Question 1: Accidental injury case 20 points □Yinshi, Class 072, Bioengineering Major, School of Chemical Engineering, China University of Mining and Technology
Case 1 Accident occurred while playing during class
Liaoning Province Wang, a first-year student in a middle school, tripped and fell to the ground while running during recess activities, causing swelling and pain in his right elbow joint. After the incident, the school promptly contacted his parents and sent Wang to a nearby hospital. After examination, he found a slight bone fracture in his right elbow joint.
Next, the student's parents sent their child for treatment, but three weeks later, the doctor told Wang that his right elbow joint had been dislocated and that he needed to go to a large hospital for surgical treatment.
Since it costs a lot to go to a large hospital for treatment, the student’s parents requested that most of the medical expenses be paid by the school in advance (because the student had accident insurance). The two parties could not reach an agreement on this issue. Later, After mediation by the Judicial Office, the school paid two-thirds of the student's medical expenses in advance, and the school borne half of the student's medical expenses.
Analysis:
In this case, student Wang’s injury accident was divided into two parts. Student Wang only suffered a slight injury to his right elbow joint due to a fall at school. A fractured bone is a minor injury and can be cured as long as you rest for a while. The subsequent dislocation of the right elbow joint was caused by bandaging in the hospital or other reasons of Wang himself, and Wang should go to the hospital to solve it.
According to Article 32, Paragraph 5 of the School Safety Work Regulations: Students who violate laws, regulations, rules and regulations, violate school rules, regulations or disciplines shall be punished according to their age and cognitive ability. If the school or teachers have warned and stopped the behavior that is dangerous or may endanger others, or the student's behavior is dangerous, but the student does not listen to the dissuasion and refuses to correct, the school will not be liable for compensation.
But later, taking into account Wang’s family situation and living reality, the school agreed to compensate Wang for the corresponding expenses. This was also an act of humanitarianism by the school.
Case 2: Parents who suddenly fell ill at school claimed 100,000 yuan
On the morning of December 17, 2006, Hu, a first-year primary school student in a private boarding school in Ningbo, vomited after getting up. more than.
During the process of sending Hu to the hospital, the school immediately notified Hu’s parents in Shanghai. When the parents rushed to Ningbo Hospital, Hu was already unconscious. Hu was treated in Ningbo for three days. During the treatment period, out of concern for the students, the school sent teachers to accompany the parents for care.
Later, Hu was transferred to Shanghai by his parents for further treatment. When he was transferred, the school also sent someone to accompany him. The Shanghai Hospital further confirmed that it was a vascular rupture and cerebral hemorrhage caused by congenital malformation of cerebral blood vessels, and made it clear that it was not caused by external force. Caused by.
During this period, the school sent people to visit him many times. The school not only advanced all the expenses for treatment in Ningbo for Hu’s parents, but also mobilized all the school staff to show love for Hu and raised nearly 30,000 yuan. , to help Hu’s parents. After surgery and nearly two months of treatment, Hu miraculously recovered.
After recovery, Hu’s parents believed that their child suddenly fell ill at school and almost lost his life. They spent more than 100,000 yuan to save the child and also missed work. Not only did they disagree He returned the medical expenses of 15,000 yuan advanced by the school, and also proposed to the school to compensate him for the medical expenses of nearly 100,000 yuan, in addition to the insurance company's compensation.
Analysis:
According to Article 12, Paragraph 3 of the Ministry of Education's "Measures for Handling Student Injury Accidents": Students have special physiques, specific diseases or abnormal mental states, and the school does not know or It is difficult to know the accidents causing injuries to students. If the school has fulfilled its corresponding responsibilities and its behavior is not inappropriate, it will not be held legally responsible.
After Hu vomited, the school promptly sent Hu to the hospital for examination and treatment. The measures taken were active and effective. At the same time, the school immediately notified the parents when sending Hu to the hospital.
These actions are enough to show that the school has fulfilled its corresponding responsibilities, and its behavior is not inappropriate and has no legal responsibility.
Out of concern for Hu, the school advanced his medical expenses, sent nursing staff, accompanied his parents to transfer Hu to Shanghai, visited Hu in Shanghai many times, and also mobilized faculty and staff to donate. These practices are also in line with Article 26 of the "Measures for Handling Student Injury Accidents": If the school has no responsibility, if conditions permit, it can provide appropriate help to injured students based on the actual situation and on the principle of voluntariness and possibility.
