Chen, a dispute over liability for injury between a hotel and an insurance company providing labor services
-- Disputes over group accident insurance may be tried together with disputes over the liability of labor service providers
keyword
- civil
- Liability for damage caused by the provider of labor services
- Employer Liability
- Group Accident Insurance
- Multiple lawsuits in one
Basic facts of the case
Chen claimed that he worked as a waiter at a hotel on March 2, 2021. On May 18, 2021, Chen suffered a fracture of his right shoulder after slipping due to water on the ground while cleaning, and was identified as a grade 10 disability. A hotel purchased group accident insurance for its employees in an insurance company, so an insurance company should bear the liability for compensation within the scope of insurance liability, and requested an order: 1. A hotel and an insurance company should compensate Chen 93,882 yuan; 2. The litigation costs shall be borne by a hotel or an insurance company. The defendant, a hotel, argued that: 1. Chen was an adult who was at fault for slipping and falling due to his failure to fulfill his duty of care when mopping the floor; 2. The hotel purchased group accident insurance for Chen, with an accidental injury of 100,000 yuan and an accidental medical treatment of 10,000 yuan, with a total insurance amount of 110,000 yuan, and the insurance company should bear the responsibility within the scope of insurance liability. The defendant, an insurance company, argued that: 1. the medical expenses had been paid within the scope of the accidental medical insurance amount; Disability compensation shall be paid after appraisal in accordance with the appraisal standards agreed in the insurance clauses; If Chen's disability level is level 10, the insurance company will bear 10%, that is, 10,000 yuan; The rest of the hospital meal subsidy, nutrition fee, appraisal fee and transportation fee are not within the scope of insurance liability and will not be compensated; 2. Litigation costs are not insurance liability and shall not be borne by the insurance. After trial, the court ascertained that a hotel was registered in accordance with the law on March 30, 2020, and its business scope was accommodation services, catering services, etc. In March 2021, Chen (then 57 years old) was introduced to a hotel to work as a waiter, mainly cleaning the hotel restaurant, cooking, etc., with a salary of 3,500 yuan/month. After lunch on May 18, 2021, while cleaning the restaurant, Chen was injured by a slip and fall caused by water pollution on the ground, and was sent to the hospital by a hotel for treatment, and was diagnosed with a proximal fracture of the right humerus and was hospitalized for 11 days. A hotel paid all the medical expenses of 13,476.58 yuan in advance, and then an insurance company paid 9,647.52 yuan of medical insurance to a hotel. According to the judicial appraisal, Chen's degree of disability is level 10. On April 27, 2021, a hotel insured 1 copy of "Group Accident Insurance Type A (2019 Edition)" for 5 employees including Chen in an insurance company, insurance liability: accidental injury, insurance amount per person: 100,000 yuan; Name of insurance: additional accidental injury medical insurance terms, insurance liability: accidental medical treatment, insurance amount per person: 10,000 yuan, total insurance amount: 550,000 yuan. Special Provisions: 2. The applicable terms of this policy are "Additional Accident Medical Insurance". 3. The deductible of additional accident injury medical insurance is 100 yuan, and the compensation ratio is 80%, which shall be paid according to the above proportion within the scope of the provisions of the terms, and the insurance amount per person shall be limited. Article 5 (2) Liability for Accidental Injury and Disability Insurance: During the insurance period, if the insured suffers an accidental injury resulting in one of the degrees of disability listed in the "Disability Assessment Standards and Codes for Life Insurance", the insurer shall pay the disability insurance benefits according to the payment ratio of the corresponding disability level in the "Assessment Standards and Codes" multiplied by the amount of accidental injury insurance. (1) The proportion of insurance benefits corresponding to the level of disability of life insurance is divided into 10 levels, with 100% corresponding to the first level of disability and 10% corresponding to the tenth level of disability, with a difference of 10% for each level. On March 15, 2022, Chen applied to the Labor Dispute Arbitration Commission for arbitration. The committee issued a Notice of Inadmissibility on the grounds that Chen had reached the statutory retirement age and did not meet the conditions for acceptance.
On December 29, 2022, the People's Court of Alarken District, Xinjiang Production and Construction Corps, rendered the (2022) Bing 0103 Min Chu No. 868 Civil Judgment: 1. An insurance company compensated Chen a total of 62,076.4 yuan in insurance money within seven days after the judgment took effect; 3. Chen's other litigation claims are rejected. After the judgment was pronounced, an insurance company appealed. On May 12, 2023, the Intermediate People's Court of the First Division of the Xinjiang Production and Construction Corps rendered the (2023) Bing 01 Min Zhong No. 46 Civil Judgment: 1. Revoke the (2022) Bing 0103 Min Chu No. 868 Civil Judgment of the People's Court of Alarken District, Xinjiang Production and Construction Corps; 2. An insurance company paid Chen an insurance amount of 10,000 yuan within the insurance liability; 3. A hotel compensated Chen for various losses of 49,077 yuan; 4. Rejecting Chen's other litigation claims.
