cciia.org.cn 2023-11-20 11:18:11 中國法院網
健康保(bao)(bao)險(xian)是以(yi)被保(bao)(bao)險(xian)人(ren)的(de)身體為保(bao)(bao)險(xian)標的(de)，投保(bao)(bao)健康保(bao)(bao)險(xian)可以(yi)應對疾病(bing)(bing)風險(xian)，能(neng)更好地實(shi)現(xian)病(bing)(bing)有所醫，購買健康保(bao)(bao)險(xian)有哪(na)些注(zhu)意事(shi)項，法律上有哪(na)些相關規定？近日，湖南(nan)省雙峰縣(xian)人(ren)民法院梓門法庭審結(jie)了一起健康保(bao)(bao)險(xian)合同糾紛案。
2018年(nian)6月(yue)(yue)(yue)，原(yuan)告彭某(mou)某(mou)的(de)妻子為其(qi)在被告某(mou)保(bao)險(xian)(xian)公司(si)購買重(zhong)(zhong)大疾病(bing)保(bao)險(xian)(xian)。2022年(nian)9月(yue)(yue)(yue)，彭某(mou)某(mou)因急性肝衰竭入院(yuan)治療。后彭某(mou)某(mou)向某(mou)保(bao)險(xian)(xian)公司(si)申請(qing)理(li)賠(pei)，2023年(nian)1月(yue)(yue)(yue)，該保(bao)險(xian)(xian)公司(si)以(yi)彭某(mou)某(mou)在投保(bao)前患有慢性乙肝病(bing)毒（重(zhong)(zhong)型）為由拒(ju)絕理(li)賠(pei)。2023年(nian)4月(yue)(yue)(yue)，彭某(mou)某(mou)向雙峰法院(yuan)提起訴訟，請(qing)求判令(ling)該保(bao)險(xian)(xian)公司(si)賠(pei)付其(qi)重(zhong)(zhong)大疾病(bing)保(bao)險(xian)(xian)金(jin)、住院(yuan)費用補償醫(yi)療保(bao)險(xian)(xian)金(jin)等(deng)，共計(ji)10萬余(yu)元。
被告(gao)(gao)某(mou)保(bao)險公司抗辯稱：原告(gao)(gao)彭某(mou)某(mou)在投(tou)保(bao)前，未如實(shi)告(gao)(gao)知(zhi)其患有慢(man)性乙肝病毒（重型），違反了合同(tong)約(yue)定(ding)的如實(shi)告(gao)(gao)知(zhi)義務，故(gu)而不承擔(dan)給付(fu)保(bao)險金的責任。
雙峰(feng)法院審理認(ren)為，根據《中華人(ren)(ren)民共和國保(bao)(bao)(bao)(bao)(bao)(bao)險(xian)(xian)(xian)法》第十六條相關規(gui)定：“投保(bao)(bao)(bao)(bao)(bao)(bao)人(ren)(ren)故意或者(zhe)因重大過(guo)失未履(lv)行(xing)前款規(gui)定的(de)如實告(gao)(gao)知義務，足以影響保(bao)(bao)(bao)(bao)(bao)(bao)險(xian)(xian)(xian)人(ren)(ren)決定是否同(tong)(tong)意承保(bao)(bao)(bao)(bao)(bao)(bao)或者(zhe)提高保(bao)(bao)(bao)(bao)(bao)(bao)險(xian)(xian)(xian)費(fei)率的(de)，保(bao)(bao)(bao)(bao)(bao)(bao)險(xian)(xian)(xian)人(ren)(ren)有權解(jie)除(chu)(chu)合(he)(he)同(tong)(tong)。前款規(gui)定的(de)合(he)(he)同(tong)(tong)解(jie)除(chu)(chu)權，自保(bao)(bao)(bao)(bao)(bao)(bao)險(xian)(xian)(xian)人(ren)(ren)知道有解(jie)除(chu)(chu)事由(you)之日(ri)起(qi)，超(chao)(chao)過(guo)三十日(ri)不(bu)行(xing)使(shi)而(er)消滅。自合(he)(he)同(tong)(tong)成立之日(ri)起(qi)超(chao)(chao)過(guo)二年的(de)，保(bao)(bao)(bao)(bao)(bao)(bao)險(xian)(xian)(xian)人(ren)(ren)不(bu)得解(jie)除(chu)(chu)合(he)(he)同(tong)(tong)；發生保(bao)(bao)(bao)(bao)(bao)(bao)險(xian)(xian)(xian)事故的(de)，保(bao)(bao)(bao)(bao)(bao)(bao)險(xian)(xian)(xian)人(ren)(ren)應當(dang)承擔(dan)賠償或者(zhe)給付(fu)保(bao)(bao)(bao)(bao)(bao)(bao)險(xian)(xian)(xian)金的(de)責任。”本案涉保(bao)(bao)(bao)(bao)(bao)(bao)險(xian)(xian)(xian)合(he)(he)同(tong)(tong)距成立之日(ri)起(qi)已超(chao)(chao)過(guo)二年，保(bao)(bao)(bao)(bao)(bao)(bao)險(xian)(xian)(xian)人(ren)(ren)不(bu)得解(jie)除(chu)(chu)合(he)(he)同(tong)(tong)。雖然原告(gao)(gao)彭某某在投保(bao)(bao)(bao)(bao)(bao)(bao)前患(huan)有慢(man)性(xing)乙肝病毒（重型），但與其投保(bao)(bao)(bao)(bao)(bao)(bao)后(hou)所患(huan)的(de)慢(man)加急性(xing)肝衰竭(jie)不(bu)是同(tong)(tong)一病癥，且被告(gao)(gao)也不(bu)能證明兩者(zhe)之間存在因果(guo)關系。因此，被告(gao)(gao)某保(bao)(bao)(bao)(bao)(bao)(bao)險(xian)(xian)(xian)公司的(de)抗辯理由(you)不(bu)成立，本院不(bu)予(yu)支(zhi)持。
遂(sui)判決：被(bei)告某(mou)保(bao)險公司于判決生效后十日內，給付原告彭某(mou)某(mou)保(bao)險金109600元。
法官提醒
訂立(li)保險合(he)(he)同(tong)時，保險人(ren)就(jiu)保險標的(de)(de)(de)或者(zhe)被(bei)保險人(ren)的(de)(de)(de)有關情(qing)況(kuang)(kuang)提出詢問的(de)(de)(de)，投保人(ren)應當如(ru)實告(gao)知(zhi)。同(tong)時，保險人(ren)在合(he)(he)同(tong)訂立(li)時，已經(jing)知(zhi)道投保人(ren)未如(ru)實告(gao)知(zhi)的(de)(de)(de)情(qing)況(kuang)(kuang)的(de)(de)(de)，保險人(ren)不得解除合(he)(he)同(tong)。訂立(li)合(he)(he)同(tong)雙方應當遵循誠信原則，根據合(he)(he)同(tong)的(de)(de)(de)性質、目的(de)(de)(de)和交易習慣(guan)，全面(mian)履行(xing)自己的(de)(de)(de)義務。
日期：2023-11-20 11:18:11 | 關閉 |
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