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Han Longmei, et al v. Sunshine Life Insurance Co., Ltd., Jiangsu Branch (Case of Disputes over Insurance Contract) (Case of Disputes over Insurance Contract)
韩龙梅等诉阳光人寿保险股份有限公司江苏分公司保险合同纠纷案
【法宝引证码】

Han Longmei, et al v. Sunshine Life Insurance Co., Ltd., Jiangsu Branch (Case of Disputes over Insurance Contract) (Case of Disputes over Insurance Contract)
(Case of Disputes over Insurance Contract)
韩龙梅等诉阳光人寿保险股份有限公司江苏分公司保险合同纠纷案

Han Longmei, et al v. Sunshine Life Insurance Co., Ltd., Jiangsu Branch (Case of Disputes over Insurance Contract)

 

韩龙梅等诉阳光人寿保险股份有限公司江苏分公司保险合同纠纷案


 
[裁判摘要]

 
保险法十七条第一款规定:“订立保险合同,保险人应当向投保人说明保险合同的条款内容,并可以就保险标的或者被保险人的有关情况提出询问,投保人应当如实告知。”保险人或其委托的代理人出售“自助式保险卡”未尽说明义务,又未对相关事项向投保人提出询问,自行代替投保人激活保险卡形成数据电文形式的电子保险单,在保险合同生效后,保险人以电子保险单内容不准确,投保人违反如实告知义务为由主张解除保险合同的,人民法院不予支持。

BASIC FACTS
 

Plaintiff: Han Longmei, female, of the Han nationality, 40 years of age, living in Zhangzhuang Town, Pei County, Jiangsu Province.
 
原告:韩龙梅。

Plaintiff: Liu Na, female, of the Han nationality, 19 years of age, living in Zhangzhuang Town, Pei County, Jiangsu Province.
 
原告:刘娜。

Plaintiff: Liu Kai, male, of the Han nationality, 13 years of age, living in Zhangzhuang Town, Pei County, Jiangsu Province.
 
原告:刘凯。

Plaintiff: Liu Yuanzhen, male, of the Han nationality, 70 years of age, living in Zhangzhuang Town, Pei County, Jiangsu Province.
 
原告:刘元贞。

Plaintiff: Wang Yuelan, female, of the Han nationality, 69 years of age, living in Zhangzhuang Town, Pei County, Jiangsu Province.
 
原告:王月兰。

Defendant: Sunshine Life Insurance Co., Ltd., Jiangsu Branch, domiciled on the 3rd floor of Yihe Commerce Building, No.68, Shanxi Road, Drum Tower District, Nanjing City.
 
被告:阳光人寿保险股份有限公司江苏分公司。

Person-in-charge: Chu Liang, deputy general manager of the company.
 
负责人:储良,该公司副总经理。

The plaintiffs, Han Longmei, Liu Na, Liu Kai, Liu Yuanzhen and Wang Yuelan filed a lawsuit with the Gulou District People's Court of Nanjing City, Jiangsu Province against the defendant, Sunshine Life Insurance Co., Ltd., Jiangsu Branch (hereinafter referred to as “Sunshine Life Insurance”) for disputes over an insurance contract.
 
原告韩龙梅、刘娜、刘凯、刘元贞、王月兰因与被告阳光人寿保险股份有限公司江苏分公司(以下简称阳光人保)发生保险合同纠纷,向江苏省南京市鼓楼区人民法院提起诉讼。

The plaintiffs claimed that: in March 2009, Liu Ji (son of Liu Yuanzhen and Wang Yuelan, Hanlong Mei's husband, as well as father of Liu Na and Liu Kai) bought one “Splendid Sunshine (xuanli yangguang)” insurance policy as recommended by the defendant, Sunshine Life Insurance, with an insured amount of 60,000 yuan for a 1-year term. On April 20 of the same year, he was killed in a traffic accident on the way to Sichuan. Though all of the five plaintiffs were Liu Ji's legitimate heirs, their insurance claim according to law was unreasonably declined by Sunshine Life Insurance. The plaintiffs requested the Court to order Sunshine Life Insurance to pay 60,000 yuan of insurance benefits as agreed, as well as the litigation costs.
 
