is determined that the insured intentionally concealed the facts and failed to fulfill its obligation to truthfully inform. Therefore, the insurance company should pay compensation.

Whether the policyholder fulfills its obligation to truthfully inform is related to the insurance company’s claim settlement decision. Although the insurance company finally paid the compensation in this case However, for the majority of policyholders, when applying for insurance, do not take any chances. You should tell the truth as much as possible. Of course, if the insurance company does not ask, there is no need to take the initiative to inform.

3. For In such a fire, the insurance company believed that the fire was caused by the intentional actions of Li's son. According to the provisions of the home property insurance, property losses caused by the intentional actions of the insured and his family members are excluded. The insurance company should not pay compensation. .However, Li believes that his son did not intentionally set the fire and should not be regarded as an intentional act by the insured’s family member, and the insurance company should pay compensation.

The focus of the dispute in this case is the identification of "intentional behavior".

According to legal interpretation, "intentional" refers to the psychological state in which the actor foresees that his behavior will cause certain harm, and still hopes that the result will happen or allows the result to happen. Obviously, intentionality is always related to the behavior. A person's "knowingly" and "intentionally" are related.

The perpetrator in this case was a child who was just 8 years old. According to the provisions of the General Principles of the People's Republic of China and the Civil Law: "Minors under 10 years old He is a person without capacity for civil conduct. "An 8-year-old child should be recognized as a person without capacity for civil conduct. There is no question of intentionality or unintentionality at all, and he is not civilly responsible for the consequences of his actions. According to the People's Republic of China and the National The provisions of the General Principles of the Law: "If a person without capacity for civil conduct or a person with limited capacity for civil conduct causes damage to others, the guardian shall bear civil liability. If the guardian has fulfilled his civil liability, his civil liability may be appropriately reduced." Li and his The fact that his wife hid the fireworks before going out shows that he has fulfilled his responsibility, but leaving the underage children alone at home may have some unpredictable adverse consequences. In this regard, Li and his wife should think of, But he did not think of it due to negligence. Even so, it can only be said that Li and his wife were at fault, but it was by no means "intentional". Conclusion: Since the property loss in this case was not caused by the intentional behavior of the insured and his family, the insurance The company should bear the liability for compensation.

4. The focus of the dispute in this case is whether the policyholder’s payment of premiums as agreed is a prerequisite for the insurer to bear the insurance liability. The property insurance contract is a commitment contract, as long as both parties agree After expressing true agreement and reaching a written agreement, the insurance contract is established and the insurer begins to assume the insurance liability. However, if the law has clear provisions or the contract has special provisions, it must be implemented in accordance with the legal provisions or the special provisions of the contract. Under normal circumstances Once an insurance contract is concluded, the parties to the contract have specific rights and obligations, the most important of which is that the policyholder has the obligation to pay premiums, and the insurer has the obligation to compensate for damage suffered by the subject matter insured. Article 13 of the Insurance Law Article stipulates: After the insurance contract is established, the policy holder shall pay the premium as agreed; the insurer shall begin to bear the insurance liability according to the agreed time.

In this case, the insurance company issued the policy to the township government, and the insurance contract was established. , the rights and obligations stipulated in the contract should be protected by law, and the township government should pay the premium as agreed. If the policyholder defaults on the premium, the insurer can recover it through claims or litigation. However, the parties in this case did not have any objection to the contract. When will it take effect, that is, the insurer will make a special agreement on when it will begin to assume the insurance liability. It only states in the policy that the premium will be paid in two installments and paid in full in November. Whether the hometown government pays the premium as agreed is not a prerequisite for the insurance company to assume the insurance liability. Conditions, unless there is a special agreement in the policy: "The policy will take effect from the date of payment of the premium." In this way, even if the policyholder fails to pay a cent, the insurer must bear the insurance liability. Therefore, when the insurance contract in this case is established, it should be regarded as a contract It comes into effect when it is signed, and the insurer begins to bear the insurance liability.

Conclusion: The insurance company should use this case as a teaching material and learn lessons. When the policyholder fails to pay the premium as agreed, the insurer must take Corresponding measures cannot be left to chance.

The insurance company will refuse compensation on the grounds of non-payment of premiums only after an insured accident occurs. The insurer should actively urge the premiums to be paid, and if necessary, stipulate the effective time of the contract in the policy, or exercise the right to terminate the insurance contract on the grounds of the other party's breach of contract. To the insurance company A compensation of 3.8 million yuan was paid, and the township government paid a premium and interest of 30,000 yuan to settle the case.

