He Lihong v. Foshan Shunde Sub-branch of China Life Insurance Co., Ltd. and Foshan Branch of China Life Insurance Co., Ltd.
(A case about disputes over insurance contracts)@#

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BASIC FACTS@#

Plaintiff: He Lihong, female, 40, domiciled at: Yang'ezhongyi Street, Lunjiao Town, Shunde District, Foshan City, Guangdong Province.@#
Defendant: Foshan Shunde Sub-branch of China Life Insurance Co., Ltd., domiciled at: North Jianhai Road, Daliang Sub-district, Shunde District, Foshan City, Guangdong Province.@#
Person-in-charge: Huang Shaoguang, general manager of this sub-branch.@#
Defendant: Foshan Branch of China Life Insurance Co., Ltd., domiciled at: Jihua 5th Road, Chancheng District, Foshan City, Guangdong Province.@#
Person-in-charge: Huang Liangjing, general manager of this branch.@#
PROCEDURAL POSTURE@#
For disputes over insurance contracts with Foshan Shunde Sub-branch of China Life Insurance Co., Ltd. (hereinafter referred to as “Shunde Sub-branch”) and Foshan Branch of China Life Insurance Co., Ltd. (hereinafter referred to as “Foshan Branch”), the plaintiff, He Lihong, filed a lawsuit with the People's Court of Shunde District, Foshan City, Guangdong Province.@#
The plaintiff, He Lihong, claimed that: The insurance applicant, Huang Guoji (the plaintiff's husband), had signed before his death two insurance contracts separately with Yan Xiaohui, a salesperson of Lunjiao Office of the defendant, Shunde Sub-branch, including a Comprehensive Personal Accident Insurance Contract dated March 16, 2004 with an insured amount of 310,000 and a premium of 390 yuan and a Xianghe Term Insurance Contract dated March 25, 2004 with an insured amount of 200,000 and a premium of 594 yuan. The insured was Huang Guoji and the beneficiary was the plaintiff under both insurance contracts. On July 7, 2004, Huang Guoji died in an accident. According to the judicial identification conclusion of the Forensic Identification Center of Sun Yat-Sen University, he died from heart and lung ruptures and hemorrhagic shock caused by a traffic accident. Believing that the accident was an insured event under the insurance contracts, the plaintiff lodged claims with the defendants, Shunde Sub-branch and Foshan Branch and submitted the relevant written materials on August 27, 2004. The two defendants, though accepted the claims, suspected without reason the plaintiff of purposely creating the insured accident and refused to fulfill their indemnity obligations, thus seriously injuring the plaintiff's legitimate rights and interests. The plaintiff requested the court to order the two defendants to immediately pay the insurance money of 500,000 yuan and the interest thereon (calculated at the lending rate of the same type of the People's Bank of China from the filing date of this action to the date of repayment) to the plaintiff and bear all the litigation costs.@#
