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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

漯河市郾城区人民法院认为:投保人栗某向被告太平洋人寿漯河支公司投保的事实为双方所认可,栗某作为受益人,在被保险人路某死亡后,有权要求太平洋人寿漯河支公司支付保险金。《中华人民共和国保险法》第十七条规定“订立保险合同,采用保险人提供的格式条款的,保险人向投保人提供的投保单应当附格式条款,保险人应当向投保人说明合同的内容。对保险合同中免除保险人责任的条款,保险人在订立合同时应当在投保单、保险单或者其他保险凭证上作出足以引起投保人注意的提示,并对该条款的内容以书面或者口头形式向投保人作出明确说明;未作提示或者明确说明的,该条款不产生效力。”《最高人民法院关于适用若干问题的解释(二)》第十条规定“保险人将法律、行政法规中的禁止性规定情形作为保险合同免责条款的免责事由,保险人对该条款作出提示后,投保人、被保险人或者受益人以保险人未履行明确说明义务为由主张该条款不生效的,人民法院不予支持。”第十一条规定“保险合同订立时,保险人在投保单或者保险单等其他保险凭证上,对保险合同中免除保险人责任的条款,以足以引起投保人注意的文字、字体、符号或者其他明显标志作出提示的,人民法院应当认定其履行了保险法第十七条第二款规定的提示义务。保险人对保险合同中有关免除保险人责任条款的概念、内容及其法律后果以书面或者口头形式向投保人作出常人能够理解的解释说明的,人民法院应当认定保险人履行了保险法第十七条第二款规定的明确说明义务。”

本案中,被告太平洋人寿漯河支公司提交的“客户权益保障确认书暨保险合同回执”签署时间为2015年3月19日,不能证明被告太平洋人寿漯河支公司在订立保险合同时对责任免除条款进行了提示并明确说明,被告太平洋人寿漯河支公司提交的“个人人身保险产品投保提示书”并未对责任免除条款进行足以引起投保人注意的文字、字体、符号或者其他明显标志作出提示,而投保单的第七部分声明与授权项虽用黑体字对责任免除条款有关的字样进行了标示,但也仅是标示了“免除……保险责任……”字样,但没有显示保险合同免责条款的条款内容(尤其是免责事由),根据《中华人民共和国保险法》第十七条及《最高人民法院关于适用若干问题的解释(二)》第十条、第十一条的规定,对责任免除条款的提示,应是对责任免除条款内容(尤其是免责事由)的提示,而不仅仅是对“责任免除条款”字样的提示,综合案情及原、被告方提交的证据,可以认定被告太平洋人寿漯河支公司未履行保险法第十七条第二款规定的提示义务,故涉案保险合同的责任免除条款无效,被告太平洋人寿漯河支公司应依据安行宝两全保险条款第2.3保险责任的交通工具意外身故保险金或交通工具意外全残保险金部分约定,向原告栗某赔付保险金,因路某死亡时未满75周岁,太平洋人寿漯河支公司应赔付保险金的金额为1000000元。

综上,依照《中华人民共和国民事诉讼法》第六十四条、《中华人民共和国合同法》第六十条、第一百零七条、《中华人民共和国保险法》第十七条及《最高人民法院关于适用若干问题的解释(二)》第十条、第十一条之规定,漯河市郾城区人民法院判决被告中国太平洋人寿保险股份有限公司漯河中心支公司于本判决生效后十日内向原告栗某赔付保险金1000000元。

责任编辑:孙鑫鑫 CN066
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