cciia.org.cn 2023-10-19 10:13:44 人民法院報
投(tou)保(bao)人(ren)在寬限期的最后(hou)一(yi)日深夜存入保(bao)險(xian)費(fei)，卻被保(bao)險(xian)公(gong)司告(gao)知已(yi)錯過系統設(she)定(ding)的劃扣(kou)時間(jian)，保(bao)險(xian)合同效力中止。近日，上海市浦東新(xin)區人(ren)民法院審(shen)結(jie)一(yi)起(qi)健康(kang)保(bao)險(xian)合同糾(jiu)紛案，判決(jue)認定(ding)保(bao)險(xian)公(gong)司中止合同違約，但對投(tou)保(bao)人(ren)要求賠償損失的訴請不(bu)予支持。
2019年7月，鄒女士(shi)向某(mou)保(bao)(bao)(bao)(bao)險(xian)(xian)公司(si)投(tou)保(bao)(bao)(bao)(bao)了一款重大疾(ji)病保(bao)(bao)(bao)(bao)險(xian)(xian)，保(bao)(bao)(bao)(bao)險(xian)(xian)期(qi)(qi)(qi)間終身，交(jiao)費(fei)年限20年，按月交(jiao)納保(bao)(bao)(bao)(bao)險(xian)(xian)費(fei)1251.18元。保(bao)(bao)(bao)(bao)險(xian)(xian)合同約定(ding)，以分(fen)期(qi)(qi)(qi)方式支付(fu)(fu)保(bao)(bao)(bao)(bao)險(xian)(xian)費(fei)，若投(tou)保(bao)(bao)(bao)(bao)人到期(qi)(qi)(qi)未(wei)支付(fu)(fu)保(bao)(bao)(bao)(bao)險(xian)(xian)費(fei)，自(zi)保(bao)(bao)(bao)(bao)險(xian)(xian)費(fei)約定(ding)支付(fu)(fu)日(ri)的次日(ri)零時起60日(ri)為寬(kuan)限期(qi)(qi)(qi)，逾(yu)期(qi)(qi)(qi)仍未(wei)支付(fu)(fu)，則(ze)合同效力中止。同時，鄒女士(shi)向保(bao)(bao)(bao)(bao)險(xian)(xian)公司(si)申請(qing)開通了“保(bao)(bao)(bao)(bao)單價值凈額自(zi)動墊交(jiao)到期(qi)(qi)(qi)應付(fu)(fu)保(bao)(bao)(bao)(bao)險(xian)(xian)費(fei)”的功能。
保(bao)(bao)(bao)單生效(xiao)(xiao)后至2020年(nian)2月(yue)，鄒(zou)(zou)女(nv)士(shi)均按月(yue)足額支付保(bao)(bao)(bao)險(xian)(xian)(xian)(xian)(xian)(xian)費(fei)(fei)。同(tong)年(nian)3月(yue)，鄒(zou)(zou)女(nv)士(shi)因(yin)手(shou)頭資金緊張，未支付當期保(bao)(bao)(bao)險(xian)(xian)(xian)(xian)(xian)(xian)費(fei)(fei)。同(tong)年(nian)5月(yue)，鄒(zou)(zou)女(nv)士(shi)分兩次向(xiang)劃(hua)扣賬戶(hu)存入(ru)合計(ji)金額相當于一期保(bao)(bao)(bao)險(xian)(xian)(xian)(xian)(xian)(xian)費(fei)(fei)的款項(xiang)，截至5月(yue)19日，保(bao)(bao)(bao)單現(xian)金價值為1516.33元。2020年(nian)5月(yue)底(di)，保(bao)(bao)(bao)險(xian)(xian)(xian)(xian)(xian)(xian)公司(si)稱劃(hua)扣保(bao)(bao)(bao)險(xian)(xian)(xian)(xian)(xian)(xian)費(fei)(fei)失(shi)敗(bai)，鄒(zou)(zou)女(nv)士(shi)未按月(yue)交納保(bao)(bao)(bao)險(xian)(xian)(xian)(xian)(xian)(xian)費(fei)(fei)，保(bao)(bao)(bao)險(xian)(xian)(xian)(xian)(xian)(xian)合同(tong)效(xiao)(xiao)力中止(zhi)。
