An environmental company v. an insurance company
-- Criteria for determining "substantial changes" in the terms of employers' liability insurance contracts
keyword
- civil
- insurance
- Employer's Liability Insurance
- Standard Terms
- Material Changes
Basic facts of the case
In September 2018, an environmental company purchased employer's liability insurance from an insurance company, and the end of the insurance policy stated that the salesman was Zhao, the main introducer was Zhang, and the environmental company paid an insurance premium of 82,500 yuan by remittance from the company's account. On September 6, 2018, an insurance company issued an employer's liability insurance policy, the insured was an environmental company, the insurance period was from September 8, 2018 to September 7, 2019, the number of insured employees was 110, and the death compensation limit for each water and river worker was 500,000 yuan; The premium is $750 per person; The absolute deductible for medical expenses per accident is 300 yuan; The total premium is $82,500. The insurance policy was handwritten with the word "Zhao". The insurance policy is accompanied by a detailed list of personnel, listing the names and ID numbers of the 110 employees who have been insured, and Liao Moujia is in the list.
On the same day, an insurance company issued another employer's liability insurance policy for which the insured was an engineering company. The contents of the insurance policy and the attached list of persons are consistent with the insurance policy of an environmental company for which the insured is insured. The insurance policy also had "Zhao" handwritten, and Liao Moujia also appeared in the list of persons attached to the insurance policy.
Clause A of the employer's liability insurance insured by an environmental company and an engineering company states the following: "During the insurance period, if an employee of the insured suffers injury, disability or death due to an accident during the period of employment due to the work of the insured specified in the insurance policy, which can be recognized as a work-related injury, the insurer shall be liable for economic compensation to be borne by the insured in accordance with the laws of the People's Republic of China, and the insurer shall be responsible for compensation, including death compensation, disability compensation, medical expenses, etc.; The insurer is not liable for compensation for the liability of the insured to the employees employed by its contractors...... Employees refer to those who have signed a labor contract with the insured or have a de facto labor contract relationship and accept salaries and wages from the insured, including formal registered employees, short-term workers, temporary workers, seasonal workers, etc., but the personnel who provide services or work for the insured due to other contracts such as entrusted agency, discipline, intermediary and so on are not employees referred to in this insurance contract. ”
In March 2018, Liao Moujia signed a "Migrant Worker Labor Contract" with an engineering company, and the engineering company began to pay wages to Liao Moujia in April 2018. In October 2018, Liao Moujia drowned while carrying out water surface cleaning work in a dredging project contracted by an environmental company and subcontracted by an engineering company. In the same month, an environmental company and an engineering company signed a "compensation agreement" with Liao's wife Bai and only son Liao Mouyi, stipulating that an environmental company and an engineering company would jointly compensate Bai and Liao Mouyi with 1 million yuan, and the compensation included a one-time work-related death subsidy, funeral subsidy, family pension, death compensation, funeral expenses, living expenses for dependents, mental injury solatium and other expenses, and the above-mentioned compensation had been paid by an environmental company.
In November 2018, an environmental company filed a claim with an insurance company. An insurance company issued a Notice of Refusal of Compensation, which stated: "The deceased Liao Moujia did not sign a labor contract with an environmental company, and the contract showed that the employee was working for an engineering company that signed a labor contract at the time of the accident, so there was no labor relationship with an environmental company, and it was not the insurance liability of this policy; The insurance liability for this accident is not established, and the insurance company cannot pay compensation. ”
In December 2018, an engineering company applied to an insurance company for compensation. Subsequently, an insurance company paid 499,700 yuan to an engineering company. On the day an engineering company received the insurance compensation, it transferred 499,700 yuan to an environmental company.
An environmental company filed a lawsuit, claiming that its insurance contract with an insurance company was valid, and demanding that the insurance company pay for the loss of insurance money and interest. An insurance company believes that the compensation of the deceased Liao Moujia has been paid to an engineering company, and although an environmental company has taken out employer's liability insurance in the insurance company, and Liao Moujia is also on the list, Liao Moujia is not an "employee" as agreed in the insurance clause, so it does not agree to the litigation claim of an environmental company.
On January 15, 2020, the Beijing Xicheng District People's Court rendered the (2019) Jing 0102 Min Chu No. 18394 Civil Judgment: an insurance company shall pay an environmental company an insurance premium of RMB 500,000 and pay interest losses within 10 days after this judgment takes effect. After the judgment was pronounced, an insurance company appealed. On May 28, 2020, the Beijing No. 2 Intermediate People's Court rendered the (2020) Jing 02 Min Zhong No. 3611 Civil Judgment: rejecting the appeal and upholding the original judgment.
Reasons for the Adjudication
The effective judgment of the court held that the focus of the dispute in this case was whether the death of Liao Moujia was within the scope of insurance liability of the employer's liability insurance. The deceased Liao Moujia signed a labor contract with an engineering company before his death, and did not have a direct labor contract relationship with an environmental company, which is indeed inconsistent with the definition of "employee" stipulated in the insurance clauses, but to explore the true intention of the parties to the contract and determine what legal effect the contract has on the parties, in addition to referring to the content of the contract clauses, it should also be comprehensively judged based on various factors such as the background of the conclusion of the contract, the personnel handling the contract signing, the form of contract performance, and the specific performance of the contract.
In this case, an environmental company and an engineering company handled employer's liability insurance at the same insurance agency of an insurance company on the same date, and both insurance policies were handled by Zhang, a salesperson of an insurance company, and the names of the insurance company's employee "Zhao" were handwritten on both insurance policies, and at the same time, all the contents of the two insurance policies were identical except for the information of the insured, and the total number of employees was 110, and the details of the two attached personnel lists were also identical. Accordingly, when an insurance company underwrites and issues an insurance policy, it has the ability and obligation to find that the contents of the two employer's liability insurance policies are the same and the list of employees covered is the same. As a commercial insurance company, an insurance company should be aware that engaging in commercial activities will inevitably face commercial risks. Therefore, at the time of underwriting, an insurance company should be able to form the expectation that if it agrees to underwrite both employers' liability insurance policies and charges double premiums, it may make more profits while assuming double insurance liabilities in the event of an insured event. An insurance company chose to assume the corresponding commercial risks after collecting double insurance premiums from an environmental company and an engineering company. The issuance of two employers' liability insurance policies in effect changed the provisions of the contract regarding the definition of insurance liability and employees. To sum up, the death of Liao Moujia falls within the scope of insurance liability of the employer's liability insurance, and the insurance company should pay the insurance money and compensate for the loss in accordance with the contract.
Summary of the trial
In determining the validity of standard clauses in an insurance contract, we should not be confined to the content of the text, but should explore the true intention of the parties to the contract, determine what kind of legal effect the contract has on the parties, pay full attention to the background of the conclusion of the contract, the details of the signing of the contract, the form of contract expression, the specific performance of the contract and other factors, and comprehensively judge whether the content of the contract has undergone substantial changes, so as to ensure the fairness of the adjudication result. On the same day, the insurance company issued two insurance policies, the insurance salesperson and the handling personnel were the same, and the contents of the insurance policies were the same except for the information of the insured. The insurance company's subsequent refusal to settle the claim on the grounds that it does not meet the definition of an employee as stipulated in the insurance clause violates the principle of fairness and good faith.
Associate indexes
Article 23 of the People's Republic of China Insurance Act
First instance: Beijing Xicheng District People's Court (2019) Jing 0102 Min Chu No. 18394 Civil Judgment (January 15, 2020)
Second instance: Beijing No. 2 Intermediate People's Court (2020) Jing 02 Min Zhong No. 3611 Civil Judgment (May 28, 2020)