原告韩龙梅、刘娜、刘凯、刘元贞、王月兰诉称:2009年3月,刘元贞、王月兰之子,韩龙梅之夫,刘娜、刘凯之父刘继购买了被告阳光人保推出的“绚丽阳光”类型保险一份,保险金额为60 000元,保险期限为1年。同年4月20日,刘继在前往四川途中发生交通事故身亡。五原告均为刘继的合法继承人,依法向阳光人保要求理赔时遭到阳光人保无理拒绝。请求法院判令阳光人保按约定支付保险金60 000元,并承担本案的诉讼费用。

The defendant, Sunshine Life Insurance, argued that: they showed sympathy to Liu Ji's death from a traffic accident, and they raised no objection to the fact that the five plaintiffs were his inheritors. However, this company's “Splendid Sunshine” insurance product under dispute used the “e-policy” mechanism for establishment of insurance contracts, in which all insurance purchasing procedures were handled through electronic messages. The process of activating the e-policy is one during which the insurer inquired about and explained to the insurance applicant. After an applicant logged into the website of Sunshine Life Insurance and filled out the related information, the insurer performed its obligation of explaining the contents of the insurance policy according to law through the design of the insurance purchasing process on the network system, and asked several questions, e.g. to request the policy buyer truly represent his/her occupation. To this end, the insurer offered all available options (i.e. “farmer”) that could be covered by the insurance policy for the applicant to choose from. If Liu Ji had informed the system of his actual occupation, “truck driver for business”, his insurance application should have been rejected. Since Liu Ji had deliberately failed to perform his obligation of truthful disclosure, and entered into an insurance contract with the company based on a false statement by selecting “farmer” as his occupation, the company had the right to cancel the insurance contract without being liable for the indemnity or insurance benefits for any insured accident that occurred before cancellation of the contract, or returning the insurance premiums. In conclusion, the plaintiffs' claim should be dismissed.
 
被告阳光人保辩称:刘继在交通事故中不幸死亡,我公司深表同情,对五原告是刘继继承人的事实我公司也没有异议。但是,我公司推出的涉案“绚丽阳光”类型保险采用的是“电子保单”形式订立保险合同,全部投保程序均采用数据电文,激活电子保单的过程,就是保险人对投保人进行询问和说明的过程。在投保人登录阳光人保的网站填写有关信息过程中,保险人通过网络系统的投保流程设计对保险内容依法履行了说明义务,也对一些问题提出了询问,例如要求投保人真实陈述自己的职业,并充分提供了所有可以承保的选项(如“农夫”)供投保人选择来进行如实告知。如果刘继如实告知其职业,即“营业用货车司机”,将被系统拒绝承保。鉴于刘继故意不履行如实告知义务,通过选择“农夫”为其职业的虚假陈述与我公司订立保险合同,我公司有权解除保险合同,且对于合同解除前发生的保险事故,不承担赔偿或者给付保险金的责任,而且不退还保险费。综上,原告的诉讼请求应当驳回。

Upon trial of the first instance, the Gulou District People's Court of Nanjing City found that:
 
南京市鼓楼区人民法院经审理查明:

The “Splendid Sunshine” insurance cards, a product in the short-term comprehensive personal accident insurance as introduced by Sunshine Life Insurance, were self-service cards that required online activation. Printed on the front of these cards was: “Insurance Liability: benefits for accidental death or disability: 60,000 yuan; medical benefits for accidental injuries: 10,000 yuan. Insurance Period: 1 year. Insurance Fee: 100 yuan. Self-service Insurance Card Series, Card Number” and on the back was: “Account Number, Password. Activation period: before June 30, 2010 (please activate before this date). Way of activating insurance: Online Activation: Log into Sunshine Insurance Group's website, www.ygbx.com, click ‘online activation', enter the account number, password and authentication code to get in the insurance application page, fill in the relevant information and confirm the successful activation. Phone Activation: call the National Customer Service Line of Sunshine Insurance: 95510, choose ‘life insurance'; wait for an agent to answer, provide the insurance information, and confirm the activation is successful.” The insurance card brochures provided detailed account of the issues related to this product, such as the contents of insurance coverage, potential policyholders, premiums and quota limits, points of attention, insurance requirements, insurance liability, exemptions, and claims procedures, along with several excerpts from the insurance clauses. According to Article 1 of the “Points of Attention” therein, the insurance card should be only used to buy policies and was not a certificate of insurance. A cardholder should purchase insurance according to the insurance purchasing procedures within the valid period of the card. The insurance liability corresponding to that card would come into effect from midnight on the next day of activation upon the holder's receipt of the policy number. Article 6 of the “Insurance Requirements” stipulated that only a person in the professions of Classes 1, 2, 3 and 4 should be accepted as an insurant, while people in those of other classes should not be insured. The occupational classification was determined in accordance with the “Occupational Classification System of Sunshine Life Insurance Co., Ltd.” According to Article 1.2 of the Comprehensive Personal Accidental Injury Insurance Clauses of Sunshine Life Insurance (filed with China Insurance Regulatory Commission in June 2008), which was submitted separately by the insurer, “This contract shall enter into force after the company has agreed to insure, received insurance premiums and issued a signed certificate of insurance.” According to Article 6.1 thereof, “when entering into this contract, the company shall clearly explain to the insurance applicant on the clauses herein, particularly the liability exemption clauses; the company will raise written inquiries about the situation related to both the insurance applicant and the insurant, and the two parties shall answer the questions true to the fact.” The above Insurance Clauses did not specify the requirements for a policyholder's occupation. Neither the Insurance Clauses nor the brochures had any reference to the Occupational Classification System of Sunshine Life Insurance Co., Ltd. This Occupational Classification System could be accessed on Sunshine Life Insurance's website. The insurance company launched the website so that, in the activation process of an insurance card, a list of questions could be asked, including the insurant's occupation, while the available options of insurant's occupations under insurance coverage were offered for the applicant to fill in or choose from. According to the Occupational Classification System, business truck drivers belonged to Class 6: operators of production and transport equipment or related workers. During the process of online activation, when “truck driver for business” was selected in the box of insurant's occupation, the insurance application would be rejected, leading to failure of insurance card activation, and thus e-policy would not be created.
......
 
“绚丽阳光”保险卡系被告阳光人保推出的短期个人综合意外伤害保险业务中销售的,在网上激活的自助式保险卡。该保险卡正面印制的内容为:“保险责任:意外身故、伤残保障6万元,意外伤害医疗保障1万元;保险期限1年,保费100元,自助保险卡系列及卡号”;该卡的背面内容为:“账号、密码,激活有效期至2010年06月30日(请在此日期前激活);投保激活方式,网络激活:登录阳光保险集团网站www.ygbx. com--点击‘网上激活'页面--输入账号、密码、验证码进入投保页面--填写相关投保信息--确认激活成功。电话激活:拨打阳光保险全国客户服务专线95510,选择人寿保险,坐席接听后,告知投保信息,确认激活成功”。保险卡宣传手册对该产品保障内容、投保对象、保费与份额限制、注意事项、投保规定、保险责任、责任免除、索赔指引等进行了详细的介绍,并摘录了部分保险条款。其中,“重要提示”部分第1条载明,保险卡仅供客户投保使用,非保险凭证,持卡人须在卡的有效期内按照投保流程进行投保,在获得保险单号后该卡所对应的保险责任于激活次日零时生效;“投保规定”第6条规定,投保职业只接受一、二、三、四类人员作为被保险人,不接受四类以上职业人员作为被保险人,职业类别按照《阳光人寿保险股份有限公司职业分类表》确定。保险人另行提交的阳光人寿个人综合意外伤害保险条款(2008年6月中国保监会备案)第1.2条规定,本合同自本公司同意承保,收取保险费并签发保险凭证后开始生效;保险条款第6.1条规定,订立本合同时,本公司会向投保人明确说明本合同的条款内容,特别是责任免除条款,本公司会就投保人和被保险人的有关情况提出书面询问,投保人和被保险人应当如实告知。该保险条款没有对参保人员的职业进行规定。保险条款和宣传手册均未记载《阳光人寿保险股份有限公司职业分类表》。阳光人保网站可以查阅《阳光光人寿保险股份有限公司职业分类表》,保险公司通过网页设置,在激活保险卡过程中,对包括被保险人职业在内的各种问题进行询问,并提供了可以承保的被保险人职业选项,要求投保人以填写或选择的方式进行告知。该职业分类表将营业用货车司机列为第六大类生产、运输设备操作人员及有关人员。网上激活过程中,如被保险人职业栏选择“营业用货车司机”,则会因被拒绝承保而不能激活保险卡,无法形成电子保单。
......

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