鄒(zou)女士認為，自(zi)(zi)己在寬限期(qi)內依約(yue)支付保(bao)(bao)(bao)險(xian)(xian)(xian)費(fei)，并且保(bao)(bao)(bao)單現金(jin)價值足以墊交保(bao)(bao)(bao)險(xian)(xian)(xian)費(fei)，保(bao)(bao)(bao)險(xian)(xian)(xian)公司中止合同屬(shu)于違約(yue)，故起訴至法院，主張保(bao)(bao)(bao)險(xian)(xian)(xian)公司賠(pei)償相當于前期(qi)八個月已付保(bao)(bao)(bao)險(xian)(xian)(xian)費(fei)金(jin)額的損失，并要求(qiu)保(bao)(bao)(bao)險(xian)(xian)(xian)公司賠(pei)償自(zi)(zi)己今后可能罹患疾病的保(bao)(bao)(bao)險(xian)(xian)(xian)金(jin)損失15萬(wan)元(yuan)。
保(bao)(bao)險(xian)(xian)公司辯(bian)稱，鄒(zou)女士在寬限期最后(hou)一日的深夜才存入一期的保(bao)(bao)險(xian)(xian)費金(jin)額，存入保(bao)(bao)險(xian)(xian)費的時間晚(wan)于保(bao)(bao)險(xian)(xian)公司當日系統(tong)自(zi)動劃扣(kou)保(bao)(bao)險(xian)(xian)費的時間，導(dao)致扣(kou)款(kuan)失敗。保(bao)(bao)單現金(jin)價(jia)值(zhi)為1516.33元，僅夠墊交(jiao)一期保(bao)(bao)險(xian)(xian)費，但鄒(zou)女士已累(lei)計有兩期保(bao)(bao)險(xian)(xian)費未交(jiao)，為避(bi)免保(bao)(bao)單的現金(jin)價(jia)值(zhi)被扣(kou)至(zhi)為零(ling)，保(bao)(bao)險(xian)(xian)公司未操作自(zi)動墊交(jiao)。鄒(zou)女士要求賠償損(sun)失的訴請(qing)沒有法律依據。
法院審理后(hou)認為(wei)(wei)，根(gen)據我國法律規定(ding)，“期(qi)間(jian)(jian)”的(de)(de)(de)最(zui)后(hou)一日(ri)(ri)的(de)(de)(de)截止(zhi)時(shi)(shi)間(jian)(jian)為(wei)(wei)24時(shi)(shi)，有業(ye)務(wu)(wu)時(shi)(shi)間(jian)(jian)的(de)(de)(de)，停止(zhi)業(ye)務(wu)(wu)活(huo)動的(de)(de)(de)時(shi)(shi)間(jian)(jian)為(wei)(wei)截止(zhi)時(shi)(shi)間(jian)(jian)。本案中(zhong)，保(bao)(bao)險(xian)(xian)公(gong)司并(bing)未告(gao)(gao)知(zhi)客(ke)戶每(mei)日(ri)(ri)停止(zhi)相關業(ye)務(wu)(wu)活(huo)動的(de)(de)(de)時(shi)(shi)間(jian)(jian)，原告(gao)(gao)在交(jiao)(jiao)費最(zui)后(hou)期(qi)限當天24時(shi)(shi)之前存(cun)入保(bao)(bao)險(xian)(xian)費，無悖社會公(gong)眾一般認知(zhi)，應認為(wei)(wei)已經于寬限期(qi)最(zui)后(hou)一日(ri)(ri)完成保(bao)(bao)險(xian)(xian)費交(jiao)(jiao)納義務(wu)(wu)。即(ji)使涉案保(bao)(bao)單(dan)超(chao)過(guo)寬限期(qi)未交(jiao)(jiao)費，保(bao)(bao)險(xian)(xian)公(gong)司也應從保(bao)(bao)單(dan)現金價(jia)值(zhi)中(zhong)自(zi)動墊交(jiao)(jiao)保(bao)(bao)險(xian)(xian)費，在2020年5月19日(ri)(ri)，原告(gao)(gao)保(bao)(bao)單(dan)現金價(jia)值(zhi)為(wei)(wei)1516.33元，超(chao)過(guo)一期(qi)的(de)(de)(de)保(bao)(bao)險(xian)(xian)費應交(jiao)(jiao)金額。因此(ci)，被告(gao)(gao)不應以原告(gao)(gao)未交(jiao)(jiao)納保(bao)(bao)險(xian)(xian)費為(wei)(wei)由中(zhong)止(zhi)保(bao)(bao)險(xian)(xian)合同效(xiao)力，被告(gao)(gao)存(cun)在違約行為(wei)(wei)。
