Electronic insurance fails to fulfill the obligation of prompt explanation, and the court finds that the special agreement clause has no effect on the policyholder

Date:2024-07-11 11:03:47  Views:246

case introduction


Mr. Ding sued that Mr. Wang collided with Mr. Ding, who was driving an electric bicycle in the same direction, while driving from east to west. According to the road traffic accident recognition certificate, Mr. Wang bears the main responsibility for the accident, while Mr. Ding bears the secondary responsibility for the accident. After the accident, Mr. Ding was sent to the hospital for emergency treatment and was discharged after 7 days of hospitalization. After investigation, it was found that Mr. Wang was the driver of the vehicle in question, and Hongda Company was its cooperating company. The vehicle in question was insured by the insurance company, and the accident occurred during the insurance period. Therefore, the lawsuit is brought to the court, requesting a judgment that Mr. Wang, Hongda Company, and the insurance company compensate him for a total of 300181.3 yuan in medical expenses, hospitalization meal allowance, nutrition expenses, disability compensation, nursing expenses, lost work expenses, transportation expenses, mental distress compensation, and appraisal fees.

Mr. Wang argued that he was a rider on a certain food delivery platform who was delivering orders at the time of the incident. He had signed a service cooperation agreement with Hongda Company and was a crowdsourced food delivery worker. Hongda Company has requirements for daily working hours and workload, and he is managed by the company. The responsibility should be borne by Hongda Company and the insurance company.

Hongda Company argues that firstly, the company is not a qualified defendant in this case. This case was caused by Mr. Wang's injury to Mr. Ding. Mr. Ding believes that Hongda Company and Mr. Wang have an employment relationship and should bear compensation responsibility. However, the fact is that Mr. Wang and Hongda Company signed a service cooperation agreement online on the platform APP, and the two parties belong to a service cooperation relationship without an employment relationship. Hongda Company is not a qualified defendant in this case. Secondly, there is no legal basis for requesting Hongda Company to assume compensation liability. In this case, Hongda Company did not engage in any infringement. Mr. Wang will receive pre video training on road traffic safety before his first registration. The company is not at fault and has fulfilled his responsibility for safety training and reminders, so he will not be liable for compensation. Thirdly, Mr. Ding's claim for compensation is too high, and he requests the court to make a discretionary decision. Fourthly, in order to reduce the loss of riders in such accidents, Hongda Company, as the policyholder, purchased accident insurance for Mr. Wang from the insurance company, which includes a third-party insurance with a limit of 300000 yuan. If this case meets the claim conditions, the third party can directly request compensation from the insurance company. Therefore, the insurance company should first claim within the scope of 300000 yuan third-party insurance.

The insurance company argues that Hongda Company has purchased personal third-party liability insurance for Mr. Wang, which includes disability, accidental medical treatment, and property damage totaling 300000 yuan. The insurance company is only liable for compensation within the scope of the policy. The insurance company recognizes the division of primary and secondary responsibilities and agrees to assume 70% of the responsibility. The self funded portion of medical expenses should be deducted, and after 70% of the responsibility is divided, 43795.77 yuan will be recognized. According to the special provisions of the insurance liability agreement, the amount of work delay fee recognized without a labor contract is only 90 days * 100 yuan, and without a tax payment certificate, the maximum amount does not exceed 5000 yuan per month, with a maximum period of 90 days. Therefore, the amount of work delay fee recognized after division of responsibilities is 6300 yuan. Nutrition fee recognition 60 days * 40 yuan * 70%=1680 yuan. Nursing fee of 60 days * 120 yuan * 70%=5040 yuan. The disability compensation is agreed to be 117632.2 yuan at a rate of 70%. Other claims are not covered by insurance.


Court Trial

After trial, the court found that Hongda Company had purchased personal third-party liability insurance for Mr. Wang. Responsibility Name: Third Party Death/Disability Liability Limit, Third Party Accidental Medical Liability Limit, Third Party Property Loss Liability Limit, Shared Insurance Amount of 300000 yuan. The compensation limit for each accident is 300000 yuan. Deductible Statement: Please refer to the special agreement for details. Article 6 of the special agreement on electronic insurance policies states that during the period of temporary loss of work ability, compensation for lost work expenses shall be provided based on the wages of the three parties, with a maximum of 90 days, as certified by the hospital. The salaries of these three individuals are calculated based on their average salaries for the first twelve months of the accident. Less than twelve months will be averaged based on the actual number of months. But the portion of the salary that the employer has already compensated needs to be deducted, and salary statements, income proof, etc. need to be provided when settling the claim. If the monthly income certificate is higher than 5000 yuan, the individual income tax payment certificate for the twelve months prior to the accident must be provided at the same time. If the labor relationship and salary level have been proven through tax receipts and salary records during claim settlement, there is no need to provide a labor contract. If the three parties are unable to provide proof of salary and tax payment, and temporarily lose their ability to work, the hospital will provide proof that the loss of lost work allowance insurance will be paid at a rate of 100 yuan per day, with a cumulative payment limit of 90 days.




After trial, the court found that in this case, according to the delivery records submitted by Hongda Company, Mr. Wang was delivering takeout at the time of the accident. According to the service cooperation agreement signed between Mr. Wang and Hongda Company, considering that Hongda Company participated in Mr. Wang's delivery activities and paid corresponding service fees, it played an important role in Mr. Wang's management, cost settlement, rights and obligations, insurance, and other aspects. Therefore, Mr. Wang's delivery behavior at the time of the incident should be considered as fulfilling the duties of Hongda Company. Therefore, if Mr. Wang causes damage to others during the execution of work tasks, Hongda Company should bear tort liability according to the proportion of responsibility. The traffic accident in this case has been determined by the traffic management department of the public security organs to be the main responsibility of Mr. Wang and the secondary responsibility of Mr. Ding. Regarding the specific proportion of responsibility for the traffic accident in this case, the court has determined that Mr. Wang bears 70% of the responsibility, while Mr. Ding bears 30% of the responsibility. As Hongda Company has purchased personal third-party liability insurance for Mr. Wang from the insurance company, for Mr. Ding's various losses that fall within the scope of compensation under this insurance, the insurance company will compensate for them, and Hongda Company will be responsible for the rest of the compensation. The court ultimately ruled that the insurance company should compensate Mr. Ding with medical expenses of 60320.25 yuan, nutrition expenses of 2625 yuan, nursing expenses of 9548 yuan, lost work expenses of 53714.72 yuan, and disability compensation of 117632.2 yuan, totaling 243840.17 yuan; Hongda Company compensated Mr. Ding with a hospital meal allowance of 490 yuan, transportation expenses of 560 yuan, mental injury compensation of 7000 yuan, and appraisal fees of 2205 yuan, totaling 10255 yuan.




After the verdict was pronounced, no party appealed, and the verdict has now come into effect.