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No. 8 of Ten Noteworthy Financial Cases in Shanghai Courts of 2018: The Admission of the Appraiser's Opinion on Disability in Dispute over Life Insurance - The case of Tang v. Insurance Company on Dispute over Life Insurance
2018年度上海法院金融商事审判十大案例之八：唐某诉乙保险公司人身保险合同纠纷案——人身保险纠纷中伤残鉴定意见的认证规则
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| No. 8 of Ten Noteworthy Financial Cases in Shanghai Courts of 2018: The Admission of the Appraiser's Opinion on Disability in Dispute over Life Insurance- The case of Tang v. Insurance Company on Dispute over Life Insurance | | 2018年度上海法院金融商事审判十大案例之八：唐某诉乙保险公司人身保险合同纠纷案——人身保险纠纷中伤残鉴定意见的认证规则 |
| [Gist] | | 【裁判要旨】 |
| In a life insurance case, the appraiser's opinion on disability is an essential piece of evidence for the purpose of determining the insurance liability. The court should comprehensively take into account of such factor as engagement of the appraiser, objection of the counterparty, and the factual circumstances in order to decide whether or not to admit the appraisal opinion. If the appraisal opinion is obviously wrong, its admission as evidence shall be denied according to law. | | 鉴定机构对人身保险案件中伤者出具的伤残鉴定意见是界定保险公司理赔范围的重要凭证。法院应综合考量委托情况、相对人异议情况、与事实相符程度等因素决定是否采纳鉴定意见。如鉴定意见有明显错误的，依法不予采纳。 |
| ．．．．．． | | 【基本案情】 |
| | 2015年4月7日，唐某所在公司为包括唐某在内的员工投保团体意外伤害保险，保障项目为意外身故、残疾给付，保险金额40万元，附加医疗费用补偿金额5万元、门急诊限额4万元。同年10月5日，唐某在工作中受伤导致牙齿脱落，至医院治疗产生医疗费18,972.49元，乙保险公司仅对其中属于医疗保险范围的3,553.87元予以核赔。某鉴定中心就唐某伤残等级进行鉴定，评定十级伤残。唐某起诉至法院，要求乙保险公司支付医疗费19,179.49元、残疾保险金4万元、鉴定费2,000元。 |
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