In this case, it is unreasonable for Hu’s parents not to return the 15,000 yuan in medical expenses advanced by the school, but also to demand compensation of nearly 100,000 yuan from the school.
Case 3: The school was fined 300 yuan for damaging the school chandelier
Ma, a junior high school student in a school in Shandong Province, studied... >>
Question Two: Cases in which people encounter accidents or misfortunes without purchasing insurance in advance. 30 cents and 3,000 yuan are required at the same time to ensure that the amount of insurance is not too high.
The order is first. Buy children’s insurance for children first and buy insurance for minors. The main options are to buy commercial insurance such as academic insurance and accidental injury comprehensive insurance.
Question 3: Personal accident insurance claims case Analysis: The question of which ones are compensated and which ones are not is too general! The key points for determining accident insurance claims when the application materials are complete: 1. Whether the time of the accident falls within the insurance period; 2. Whether the insured accident is an accidental liability. The Insurance Law defines an accident as “an external, sudden, or unintentional accident.” "Objective events that cause harm to the body, non-disease", pay attention to "non-disease" here! 3. Whether the insured accident belongs to the "disclaimers" in the insurance clauses; based on the above content, you can judge whether compensation can be paid.
Question 4: A case is needed regarding the principle of proximate cause in insurance. . On the Proximate Cause Principle in Insurance Law
[Huang Yixin]——(2005-8-29) / Read 21182 times
On the Proximate Cause Principle in Insurance Law
Huang Yixin
The principle of proximate cause is the earliest basic principle established by British marine insurance law to determine causation. After long-term practice summary and development, it has now been adopted by many national insurance laws. When insurance accidents occur, insurance companies in our country often refuse to pay compensation on the grounds that the damage was caused by non-proximate causes. However, due to the lack of clear provisions in my country's insurance legislation, courts in various places are generally unfamiliar with this imported product, and judges will not or dare not apply it in judicial documents, resulting in difficulties or unclear explanations in some insurance dispute cases. In order to improve our country's insurance legislation and integrate it with international insurance practice, our country should confirm the principle of proximate cause in legislation and judiciary as soon as possible. This article attempts to give an explanation to introduce some ideas.
1. The meaning of the principle of proximate cause
"Proximate Cause" in English is Proximate Cause, where Proximate means "the closest or approximate (in time, place or sequence)" ", immediately before and after", it is difficult to find a word that completely corresponds to it in Chinese. For example, if it is translated as "direct cause" (corresponding to Direct Cause), it cannot fully cover its connotation, so now it is simply translated as "proximate cause". The introduction of this imported product is not just a fashion, but also a complete set of mature legal rule systems from British and American law that regulate causality. The "proximate cause principle", in short, means that the scope of the insurance company's liability should be limited to losses caused by the insured risk as the proximate cause. Although my country's current insurance law and maritime law do not stipulate the principle of causation, in foreign-related relations such as marine insurance, international practices are followed and the principle of proximate cause is generally applied. Interpretation (Draft for Comments)" has also adopted this concept. Article 19 of the consultation draft clearly stipulates: "The People's Court should support the claim of the insurer that its liability is limited to losses caused by the insured risk as the proximate cause."