原告(gao)(gao)已(yi)交納(na)八(ba)個(ge)月(yue)保(bao)險(xian)費，但保(bao)險(xian)公司也(ye)已(yi)為其提供了相(xiang)應八(ba)個(ge)月(yue)的(de)(de)保(bao)險(xian)保(bao)障，原告(gao)(gao)該項訴請(qing)(qing)不(bu)(bu)屬于(yu)實際發生(sheng)(sheng)的(de)(de)損失(shi)，無法予以(yi)支持(chi)。同時(shi)，關(guan)于(yu)原告(gao)(gao)要求賠付未來保(bao)險(xian)金損失(shi)15萬元的(de)(de)訴請(qing)(qing)，法院認為，保(bao)險(xian)合同系射幸合同，保(bao)險(xian)事故(gu)是否發生(sheng)(sheng)屬于(yu)概率問題(ti)，保(bao)險(xian)金并非(fei)原告(gao)(gao)履(lv)行保(bao)險(xian)合同必(bi)然(ran)可(ke)得的(de)(de)收益，故(gu)不(bu)(bu)屬于(yu)因(yin)被告(gao)(gao)違(wei)約產生(sheng)(sheng)的(de)(de)原告(gao)(gao)預期損失(shi)。對于(yu)該項訴請(qing)(qing)，法院不(bu)(bu)予支持(chi)。
綜上，法院作出(chu)上述判決。鄒(zou)女士不服(fu)一審(shen)判決，提(ti)起上訴(su)。二審(shen)法院判決維持(chi)原判。
■法官說法■
分期(qi)支付(fu)保險(xian)費(fei)的(de)人(ren)身保險(xian)合同，若(ruo)發生(sheng)合同效力(li)被中止(zhi)的(de)情況(kuang)，將對投保人(ren)、被保險(xian)人(ren)的(de)利益(yi)(yi)產(chan)生(sheng)直接的(de)不利影響。因此，基(ji)于依法(fa)保護金融消費(fei)者權(quan)益(yi)(yi)的(de)考慮，本案判決(jue)將未明示停(ting)止(zhi)營(ying)業時間的(de)后果(guo)責任分配(pei)由保險(xian)公司承擔，要求保險(xian)公司不得擅自中止(zhi)人(ren)身保險(xian)合同的(de)效力(li)。
當(dang)(dang)然(ran)，交納(na)保(bao)(bao)(bao)(bao)費(fei)(fei)是(shi)保(bao)(bao)(bao)(bao)險(xian)(xian)合(he)同項下投(tou)保(bao)(bao)(bao)(bao)人(ren)(ren)的(de)(de)(de)主要義務(wu)。投(tou)保(bao)(bao)(bao)(bao)人(ren)(ren)應當(dang)(dang)按照(zhao)合(he)同約(yue)定(ding)的(de)(de)(de)時間和金額交納(na)保(bao)(bao)(bao)(bao)險(xian)(xian)費(fei)(fei)用，否(fou)則將構成違約(yue)，需承(cheng)擔相(xiang)應的(de)(de)(de)不(bu)利(li)后果(guo)。根據我(wo)國保(bao)(bao)(bao)(bao)險(xian)(xian)法規定(ding)，分期(qi)支(zhi)(zhi)付保(bao)(bao)(bao)(bao)險(xian)(xian)費(fei)(fei)的(de)(de)(de)，首期(qi)保(bao)(bao)(bao)(bao)險(xian)(xian)費(fei)(fei)交納(na)之(zhi)后，投(tou)保(bao)(bao)(bao)(bao)人(ren)(ren)自保(bao)(bao)(bao)(bao)險(xian)(xian)人(ren)(ren)催告之(zhi)日起超(chao)過(guo)三(san)十日未(wei)(wei)支(zhi)(zhi)付當(dang)(dang)期(qi)保(bao)(bao)(bao)(bao)險(xian)(xian)費(fei)(fei)，或(huo)者(zhe)超(chao)過(guo)約(yue)定(ding)的(de)(de)(de)期(qi)限六十日未(wei)(wei)支(zhi)(zhi)付當(dang)(dang)期(qi)保(bao)(bao)(bao)(bao)險(xian)(xian)費(fei)(fei)的(de)(de)(de)，投(tou)保(bao)(bao)(bao)(bao)人(ren)(ren)可能承(cheng)擔兩種不(bu)利(li)法律(lv)后果(guo)：一是(shi)人(ren)(ren)身保(bao)(bao)(bao)(bao)險(xian)(xian)合(he)同效(xiao)力中(zhong)止(zhi)，且自合(he)同效(xiao)力中(zhong)止(zhi)之(zhi)日起滿(man)二年雙方未(wei)(wei)達成協議(yi)的(de)(de)(de)，保(bao)(bao)(bao)(bao)險(xian)(xian)人(ren)(ren)有權解除合(he)同；二是(shi)保(bao)(bao)(bao)(bao)險(xian)(xian)人(ren)(ren)按照(zhao)合(he)同約(yue)定(ding)的(de)(de)(de)條件減(jian)少(shao)保(bao)(bao)(bao)(bao)險(xian)(xian)金額。
日期：2023-10-19 10:13:44 | 關閉 |
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