cciia.org.cn 2024-2-27 13:57:58 人(ren)民(min)法院報
父(fu)親(qin)(qin)重(zhong)病住院，女(nv)(nv)兒為(wei)其購買了高(gao)額壽(shou)險(xian)(xian)，但未(wei)告(gao)知(zhi)保(bao)險(xian)(xian)公(gong)司(si)父(fu)親(qin)(qin)的(de)真實(shi)健(jian)康狀況。就(jiu)在保(bao)險(xian)(xian)合同生效并履行(xing)大半年后，父(fu)親(qin)(qin)病亡，女(nv)(nv)兒據(ju)此向保(bao)險(xian)(xian)公(gong)司(si)申請理(li)賠。保(bao)險(xian)(xian)公(gong)司(si)以(yi)投保(bao)人隱瞞(man)真實(shi)健(jian)康情況為(wei)由拒賠，卻因(yin)超過法(fa)定期(qi)限未(wei)行(xing)使(shi)解除(chu)合同的(de)權利(li)陷(xian)于(yu)不利(li)。近日(ri)，安徽省淮北市中級人民法(fa)院作出二審判決，維持相(xiang)山(shan)區人民法(fa)院一審判決，保(bao)險(xian)(xian)公(gong)司(si)因(yin)在知(zhi)道有解除(chu)事由之日(ri)起30日(ri)內未(wei)解除(chu)保(bao)險(xian)(xian)合同，應(ying)按(an)照(zhao)合同約定履行(xing)賠付責任。
2021年10月30日(ri)(ri)(ri)，陳(chen)(chen)(chen)(chen)(chen)某(mou)(mou)作為(wei)投(tou)保(bao)(bao)(bao)(bao)(bao)(bao)(bao)人(ren)，以(yi)父親老陳(chen)(chen)(chen)(chen)(chen)為(wei)被(bei)投(tou)保(bao)(bao)(bao)(bao)(bao)(bao)(bao)人(ren)與某(mou)(mou)保(bao)(bao)(bao)(bao)(bao)(bao)(bao)險(xian)(xian)(xian)公(gong)司簽署了(le)保(bao)(bao)(bao)(bao)(bao)(bao)(bao)險(xian)(xian)(xian)合同，投(tou)保(bao)(bao)(bao)(bao)(bao)(bao)(bao)險(xian)(xian)(xian)種(zhong)為(wei)一款終身(shen)壽險(xian)(xian)(xian)，基本保(bao)(bao)(bao)(bao)(bao)(bao)(bao)險(xian)(xian)(xian)金(jin)額為(wei)72萬余(yu)元；保(bao)(bao)(bao)(bao)(bao)(bao)(bao)險(xian)(xian)(xian)年限為(wei)終身(shen)；保(bao)(bao)(bao)(bao)(bao)(bao)(bao)費(fei)為(wei)每月1萬元。保(bao)(bao)(bao)(bao)(bao)(bao)(bao)險(xian)(xian)(xian)單(dan)也載(zai)明：保(bao)(bao)(bao)(bao)(bao)(bao)(bao)險(xian)(xian)(xian)合同生(sheng)效日(ri)(ri)(ri)為(wei)2021年10月31日(ri)(ri)(ri)0時(shi)(shi)，身(shen)故保(bao)(bao)(bao)(bao)(bao)(bao)(bao)險(xian)(xian)(xian)金(jin)受益人(ren)為(wei)陳(chen)(chen)(chen)(chen)(chen)某(mou)(mou)。陳(chen)(chen)(chen)(chen)(chen)某(mou)(mou)如期繳納了(le)保(bao)(bao)(bao)(bao)(bao)(bao)(bao)險(xian)(xian)(xian)費(fei)用。2022年7月2日(ri)(ri)(ri)，被(bei)保(bao)(bao)(bao)(bao)(bao)(bao)(bao)險(xian)(xian)(xian)人(ren)老陳(chen)(chen)(chen)(chen)(chen)因病身(shen)故。