Reasons for the Adjudication
The effective judgment of the court held that the focus of the dispute in this case is: 1. If the insured is assessed as a grade 10 disability in type A of group accident insurance, whether the insurance benefit is 100,000 yuan or only 10% of 10,000 yuan; 2. Whether the insurance money in this case is offset against the compensation payable by the hotel. Regarding Focus 1, the first paragraph of Article 11 of the Insurance Law of the People's Republic of China stipulates: "When concluding an insurance contract, consensus shall be reached and the rights and obligations of all parties shall be determined in accordance with the principle of fairness. According to this article, the conclusion of an insurance contract shall take into account the interests of the policyholder and the insurer, and reasonably share the rights and obligations of all parties. In this case, a hotel and an insurance company reached an agreement to insure the Group Accident Insurance Type A (2019 Edition) for five employees including Chen, in which Article 5 (2) of the insurance liability stipulates that the proportion of insurance payment is divided into 10 levels, with a difference of 10% for each level. The agreement is an agreement on the calculation method of disability insurance benefits to be paid to the insured after suffering an accidental injury, and the insurer shall pay different amounts of compensation according to the payment ratio corresponding to the disability level multiplied by the amount of accidental injury insurance, which does not limit or damage the interests of the insured, nor does it reduce or exclude the risks and losses that the insurance company should bear within the scope of the insurance liability. Article 9 of the Interpretation (II) of the Supreme People's Court on Several Issues Concerning the Application of the <People's Republic of China Insurance Law> "proportional compensation or payment" shall not be deemed to be a clause exempting the insurer from liability. A hotel's argument that it did not inform it of the content of the insurance clause, did not clearly prompt and explain the liability exemption clause, and that the agreement to compensate according to 10% was not legally effective could not be established and was not supported. Chen's injury occurred during the insurance period and was rated as a grade 10 disability, and the insurance company shall, in accordance with the provisions of the insurance contract, pay Chen an insurance premium of 10,000 yuan (100,000 yuan×10%) within the scope of the group accident insurance involved in the case. With regard to focus 2, the determination of the nature and consequences of a civil act shall be based on the true intention of the parties. In this case, the insurance involved in the case was purchased by a hotel for Chen and others in order to exclude liability for damages that may occur in the future, and its purpose was also to share the liability for compensation. The most fundamental meaning of group accident insurance is to allow the insurance company to compensate the injured employees in the event of an accident on its behalf, so as to reduce the amount of compensation that should be borne after an accident in the future. A hotel not only had the intention of deducting part of the compensation with the insurance money, but also objectively paid the insurance premium. Chen did not know the fact that the hotel was insured before he was injured, and he did not express his intention to take out insurance, so his civil legal act of expecting certain legal consequences, that is, obtaining insurance money, did not have this premise. At the same time, because the dispute over the liability of the labor service provider is a tort dispute and the purpose is to make up for the damage, according to the principle of compensation, no matter what method and channel Chen obtains relief, as long as his losses can be compensated. Although the hotel was not the direct owner of the insurance interest involved in the case, i.e., the insured, and had no right to directly request the insurance company to pay the insurance money in its own name, as the policyholder, it was exempted from the liability for compensation that it should have borne to the injured employee from the insurance interest, so the insurance money should be deducted from the hotel's compensation for Chen's damages.
Summary of the trial
The combination of the dispute over the liability of the employee suing the employer for the labor service and the dispute over the employee's claim against the insurance company for the liability for the damage within the scope of the insurance liability not only conforms to the provisions of the Civil Procedure Law, but is also conducive to further ascertaining the facts of the case and accurately determining the liability for compensation, while avoiding the burden of litigation by the parties and saving judicial resources.
Associate indexes
Articles 1165 and 1179 of the Civil Code of the People's Republic of China
Articles 2 and 11 of the People's Republic of China Insurance Act (2015 Revision).
Article 9 of the Interpretation (II) of the Supreme People's Court on Several Issues Concerning the Application of the Insurance Law of the People's Republic of China (Amended in 2020).
Articles 6, 7, 9, 10, 11 and 12 of the Interpretation of the Supreme People's Court on Several Issues Concerning the Application of Law in the Trial of Personal Injury Compensation Cases (Amended in 2022).
First instance: Civil Judgment of the People's Court of Alarken District, Xinjiang Production and Construction Corps (2022) Bing 0103 Min Chu No. 868 (December 29, 2022)
Second instance: Civil Judgment of the Intermediate People's Court of the First Division of the Xinjiang Production and Construction Corps (2023) Bing 01 Min Zhong No. 46 (May 12, 2023)