Case 1: Zhang purchased a leather jacket worth 2,100 yuan from a leather jacket factory at an exhibition, and saw : "Inspection in person, no returns." Eight words. When I came back, I found that the leather jacket was peeling and the quality was substandard. Zhang requested a return but was refused. Zhang then announced it to the TV station and exposed the leather garment factory, causing the leather garment factory's sales to drop significantly. The leather garment factory sued Zhang for infringement of his reputation and demanded compensation for damages and financial losses.

Question: 1. Are the eight characters for leather garment factory valid?

2. Is the leather garment factory suing Zhang for infringement established? Why?

3. Does Zhang bear liability for breach of contract? Why?

4. Does the leather garment factory bear product responsibility?

Answer: 1. Those 8 words are standard clauses, that is, overlord clauses, which are definitely invalid. This clause exempts the merchant from the quality assurance obligation and excludes the consumer’s right to remedy. According to the contract According to the provisions of the law, it is an invalid standard clause.

2. Not established. On the surface, Zhang's behavior caused a decrease in the sales of the leather garment factory, but it was not an infringement, but a legal act to safeguard his own rights and interests. He has the right to adopt social supervision methods to safeguard his own rights and interests; in essence, , the reason for the decline in sales of the leather garment factory is that its products do have quality problems. There is no essential causal relationship between Zhang’s behavior and the decline in sales of the leather garment factory. Moreover, Zhang was not subjectively at fault, and there was no intention or negligence to infringe on the rights of others. This behavior is worthy of encouragement. Zhang's behavior did not meet the constituent elements of infringement, so it was not established as an infringement.

3. Zhang does not need to bear liability for breach of contract. Because the sales contract between Zhang and the leather garment factory does not stipulate that Zhang shall not disclose such obligations to the media, there is no issue of breach of contract.

4. The leather garment factory is responsible for quality assurance of the products it produces, and therefore should bear product liability. When the product sold does not have the performance that the product should have, it should be responsible for repairing, replacing or returning the product.

Product Quality Law Case Analysis

Case 2: In 1994, when a family named Zhao was celebrating the birthday of an elderly member of the family, the pressure cooker suddenly exploded, and the daughter-in-law was hit in the head by the pot lid. , died after resuscitation failed. According to the identification of experts responsible for the quality inspection of the pressure cooker, the direct cause of the pressure cooker explosion was a problem with the design of the pressure cooker, which caused the vent hole on the lid to be blocked. Since the manufacturer of the pressure cooker is far away, the Zhao family requires the shopping mall where the pressure cooker was sold to bear civil liability for damages. However, the mall claimed that the defect was not caused by itself, and that the mall had signed a contract with the buyer when selling this pressure cooker (which was still in the trial sale period), stipulating that if the product had quality problems, the mall would be responsible for returning the product and double the payment. Therefore, the mall is only liable for breach of contract by returning double the payment.

Excuse me: 1. Can the Zhao family ask the mall to take responsibility? Why?

2． Can the Zhao family claim liability for breach of contract or liability for tort compensation?

1. Yes, Article 43 of the "Product Quality Law" states that if a defect in a product causes personal or property damage to others, the victim may seek compensation from the product's owner. The producer can also ask for compensation from the seller of the product. If the responsibility of the producer of the product is compensated by the seller of the product, the seller of the product has the right to recover compensation from the producer of the product. It is the responsibility of the seller of the product. If the producer of the product compensates, the producer of the product has the right to recover compensation from the seller of the product.

2. Liability for infringement compensation. Because it caused personal damage, it exceeded the liability for breach of contract and should be subject to tort liability.

Article 44 of the "Product Quality Law" If the victim is injured due to a product defect, the offender shall compensate for medical expenses, nursing expenses during treatment, loss of income due to missed work, etc.; If the person is disabled, the disabled person shall also be paid for self-help equipment, living allowances, disability compensation and necessary living expenses for his dependents; if the death of the victim is caused, funeral expenses, death compensation and other expenses shall also be paid. Necessary living expenses and other expenses for the people supported by the deceased during his lifetime. If the victim's property is damaged due to product defects, the offender shall restore the original condition or compensate at a discounted price.

If the victim suffers other major losses as a result, the offender shall compensate for the losses.