同年7月14日(ri)(ri)(ri)，陳(chen)(chen)(chen)(chen)(chen)某(mou)(mou)向(xiang)某(mou)(mou)保(bao)(bao)(bao)(bao)(bao)(bao)(bao)險(xian)(xian)(xian)公(gong)司申請理賠。11月7日(ri)(ri)(ri)，某(mou)(mou)保(bao)(bao)(bao)(bao)(bao)(bao)(bao)險(xian)(xian)(xian)公(gong)司向(xiang)陳(chen)(chen)(chen)(chen)(chen)某(mou)(mou)出具《理賠結果(guo)通知書》，以(yi)投(tou)保(bao)(bao)(bao)(bao)(bao)(bao)(bao)人(ren)在(zai)投(tou)保(bao)(bao)(bao)(bao)(bao)(bao)(bao)時(shi)(shi)未告(gao)知事項(xiang)影響承(cheng)保(bao)(bao)(bao)(bao)(bao)(bao)(bao)為(wei)由(you)解除合同并不履行賠償義(yi)務(wu)。陳(chen)(chen)(chen)(chen)(chen)某(mou)(mou)認(ren)為(wei)保(bao)(bao)(bao)(bao)(bao)(bao)(bao)險(xian)(xian)(xian)公(gong)司沒有理由(you)拒賠，于是起(qi)訴至相(xiang)山區法院(yuan)。
相山區法(fa)(fa)院一審認為，陳某作為投(tou)保人(ren)與某保險公司(si)之間形成保險合同關(guan)系，系雙(shuang)(shuang)方(fang)(fang)當(dang)事人(ren)的真實意思(si)表示，且(qie)未(wei)違(wei)反(fan)法(fa)(fa)律、法(fa)(fa)規的強制性規定，應屬合法(fa)(fa)有效，對雙(shuang)(shuang)方(fang)(fang)均(jun)具有約束(shu)力，雙(shuang)(shuang)方(fang)(fang)均(jun)應遵照履行。
但(dan)是(shi)(shi)，如(ru)(ru)實告(gao)知(zhi)(zhi)義(yi)務是(shi)(shi)投保(bao)(bao)(bao)(bao)人(ren)訂立保(bao)(bao)(bao)(bao)險合(he)同必須履(lv)行(xing)的(de)基本義(yi)務，投保(bao)(bao)(bao)(bao)人(ren)是(shi)(shi)否(fou)對保(bao)(bao)(bao)(bao)險人(ren)的(de)詢問作如(ru)(ru)實說(shuo)明，直接影(ying)響保(bao)(bao)(bao)(bao)險人(ren)測定(ding)和評(ping)估(gu)承(cheng)(cheng)保(bao)(bao)(bao)(bao)的(de)風險，進而影(ying)響是(shi)(shi)否(fou)提高保(bao)(bao)(bao)(bao)險費率及(ji)承(cheng)(cheng)保(bao)(bao)(bao)(bao)的(de)選(xuan)擇(ze)。投保(bao)(bao)(bao)(bao)人(ren)如(ru)(ru)未履(lv)行(xing)如(ru)(ru)實告(gao)知(zhi)(zhi)義(yi)務，并(bing)足以影(ying)響保(bao)(bao)(bao)(bao)險人(ren)承(cheng)(cheng)保(bao)(bao)(bao)(bao)的(de)，保(bao)(bao)(bao)(bao)險人(ren)有權(quan)解除保(bao)(bao)(bao)(bao)險合(he)同。在該(gai)案審理中，法院(yuan)查實，被保(bao)(bao)(bao)(bao)險人(ren)老陳(chen)在投保(bao)(bao)(bao)(bao)前就患有腦梗、高血壓(ya)病、肝多發性囊腫(zhong)、膽囊炎、鼻竇炎以及(ji)長期(qi)飲酒(jiu)的(de)事(shi)實，并(bing)在醫(yi)院(yuan)住(zhu)院(yuan)治療(liao)，但(dan)陳(chen)某(mou)在投保(bao)(bao)(bao)(bao)單健康(kang)告(gao)知(zhi)(zhi)欄的(de)詢問表中均勾選(xuan)了(le)“否(fou)”選(xuan)項。陳(chen)某(mou)對上述事(shi)實進行(xing)了(le)隱瞞，應認定(ding)其故意違反了(le)如(ru)(ru)實告(gao)知(zhi)(zhi)義(yi)務。
