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Jia Shaoping v. Marketing Service Department of Weihai Sub-Branch of ABC Life Insurance Co., Ltd. (case of dispute over an insurance contract)
(case of dispute over an insurance contract)
贾绍平诉农银人寿保险股份有限公司威海中心支公司文登营销服务部保险合同纠纷案
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[Key Terms]
exemption clauses ; proportionate compensation or payment ; obligation of presentation and explanation
[核心术语]
免责条款;比例赔付;提示说明义务
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[Disputed Issues]
An insurer has the obligation to present and explain the clause for the proportionate compensation or payment as agreed upon in the insurance contract.
[争议焦点]
保险人对于约定比例赔付的保险合同条款负有提示和说明义务。
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[Case Summary]
The clause specifying the proportionate compensation or payment in an insurance contract is a clause exempting the insurer from liability so the insurer shall present this clause in words fonts...
[案例要旨]
保险合同中的保险条款约定了比例赔付的应属于“免除保险人责任的条款”...
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Full-text omitted. | | 贾绍平诉农银人寿保险股份有限公司威海中心支公司文登营销服务部保险合同纠纷案 |
| | 山东省威海市文登区人民法院 |
| | 民事判决书 |
| | (2014)威文商初字第518号 |
| | 原告贾绍平。 |
| | 委托代理人：隋中英，文登大水泊法律服务所法律工作者。 |
| | 被告农银人寿保险股份有限公司威海中心支公司文登营销服务部。住所地：威海市文登区大众村富尔佳商场7楼。 |
| | 负责人：王妍，营销部经理。 |
| | 委托代理人：李海亮，该公司职员。 |
| | 委托代理人：李建林，该公司职员。 |
| | 原告贾绍平与被告农银人寿保险股份有限公司威海中心支公司文登营销服务部保险合同纠纷一案，本院于2014年11月4日受理后，依法由审判员于连江独任审判公开开庭进行了审理。原告贾绍平的委托代理人隋中英、被告农银人寿保险股份有限公司威海中心支公司文登营销服务部的委托代理人李海亮、李建林到庭参加了诉讼。本案现已审理终结。 |
| | 原告贾绍平诉称，原告于2013年5月21日在被告处投保农银鸿康重大疾病保险，保险期间至70周岁，交费期间为10年，保险金额为50000元，保险费为1165元。原告于2014年4月15日入院治疗，发现主动脉夹层，经医院风险告知，开胸治疗死亡率为30%，原告选择了保守治疗即主动脉腔内修复术。原告出院后按保险合同理赔，被告以原告系轻型疾病为由赔付原告10000元。现要求被告按保险合同赔付原告保险金40000元。 |
| | 被告农银人寿保险股份有限公司威海中心支公司文登营销服务部辩称，原告在被告处投保农银鸿康重大疾病保险属实，但原告疾病属于保险合同约定的轻型疾病，按合同约定应赔付10000元保险金，被告已经按合同约定赔付，不同意原告的诉讼请求。 |
| | 经审理查明，原被告签订保险合同一份，该保险合同于2013年5月22日生效，险种名称为农银鸿康重大疾病保险，保险费为1165元，基本保险金额为50000元。该合同第2.3条保险责任约定保险金分为两类，一是重大疾病保险金，为全额赔付保险金50000元，二是轻症疾病保险金，为赔付基本保险金额的20%即10000元。该合同第10.6条明确罗列了二十五种重大疾病类型并有疾病定义，该条款系根据中国保险行业协会统一制定，其中第二十五项为“主动脉手术”，指为治疗主动脉疾病，实际实施了开胸或开腹进行的切除、置换、修补病损主动脉血管的手术。该合同第10.7条明确罗列了十八种轻型疾病，其中第八项为“主动脉内手术”，指为了治疗主动脉疾病实际实施了经皮经导管进行的动脉内手术。 |
| | ．．．．．． |
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