In June 2023, Wang insured his vehicle under the name of a certain insurance company, covering compulsory traffic insurance, commercial insurance, and additional motor vehicle passenger accidental injury insurance. The additional motor vehicle passenger accidental injury insurance policy specified: the insured was the vehicle owner, Wang, with coverage including: 1. death or disability due to accidental injury while driving or riding in a non-operational vehicle, with an insurance amount of 300,000 yuan per person; 2. compensation for accidental medical expenses, with an insurance amount of 10,000 yuan per person. On June 15, 2023, Wang's father, Wang A, was involved in a traffic accident while driving the vehicle and died despite rescue efforts. The traffic accident liability determination document stated that Wang A bore full responsibility for the accident. Wang filed a claim with the insurance company, which refused to pay the 300,000 yuan accidental injury death insurance benefit, arguing that the insured under the additional passenger accidental injury insurance was limited to the vehicle owner, Wang, and Wang A was not a covered party under the contract. Wang subsequently sued the insurance company in court.

The court ruled that the key issue in this case was whether Wang Moujia fell under the coverage of the supplementary accidental injury insurance for occupants of the motor vehicle involved. First, the insurance was titled "Motor Vehicle Occupant Supplementary Accidental Injury Insurance," and the policy clearly stated the coverage as "death or disability due to accidental injury while driving or riding in a non-operational motor vehicle, with an insurance amount of 300,000 yuan per person." Based on the general understanding of typical policyholders, this insurance was intended to cover unspecified drivers within the "mobile space" of the specific vehicle involved, rather than being limited solely to "the insured individual." Second, Article 30 of the Insurance Law of the People's Republic of China stipulates that in case of disputes over standard form clauses, the interpretation should favor the insured and beneficiaries. The plaintiff and defendant had differing interpretations of the "insured" scope, ranging from "limited to the policyholder" to "including qualified drivers." Since the insurance contract involved was a standard form clause provided by the insurer—a professional insurance institution—the lack of explicit exclusivity in defining the insured scope during the sale of the supplementary accidental injury insurance led to ambiguity in the coverage. Consequently, the interpretation should favor the insured. The court held that Wang Moujia should be considered within the insured scope of the accidental injury insurance and ordered the insurer to pay the death benefit of 300,000 yuan as per the contract. After the judgment, the defendant insurance company filed an appeal, but the second-instance court upheld the original ruling.

This article is reprinted from the WeChat Official Account "Shandong High Court," and our gratitude is extended here!