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A delivery man drowned, and the insurance company refused to pay compensation on the grounds that he had obtained occupational injury insurance, but the court rejected it

2024-08-28

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The food delivery platform insured Liu, a delivery man, with accidental injury insurance. Later, Liu accidentally drowned, but the insurance company refused to pay 600,000 yuan in insurance money on the grounds that his parents had applied for "new employment form occupational injury protection" and had been accepted. Liu's parents sued the court. Recently, the Nanjing Intermediate People's Court concluded the second instance of this insurance contract dispute and upheld the original judgment, requiring the insurance company to pay 600,000 yuan in compensation.

Liu is a rider on a food delivery platform. The platform has insured him with "rider personal accident insurance". After he obtains the first delivery income on the platform every day, the system automatically deducts an insurance premium of 2.5 yuan. The insurance terms stipulate that the scope of insurance liability includes accidental injury death, disability, etc., and the insurance amount is 600,000 yuan. The insurance starts from the time when the rider first accepts the order and ends at 1:30 the next day. Unless otherwise agreed, if the rider meets the occupational injury conditions stipulated in the "Measures for the Protection of Occupational Injuries for Personnel in New Employment Forms", the insurance company shall not bear the insurance payment liability for the rider's injuries and deaths.

On February 5 last year, after Liu obtained his first delivery income of 12.5 yuan on the platform, the system deducted 2.5 yuan in insurance premiums. At 22:34 on the same day, Liu completed the delivery of the last order and accidentally drowned around 23:30. His parents applied for insurance compensation of 600,000 yuan, but the insurance company refused, saying that they had applied to the Nanjing Labor Administration Department for occupational injury protection for new employment forms and had been accepted. Liu met the occupational injury conditions stipulated in the "Measures for Occupational Injury Protection for New Employment Forms", which was a special exemption situation stipulated in the insurance contract, and the insurance company should not bear the insurance compensation liability.

The Jiangning Court held at first instance that Liu's drowning was an objective event that caused physical injury due to external, sudden, unintentional, and non-disease factors, and should be deemed to constitute an insurance accident and fall within the scope of insurance liability. New employment forms of occupational injury protection is a social security system that provides necessary medical treatment and economic compensation to workers who suffer accidental injuries or occupational diseases in production and operation, resulting in death, temporary or permanent loss of ability to work, through social pooling. The purpose is to safeguard the basic rights and interests of workers, give full play to the advantages of social insurance, and solve the problem of unbalanced and insufficient occupational injury protection within the framework of the work-related injury insurance system. It does not conflict with commercial insurance. The death compensation limit of occupational injury protection is limited and cannot fully cover the losses caused by Liu's death. Accidental injury insurance can be used as a supplement, and the insurance company has already collected premiums. Failure to compensate is also unfair to the policyholder and the insured.

The court held that workers in the new employment form who suffer related occupational injuries have the right to apply for occupational injury protection benefits and to claim compensation from accidental injury insurance. Using occupational injury protection benefits as a condition to exempt the insurer from liability for compensation under the accidental injury insurance contract is contrary to the original intention of accidental injury insurance and violates the principle of fairness. In the end, the court ruled that the insurance company should pay Liu's parents 600,000 yuan.