The defendants, Shunde Sub-branch and Foshan Branch, argued that: They had sufficient reasons to reject the said claims. (1) The insurance applicant, Huang Guoji, had violated his obligation of telling the truth. On March 8, 2004, Huang Guoji submitted two Personal Insurance Application Forms when applying for the Xianghe Term Insurance and the Comprehensive Personal Accident Insurance provided by the defendants, in which he stated that he was not holding or applying for any other personal insurance policy at that time. In fact, however, records showed that Huang Guoji had taken out a number of other insurance policies before and after that date, including three “Ankang Ruyi Card Insurance” policies from Shunde Sub-branch of China Pacific Life Insurance Co., Ltd. on February 29 and March 2, 2004 with an insured amount of 288,000 yuan; five “Ruyi Card Insurance” policies from Ping An Life Insurance Co., Ltd. on March 1, 2004 with an insured amount of 150,000 yuan; one “Yukuai Personal Accident Insurance” policy from Shunde Branch of Tian'an Insurance Co., Ltd. on March 4, 2004 with an insured amount of 1 million yuan; and three “Duobaotong Auspicious Cards” from Guangzhou Branch of Xinhua Life Insurance Co., Ltd. on March 5, 2004 with an insured amount of 30,000 yuan. These policies contributed to a total insurance amount of 1,738,000 yuan. In addition, Huang Guoji also pretended to be a person in charge of an enterprise when applying for insurance. In the two Personal Insurance Application Forms at issue completed by him, the employer of him was “Building Water and Electricity Installation Team of Lunjiao Town,” his job title was “person in charge,” his occupational code was “070121,” and his occupational category was “Class I.” In the Financial Questionnaire on Large Insured Amount, he entered “Shunji Water and Electricity Decoration” as his employer and “Comprehensive Management” as his job. However, neither the “Building Water and Electricity Installation Team of Lunjiao Town” nor the “Shunji Water and Electricity Decoration” was registered with the local administration for industry and commerce. Therefore, it could be determined that Huang Guoji was not employed by any entity but himself, and his occupational code should be “210302”. (2) Huang Guoji deliberately violated his obligation of telling the truth. Both Huang Guoji and He Lihong, the beneficiary and plaintiff in this case, used to be salespersons of Taikang Life Insurance Co., Ltd., had received professional training on the related insurance knowledge, and should know the provisions of the Insurance Law of the People's Republic of China on the obligation of telling the truth. Besides, they had bought personal accident insurance policies from four insurance companies within one week before application for the insurance at issue, with premiums of several thousand yuan. It was