某(mou)(mou)(mou)(mou)保(bao)(bao)(bao)(bao)(bao)險(xian)(xian)公(gong)(gong)(gong)(gong)(gong)司(si)拒絕理(li)(li)(li)賠(pei)的(de)(de)理(li)(li)(li)由(you)雖然成立，但是保(bao)(bao)(bao)(bao)(bao)險(xian)(xian)公(gong)(gong)(gong)(gong)(gong)司(si)的(de)(de)一個舉動卻給自(zi)己(ji)帶來了(le)不(bu)利后果。根據《中(zhong)華人民(min)共和國保(bao)(bao)(bao)(bao)(bao)險(xian)(xian)法(fa)(fa)》第(di)十六(liu)條(tiao)第(di)二款規(gui)定(ding)(ding)(ding)(ding)，保(bao)(bao)(bao)(bao)(bao)險(xian)(xian)公(gong)(gong)(gong)(gong)(gong)司(si)的(de)(de)投保(bao)(bao)(bao)(bao)(bao)單詢問表中(zhong)所列的(de)(de)概括性(xing)條(tiao)款有(you)(you)具體內(nei)容(rong)，陳(chen)(chen)(chen)某(mou)(mou)(mou)(mou)均(jun)填“否(fou)”，陳(chen)(chen)(chen)某(mou)(mou)(mou)(mou)違反了(le)如實告知(zhi)(zhi)義務(wu)，某(mou)(mou)(mou)(mou)保(bao)(bao)(bao)(bao)(bao)險(xian)(xian)公(gong)(gong)(gong)(gong)(gong)司(si)有(you)(you)權解(jie)(jie)(jie)除合同(tong)，但是根據合同(tong)約(yue)定(ding)(ding)(ding)(ding)及(ji)法(fa)(fa)律規(gui)定(ding)(ding)(ding)(ding)，保(bao)(bao)(bao)(bao)(bao)險(xian)(xian)公(gong)(gong)(gong)(gong)(gong)司(si)有(you)(you)權應自(zi)其知(zhi)(zhi)道有(you)(you)解(jie)(jie)(jie)除事由(you)之日(ri)起30日(ri)內(nei)作(zuo)出(chu)(chu)(chu)。該案中(zhong)，陳(chen)(chen)(chen)某(mou)(mou)(mou)(mou)在2022年7月18日(ri)向某(mou)(mou)(mou)(mou)保(bao)(bao)(bao)(bao)(bao)險(xian)(xian)公(gong)(gong)(gong)(gong)(gong)司(si)申請理(li)(li)(li)賠(pei)。某(mou)(mou)(mou)(mou)保(bao)(bao)(bao)(bao)(bao)險(xian)(xian)公(gong)(gong)(gong)(gong)(gong)司(si)向陳(chen)(chen)(chen)某(mou)(mou)(mou)(mou)出(chu)(chu)(chu)具拒賠(pei)付、解(jie)(jie)(jie)除合同(tong)《理(li)(li)(li)賠(pei)結(jie)果通知(zhi)(zhi)書》，根據陳(chen)(chen)(chen)某(mou)(mou)(mou)(mou)提交的(de)(de)其與某(mou)(mou)(mou)(mou)保(bao)(bao)(bao)(bao)(bao)險(xian)(xian)公(gong)(gong)(gong)(gong)(gong)司(si)工作(zuo)人員對(dui)話的(de)(de)視頻能夠反映出(chu)(chu)(chu)，某(mou)(mou)(mou)(mou)保(bao)(bao)(bao)(bao)(bao)險(xian)(xian)公(gong)(gong)(gong)(gong)(gong)司(si)作(zuo)出(chu)(chu)(chu)《理(li)(li)(li)賠(pei)結(jie)果通知(zhi)(zhi)書》的(de)(de)時間為(wei)“2022年11月7日(ri)”。