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客户身故拒赔遭起诉 法院判太平洋人寿赔偿100万

2017-08-11 08:52:45   中国经济网

根据判决书,被告太平洋人寿漯河支公司辩称,“我公司与被保险人在订立保险合同时故意隐瞒被保险人路某的职业身份是营业用货车司机,违反了如实告知义务。我公司与原告栗某、被保险人路某在订立保险合同履行‘告知事项’时,回答第一部分基本告知事项里第7个问题“是否为职业司机?若‘是’,请详述车辆种类、载重量或载人数等,二人均回答‘否’。事实上,被保险人路某具有准驾车型A2驾驶证,从事货运司机工作已经15年之久。依据中国太平洋人寿保险股份有限公司职业分类表第5类0501023营业用货车司机、随车人员(4吨或4吨以上),答辩人是拒保的。据此,可以认定二人在投保时故意隐瞒被保险人路某的职业身份是营业用货运司机,违反了如实告知义务,不再承担给付保险金责任。答辩人不再承担给付保险金的责任。另,根据安行宝保险条款2.3保险条款约定,被保险人系在驾驶营运车辆时发生交通事故,因此被保险人违反条款约定,我公司不承担赔偿责任。保险责任条款采取了黑体加粗,足以提醒投保人注意,且在客户电子签名部分投保人明确注明:本人已阅读保险条款、产品说明书和投保提示书,了解本产品的特点和保单利益的不确定性”。

对有上述争议的证据和事实,漯河市郾城区人民法院表示,首先,对于被告太平洋人寿漯河支公司是否已履行了提醒义务以及投保人是否明确知道保险合同内容的问题。由于原、被告双方所签订的保险合同是由被告太平洋人寿漯河支公司提供的格式合同,其内容繁多,非常人所能了解,作为提供格式合同的太平洋人寿漯河支公司,应当遵循公平原则确定双方当事人之间的权利和义务,采取合理的方式,如实告知投保方保险合同的内容。如果保险合同中规定有关于保险人责任免除条款或限制责任条款的,保险人应当在订立保险合同时针对该免责、限责条款提请对方特别注意,向投保人作明确的说明或特别的解释,以便让投保人能在对主要条款,特别是免责条款、限责条款充分理解后,决定是否投保。如果保险人未作明确说明的,该条款对投保人不产生效力。本案中,被告太平洋人寿漯河支公司仅以投保提示书及保险合同回执单中投保人栗某和被保险人路某的签名证明其进行了必要的提示和说明,并不能充分体现其对合同中关于责任条款的约定履行了特别的解释和说明义务,故对被告太平洋人寿漯河支公司表示其已履行了提示义务且投保人已明确知道保险合同内容的主张,不能成立,不予支持。

其次,对被告太平洋人寿漯河支公司主张投保人栗某所投保的安行宝两全保险,关于交通工具意外身故保险金的约定条款中被保险人驾驶或乘坐的交通工具应为非营运机动车,而被保险人路某是因驾驶营运机动车,因而应免除被告太平洋人寿漯河支公司的保险责任。本案中,被告太平洋人寿漯河支公司把交通工具意外身故保险金的约定条款中被保险人驾驶或乘坐的交通工具限定为非营运机动车,缩小了常人对交通工具的理解范围,应属限责条款,对该条款的约定,被告太平洋人寿漯河支公司应向投保人作出明确具体的解释。庭审中,被告太平洋人寿漯河支公司仅以投保提示书及保险合同回执单中投保人栗某和被保险人路某的签名证明其进行了必要的提示和说明,并不能充分体现其履行了特别的解释和说明义务,故被告太平洋人寿漯河支公司辩称理由不能成立,本院不予支持。

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