impossible that they did not know that they were holding or applying for other personal insurance policies. It could be inferred that Huang Guoji deliberately failed to perform his obligation of telling the truth. (3) By deliberately failing to fulfill his obligation of telling the truth, Huang Guoji seriously affected the insurer's underwriting and determination of the insurance premium, and eventually caused the insurer to make a wrong expression of will. According to Article 17 of the Insurance Law of the People's Republic of China, the insurer had the right to rescind the insurance contract without paying the insurance amount. (4) Since both insurance policies in dispute were signed and issued by Foshan Branch and the related invoices were also issued by Foshan Branch, the parties to the insurance contracts involved in this case should be Huang Guoji and Foshan Branch. Shunde Sub-branch was neither a party to the insurance contracts at issue nor an eligible defendant in this case. Shunde Sub-branch should not bear any legal responsibility.@#
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何丽红诉中国人寿保险股份有限公司佛山市顺德支公司、中国人寿保险股份有限公司佛山分公司保险合同纠纷案@#
【裁判摘要】@#
一、基于保险合同的特殊性，合同双方当事人应当最大限度的诚实守信。投保人依法履行如实告知义务，即是最大限度诚实守信的一项重要内容。根据《中华人民共和国保险法》第十七条的规定，投保人在订立保险合同前，应当如实回答保险人就保险标的或者被保险人的有关情况作出的询问，如实告知影响保险人对是否承保以及如何设定承保条件、承保费率做出正确决定的重要事项。对于投保人故意隐瞒事实，不履行如实告知义务的，或者因过失未履行如实告知义务，足以影响保险人决定是否同意承保或者提高保险费率的，保险人有权解除保险合同，并对于保险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。@#
二、如果保险人在明知投保人未履行如实告知义务的情况下，不是进一步要求投保人如实告知，而是仍与之订立保险合同，则应视为其主动放弃了抗辩权利，构成有法律约束力的弃权行为，故无权再以投保人违反如实告知义务为由解除保险合同，而应严格依照保险合同的约定承担保险责任。@#
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原告：何丽红。@#
被告：中国人寿保险股份有限公司佛山市顺德支公司。@#
负责人：黄绍光，该支公司总经理。@#
被告：中国人寿保险股份有限公司佛山分公司。@#
负责人：黄良景，该分公司总经理。@#
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原告何丽红因与被告中国人寿保险股份有限公司佛山市顺德支公司(以下简称顺德支公司)、中国人寿保险股份有限公司佛山分公司(以下简称佛山分公司)发生保险合同纠纷，向广东省佛山市顺德区人民法院提起诉讼。@#
原告何丽红诉称：投保人黄国基(系原告之夫)生前与被告顺德支公司属下的伦教办事处营业员严小惠先后签订了两份保险合同，包括：2004年3月16日签订的“人身意外伤害综合保险合同”1份，保险金额为31万元，保险费为390元；2004年 3月25日签订的“祥和定期保险合同”1份，保险金额为20万元，保险费为594元。上述两份保险合同的被保险人均为黄国基，受益人均为原告。2004年7月7日，黄国基意外死亡，根据中山大学法医鉴定中心出具的司法鉴定书，黄国基符合交通事故致心肺破裂、失血性休克死亡。原告认为该事故符合保险合同约定的赔偿条件，于 2004年8月27日向被告顺德支公司、佛山分公司提出理赔申请，并提交了相关书面材料。二被告受理赔偿请求后，无端猜疑原告制造保险事故，拒不履行赔偿义务，严重侵害了原告的合法权益。故请求判令二被告立即向原告支付保险赔偿金50万元及利息(从起诉之日起至还款之日止，按中国人民银行同类贷款利率计算)，并承担本案诉讼费用。@#
被告顺德支公司、佛山分公司答辩称：被告方拒绝理赔具有充分的理由。1．投保人黄国基违反了如实告知义务。2004年3月8日，黄国基为申请投保被告方的“祥和定期保险”及“人身意外综合保险”，提交了两份《个人保险投保单》，并在投保单中明确其当时没有参加或正在申请其他人身保险。但事实上，黄国基在此前后数日中有多次投保记录，包括2004年2月29日、3月 2日向中国太平洋人寿保险股份有限公司顺德支公司购买了3份“安康如意卡保险”，保险金额为288000元；2004年3月1日向中国平安人寿保险股份有限公司购买了5份“如意卡保险”，保险金额为15万元；2004年3月4日，向天安保险股份有限公司顺德分公司购买了“愉快人身意外伤害保险”1份，保险金额为100万元；2004年3月5日、3月9日向新华人寿保险股份有限公司广州分公司购买了“多保通吉祥卡”3份，保险金额为30万元。上述保险累计保险金额为1 738000元。此外，黄国基在投保时还谎称自己是企业负责人。黄国基在涉案两份《个人保险投保单》中均注明其工作单位是“伦教建筑水电安装队”，职务是“负责人”，职业代码为“070121”，职业类别为“一级”。在《高额财务问卷》中注明其工作单位是“顺基水电装修”，职务为“全面管理”，但“伦教建筑水电安装队”、“顺基水电装修”并无工商注册登记。因此可以认定黄国基当时并无工作单位，属于自由职业，职业代码应为“210302”。2．黄国基违反如实告知义务具有主观上的故意。黄国基及涉案保险受益人、本案原告何丽红曾是泰康人寿保险公司业务员，受过相关保险知识的专业培训，应当知道保险法关于投保人如实告知义务的规定，且他们在投保涉案保险前一周内先后向4家保险公司投保人身意外险，支付保费数千元，不可能不知道自己已经参加或正在申请其他的人身保险。故可以推断黄国基系故意不履行如实告知义务。3．黄国基故意不履行如实告知义务的行为，严重影响保险人的核保工作及对于保险费的确定，并最终导致保险人做出不真实的意思表示。依照保险法第十七条的规定，保险人有权解除保险合同，并不承担保险金给付责任。4．涉案两份保险单均由佛山分公司签发，发票也由佛山分公司出具，故涉案保险合同的双方当事人是黄国基与佛山分公司，顺德支公司不是涉案保险合同当事人，既不是本案适格被告，也不应承担法律责任。@#