The principle of proximate cause originated from the United Kingdom. Marine Insurance Act, 1906. Article 55(1) of the Act stipulates: “In accordance with the provisions of this Act and unless otherwise agreed in the insurance policy, the insurer shall be liable for losses caused by the insured peril as proximate causes, but shall not be liable for losses not caused by the insured perils. If the danger is a proximate cause of the loss, we are not responsible.”⑴ This is because the marine insurance contract is a relatively strict “limited compensation contract”, and the scope of the insurer’s liability cannot cover all losses incurred by the insured subject matter. Rather, it is certain losses (the so-called “covered losses”) caused by hazards within a certain range (the so-called “covered risks”). Therefore, in the settlement of marine insurance claims, a special principle of causation should be applied, which is the so-called "proximate cause principle" in common law. This principle requires that the insurer must have a causal relationship that complies with marine insurance law between the occurrence of the insured danger and the damage to the subject matter insured. This principle has gradually been extended by judges and scholars in the Anglo-American legal system to the entire insurance law and even tort law (and even part of contract law). At present, the insurance legislation in many countries around the world has mostly established the principle of proximate cause as the basic principle of insurance law. ①
However, because the Anglo-American legal system emphasizes case analysis rather than abstract generalization, the meaning of proximate cause has not yet been completely clear. For example, Prosser, a famous American tort law professor, believes that the word "proximate" means closest in time and space. "Black's Dictionary of Laws" believes: "The so-called recent here does not necessarily mean the recent in time or space, but the recent in a causal relationship. The proximate cause of the damage is the main cause or the moving cause or the effective cause." Nonetheless, in the long term, In the trial practice of the two major legal systems, judges of the two major legal systems have established three basic rules for the determination of proximate cause through jurisprudence and doctrine: first, the proximate cause is a substantive, significant and positive factor that caused the harm; second, this One factor acts naturally and continuously, without intervening other factors that affect the outcome or interrupt the causal relationship; third, analysis is based on the concepts and policies of fairness and justice. ② This time, the Supreme Court also defined proximate cause in Article 19, Paragraph 2, of the Insurance Judicial Interpretation (Draft for Comments): “Proximate cause refers to the decisive and effective cause of the insured loss.”
However, the meanings of "decisiveness" and "validity" are obviously too vague and lack operability. Judicial practice still needs to be case-by-case and concrete in the form of precedents.
2. Specific identification of the proximate cause
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Question 5: Personal accident insurance case analysis: A, the proximate cause of death Because it was a car accident, it is the insurance liability, and the insurance company should compensate; the proximate cause of B's ??death is heart disease, which is an excluded liability. The insurance company is not responsible for death benefits, but it should be liable for B's fractures caused by the car accident.
Question 6: Ask about insurance compensation cases? In fact, for this matter, just look at who the designated beneficiary is.
However, there is a special reason for this. According to the insurance law, the beneficiary of the policy must be the direct blood relative or legal person of the insured. companion!
In this case, because Hu and Wang were divorced, the first claim was made because Wang was only disabled. According to the insurance law, the claim was paid by Wang himself
The second In part, after Wang's death, the identity of the beneficiary changed, and Wang's parents had reasons to propose insurance benefits
In this matter, because Wang and Hu had divorced, The beneficiary is still Hu, so an investigation may be initiated to confirm that Wang’s death is not related to Hu before the claims process can continue!
Question 7: Sunshine Insurance sincerely protects accident insurance claims case Li Mr., 30 years old, has insured himself with the "True Guardian" protection plan. The basic insured amount is 500,000 yuan, and the monthly premium is 1,548 yuan. The payment is for 10 years, and the insurance is for 25 years. The first premium is 186,000 yuan. From the first payment Starting from the premium, he can obtain the following insurance benefits:
1. Death insurance benefit:
If Mr. Li unfortunately dies during the validity period of the contract, his death beneficiary can Obtain a death insurance benefit of up to 18.6×118%=219,000 yuan, and the primary and supplementary insurance contract is terminated.
2. Accidental death insurance:
If Mr. Li unfortunately dies due to an accident during the validity period of the contract, his deceased beneficiary will receive the following amount of death insurance: The main insurance contract is terminated.
Death in aviation accident: 50×20=10 million yuan
Death in public traffic accident: 50×10=5 million yuan
Since Driving accidental death: 50×2=1 million yuan
Ordinary accidental death: 500,000 yuan
All of the above will also pay 118% of the accumulated insurance premium
3. Accidental disability insurance:
If Mr. Li is unfortunately disabled due to an accident during the validity period of the contract, he can receive the following amount of accidental disability insurance:
Aviation Accidental disability: 10 million yuan × disability ratio
Bus accident disability: 5 million yuan × disability ratio
Self-driving accident disability: 1 million yuan × Disability ratio
Ordinary accidental disability: 500,000 yuan × Disability ratio
4. Accidental hospitalization allowance insurance:
If Mr. Li is in the year If an accident occurs before the age of 80 and requires hospitalization, we will pay the accident hospitalization allowance insurance based on the actual number of hospitalization days of the insured × 250 yuan/day
5. Maturity insurance benefit:
If Mr. Li survives in good health when this contract expires, he will receive a maturity insurance premium of 219,000 yuan, and the main supplementary insurance contract will be terminated
Question 8: There is no compensation for the insurance claim event. This is not Accident, although we think it is unexpected that this happened.