法(fa)(fa)院認定(ding)(ding)(ding)(ding)，某(mou)(mou)(mou)(mou)保(bao)(bao)(bao)(bao)(bao)險(xian)(xian)公(gong)(gong)(gong)(gong)(gong)司(si)在知(zhi)(zhi)道有(you)(you)解(jie)(jie)(jie)除事由(you)之日(ri)起30日(ri)內(nei)未行使該解(jie)(jie)(jie)除權，其解(jie)(jie)(jie)除權已消滅(mie)。某(mou)(mou)(mou)(mou)保(bao)(bao)(bao)(bao)(bao)險(xian)(xian)公(gong)(gong)(gong)(gong)(gong)司(si)作(zuo)出(chu)(chu)(chu)的(de)(de)解(jie)(jie)(jie)除合同(tong)的(de)(de)決(jue)定(ding)(ding)(ding)(ding)不(bu)發生(sheng)法(fa)(fa)律效(xiao)力。所以，案件涉及(ji)的(de)(de)保(bao)(bao)(bao)(bao)(bao)險(xian)(xian)合同(tong)在未解(jie)(jie)(jie)除的(de)(de)情況下，對(dui)雙方仍具有(you)(you)約(yue)束力，某(mou)(mou)(mou)(mou)保(bao)(bao)(bao)(bao)(bao)險(xian)(xian)公(gong)(gong)(gong)(gong)(gong)司(si)應當按照合同(tong)的(de)(de)約(yue)定(ding)(ding)(ding)(ding)承擔給付陳(chen)(chen)(chen)某(mou)(mou)(mou)(mou)保(bao)(bao)(bao)(bao)(bao)險(xian)(xian)金(jin)的(de)(de)責任。最(zui)終，法(fa)(fa)院根據某(mou)(mou)(mou)(mou)終身(shen)壽險(xian)(xian)條(tiao)款相(xiang)關約(yue)定(ding)(ding)(ding)(ding)，其中(zhong)載明身(shen)故(gu)保(bao)(bao)(bao)(bao)(bao)險(xian)(xian)金(jin)最(zui)大值為(wei)保(bao)(bao)(bao)(bao)(bao)單的(de)(de)有(you)(you)效(xiao)期保(bao)(bao)(bao)(bao)(bao)險(xian)(xian)金(jin)額72萬余(yu)元，判決(jue)某(mou)(mou)(mou)(mou)保(bao)(bao)(bao)(bao)(bao)險(xian)(xian)公(gong)(gong)(gong)(gong)(gong)司(si)賠(pei)付陳(chen)(chen)(chen)某(mou)(mou)(mou)(mou)保(bao)(bao)(bao)(bao)(bao)險(xian)(xian)金(jin)72萬余(yu)元。
淮北中院二(er)審維持了(le)該判決。
■法官說法■
投保人(ren)在投保時應當做到誠實守(shou)信，如實履行告(gao)知(zhi)義務(wu)(wu)，若未(wei)履行如實告(gao)知(zhi)義務(wu)(wu)，保險公(gong)(gong)司(si)有理(li)由在三十天(tian)內行使合同解(jie)除(chu)權。如果保險公(gong)(gong)司(si)未(wei)在規定的期限內及(ji)時行使，合同解(jie)除(chu)權就會喪失，保險公(gong)(gong)司(si)可(ke)能(neng)會落得不賠(pei)(pei)(pei)也(ye)得賠(pei)(pei)(pei)的尷(gan)尬境(jing)地。保險公(gong)(gong)司(si)要認真(zhen)收集(ji)整(zheng)理(li)好拒(ju)賠(pei)(pei)(pei)的相(xiang)(xiang)關(guan)資(zi)料，全力避免有理(li)不賠(pei)(pei)(pei)變成無理(li)拒(ju)賠(pei)(pei)(pei)。當事人(ren)若因(yin)未(wei)履行告(gao)知(zhi)義務(wu)(wu)而拒(ju)賠(pei)(pei)(pei)，也(ye)要留好相(xiang)(xiang)關(guan)拒(ju)賠(pei)(pei)(pei)的資(zi)料及(ji)錄音、視(shi)頻(pin)資(zi)料等(deng)，以(yi)便后期合法維(wei)權。
日期：2024-2-27 13:57:58 | 關閉 |
Copyright © 1999-2021 法律(lv)圖書館
.
.