针对被告顺德支公司、佛山分公司的答辩意见，原告何丽红补充如下意见：投保人黄国基在多家保险公司购买人身保险属实，但黄国基在购买涉案“人身意外伤害综合保险”时，在填写投保单的告知事项第十一项(即是否参加过或正在申请其他人身保险)中未作答复，没有违反如实告知义务；在购买涉案“祥和定期保险”时，虽然黄国基没有说明向其他保险公司投保的事项，但黄国基是因过失而未能履行告知义务。只有在投保人未告知的重大事项严重影响保险事故发生的情形下，保险人才有权对于保险合同解除前发生的保险事故拒绝理赔，而涉案保险事故的发生并非因投保人未告知的重大事项所致，可以认定投保人未履行告知义务对涉案保险事故的发生没有“严重影响”，故保险人不得以此为由解除保险合同或者不承担保险责任。@#
经依法组织双方当事人质证并公开开庭审理，佛山市顺德区人民法院认定：@#
被告顺德支公司系被告佛山分公司的下属分支机构。2004年3月8日，黄国基与原告何丽红一起到顺德支公司下属的伦教办事处，投保“祥和定期保险”20万元 (投保单号为1001440200964435)、“人身意外伤害综合保险”31万元(投保单号为 1001440200731249)。以上两份保险的投保人、被保险人均为黄国基，受益人均为何丽红。黄国基在保险投保单中填写的工作单位是“伦教建筑水电安装队”，职业是“负责人”，职业代码是“070121”，平均年收入为“5万元”。对于保险投保单第三项告知事项中的第十一款内容，即“A．目前是否有已参加或正在申请中的其他人身保险?如有，请告知承保公司、保险险种名称、保险金额、保单生效时间；B、过去两年内是否曾被保险公司解除合同或申请人身保险而被延期、拒保或附加条件承保；C、过去有无向保险公司索赔”，　黄国基在 1001440200964435号保险投保单中均填写“否”，而在1001440200731249号保险投保单中未填写任何内容。@#
2004年3月15日，被告佛山分公司向黄国基签发了合同编号为2004- 441406-D31-58001682-5的“人身意外伤害综合保险合同”，保险金额为31万元(其中包括人身意外伤害险30万元、意外医疗险1万元)，保险费390元，合同生效日期为2004年3月16日。当日黄国基即向佛山分公司交纳了保险费390元。2004年3月24日，佛山分公司又向黄国基签发了合同编号为2004-441406-S51-00007131-0的“祥和定期保险合同”，保险金额为20万元，保险费为594元，合同生效日期为 2004年3月25日。当日黄国基向佛山分公司交纳了保险费594元。@#
2004年7月7日，黄国基意外死亡。中山大学法医鉴定中心司法鉴定书认定：黄国基符合交通事故致心肺破裂、失血性休克死亡。同年8月27日，原告何丽红向被告佛山分公司提出理赔申请，并提交了相关书面材料，但佛山分公司以投保人黄国基故意违反如实告知义务、保险人有权解除合同等为由，未予赔付。同年8月31日，佛山分公司及被告顺德支公司向佛山市公安局顺德分局报案，反映何丽红涉嫌保险诈骗罪。同年11月15日，佛山市公安局顺德分局作出不予立案通知书。@#
另查明：黄国基于2004年2月29日、 3月2日向中国太平洋人寿保险股份有限公司顺德支公司购买了3份“安康如意卡保险”，保险金额为288000元；于2004年 3月1日向中国平安人寿保险股份有限公司购买了5份“如意卡保险”，保险金额为 15万元；于2004年3月4日向天安保险股份有限公司顺德分公司购买了“愉快人身意外伤害保险”1份，保险金额为100万元；于2004年3月5日、3月9日向新华人寿保险股份有限公司广州分公司购买了“多保通吉祥卡”3份，保险金额为30万元。上述保险金额共计1 738000元。@#
黄国基于2003年9月16日进入泰康人寿保险股份有限公司，从事兼职个人寿险业务代理工作，2004年1月2日离职。原告何丽红于2003年9月4日进入泰康人寿保险股份有限公司，从事兼职个人寿险业务代理工作，2004年2月2日离职。@#
以上事实，有双方当事人提交的、经依法质证、认证的各项证据在案为证，足以认定。@#
本案一审的争议焦点是：一、黄国基在投保涉案保险时是否故意违反了如实告知义务；二、被告佛山分公司、顺德支公司应否承担保险责任。@#
佛山市顺德区人民法院一审认为：@#
一、关于投保人黄国基在投保涉案保险时是否故意违反了如实告知义务的问题。@#
基于保险合同的特殊性，合同双方当事人应当最大限度的诚实守信。投保人依法履行如实告知义务，即是最大限度诚实守信的一项重要内容。《中华人民共和国保险法》(以下简称保险法)第十七条规定：“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。投保人故意隐瞒事实，不履行如实告知义务的，或者因过失未履行如实告知义务，足以影响保险人决定是否同意承保或者提高保险费率的，保险人有权解除保险合同。投保人故意不履行如实告知义务的，保险人对于保险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，并不退还保险费。投保人因过失未履行如实告知义务，对保险事故的发生有严重影响的，保险人对于保险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，但可以退还保险费。保险事故是指保险合同约定的保险责任范围内的事故。”据此，如实告知义务是投保人订立保险合同时必须履行的基本义务，投保人是否对保险标的或者被保险人的有关情况作如实说明，直接影响到保险人测定和评估承保风险并决定是否承保，影响到保险人对保险费率的选择。所以，投保人在订立保险合同前，应当如实回答保险人就保险标的或者被保险人的有关情况作出的询问，如实告知影响保险人是否承保以及设定承保条件、承保费率的重要事项。@#
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