Case Analysis of Proximate Cause Principle in Insurance

The principle of proximate cause is an important principle in insurance damage compensation. In judicial practice, the principle of proximate cause has become an important criterion for judging whether the insurer should bear insurance liability. The following is a case I compiled for you on the principle of proximate cause in insurance for your reference. Welcome to read!

Case 1 of the principle of proximate cause in insurance

November 28, 2008, Wan__ drove the Gan AL0___ school bus and Zhang__, a teacher from Wangwang Kindergarten, to pick up the children from the kindergarten. They passed by the grain drying field of Anyi County Grain Farm. After picking up a child on the bus, the car turned around and started driving. As soon as he left When they were five or six meters away, Wan __ found Zhang __ fell out of the car and fell on the cement floor of the grain drying field. Wan __ immediately got out of the car and carried Zhang __ into the car and sent him to the hospital for rescue. He died after the rescue failed. The accident was determined by the "Traffic Accident Determination Letter" No. 50 of the Traffic Police Brigade of the Anyi County Public Security Bureau: An Gongzhizi [2008] No. 50: Wan__ and Zhang__ respectively bear equal responsibility for this traffic accident. After the relevant departments presided over the mediation between the parties, the actual owner of the accident vehicle, Gao __, reached a "compensation agreement" with Zhang __'s relatives, agreeing that Gao __ would compensate Zhang __'s relatives in a lump sum of 375,000 yuan, and Zhang __'s relatives Cooperate with Gao in making insurance claims, and all claim funds will belong to Gao __. After the agreement was signed, Gao __ and Wangwang Nursery School of Dinghu Town, Anyi County requested the court to revoke the agreement on the grounds that the subject of the compensation agreement was unqualified, there was coercion when the agreement was signed, and taking advantage of others' danger. After the first-instance judgment of the Anyi County People's Court and the Nanchang Intermediate People's Court, The second-instance judgment of the People's Court determined that the compensation agreement was legal and valid. After the court's judgment came into effect, Gao __ paid 375,000 yuan in compensation to Zhang__'s relatives and 100,000 yuan in liquidated damages for overdue payment.

Case Study 2 of the Proximate Cause Principle of Insurance

At the end of 2007, a company transported a load of 1,000 baskets of peeled banana tangerines from the south to the northwest via railway, and was insured with comprehensive cargo transportation insurance. The goods arrived at the destination within the agreed time limit, but when unloading the goods, it was discovered that there were obvious signs of theft near the door, and the insulation layer at the door was torn with a length of 1.2 meters and a width of 0.65 meters. After unloading, there were 927 baskets of goods counted, and 73 baskets were stolen; among the goods received, 150 baskets were damaged by freezing. It was verified that the lowest temperatures in the northwest region at that time were around minus 18 degrees Celsius. The insured requested the insurance company to compensate for theft losses and freezing damage suffered by the goods. However, the insurance company believed that the 73 baskets of bananas and tangerines that were stolen fell within the scope of insurance liability of the comprehensive cargo transportation insurance, and it was undisputed that they should be compensated. However, it was not liable for the 150 baskets of bananas that were damaged by freezing. The insurance company believes that there are three reasons for the freeze damage of banana oranges: theft, damage to the insulation layer and cold weather. Among them, the most direct reason is the cold weather rather than theft. Theft does not necessarily cause frost damage to the subject, but cold weather is a necessary condition for frost damage. According to the principle of proximate cause, in the terms of the comprehensive cargo transportation insurance contract signed between the insurance company and the policyholder in this case, cold weather was not within the scope of the insured accident stipulated in the insurance liability clause, so the insurer would not pay compensation. Unable to reach an agreement, the two parties went to court.

Case Study 3 of the Proximate Cause Principle in Insurance

Most people think that it is easy to buy insurance but difficult to settle claims. Some people even believe that insurance is a scam. However, many people know little about the concept of proximate cause principle in insurance. When it is difficult to settle an insurance claim, you should take a look to see if the principle of proximate cause is at play.

Let’s first understand what the principle of proximate cause in insurance is. The proximate cause here refers to the most direct, most effective and decisive cause of loss, not the most direct cause in time or space to a certain woman. I purchased accident insurance in 2016. She was slightly bumped by a medium-speed car and suddenly felt chest tightness and dizziness. Unfortunately, his condition worsened on the way to the hospital, and he eventually died in the hospital. The hospital's death certificate stated the cause of death as myocardial infarction. The family filed a claim with the insurance company with valid insurance policies and death certificates, but the insurance company considered the accident that caused the death to be a non-insured accident and not an accidental injury, so it would not pay the claim. In this case, the woman was slightly touched by a car. If this happens to an ordinary healthy person, it will not cause death. The cause of the lady's death was heart disease. Although the vehicle collision was an accident, it was not the proximate cause of his death, so the insurance company would not pay compensation.

Case 4 of the Proximate Cause Principle of Insurance

An insured person purchased personal accident insurance and also received accidental injury medical insurance. One day, the insured went to the hospital for treatment due to bronchial inflammation. The hospital followed medical procedures and first conducted a penicillin skin test on the insured, and the result was negative. Then inject penicillin at the dose prescribed by the doctor. Two days after treatment, the insured suffered an allergic reaction. Although the hospital tried its best to rescue him, the treatment failed and he died. The death certificate issued by the hospital was: delayed penicillin allergy.

The beneficiary of the insured submits a claim application to the insurer with the hospital certificate and insurance contract.

Case Study 5 of the Proximate Cause Principle of Insurance

On January 31, 2011, Yongfa Company, as the policy holder, insured a Mercedes-Benz sedan owned by the company at the Xishan Branch of the People's Insurance Company of China. Motor vehicle loss insurance and corresponding non-deductible insurance.

During the insurance period, when Geng Rongfa, the legal representative of Yongfa Company, drove a Mercedes-Benz into a tunnel, the vehicle was flooded and stalled due to water accumulation in the tunnel, and the engine was damaged by water. On the same day, the traffic patrol brigade of the city's Public Security Bureau issued a road traffic accident determination certificate for the accident, confirming that Geng Rongfa was fully responsible for the accident.

Neither Yongfa Company nor PICC Xishan Branch disputed the fact that there was no rainfall in the area on the day of the accident and that the water accumulation in the tunnel in the accident section was caused by rainfall in the area the day before the accident. However, Yongfa Company and PICC The Xishan branch company has a dispute over the cause of water damage to the engine of the insured vehicle. Yongfa Company believes that the heavy rain in the area the day before the accident caused water damage to the engine of the insured vehicle. That is what caused the damage to the insured vehicle? The proximate cause was heavy rain; PICC Xishan Branch believed that the proximate cause of water damage to the engine of the insured vehicle was Geng Rongfa’s behavior of driving through water on the accident road section on the day of the accident, not heavy rain.

Subsequently, Yongfa Company incurred maintenance expenses of 1.3 million yuan for repairing damaged vehicles. Since the Xishan Branch of the People's Insurance Company of China refused to fulfill its obligation to compensate for the above expenses, it requested the court to order the Xishan Branch of the People's Insurance Company to pay the insurance immediately. gold.