If the victim dies in a long term due to a traffic accident, should the insurance company consider the injury participation when assuming the liability for the claim? Recently, the Huangyan District People's Court of Taizhou City, Zhejiang Province heard a case of a dispute over liability for a motor vehicle traffic accident and clarified the relevant issues.
Comics: Muyi
The pedestrian was hit and hospitalized and died more than four months after being discharged
On the evening of June 11, 2023, a traffic accident occurred between a small ordinary passenger car driven by Pan and a pedestrian Wang who crossed the road, and the traffic police determined that Pan bore the primary responsibility for the accident and Wang bore the secondary responsibility for the accident. Wang was immediately taken to the hospital for treatment after being injured, and after 17 days of hospitalization, Wang recovered and was discharged from the hospital on June 29. Hou Wang died in a nursing home on October 28 of the same year. After the appraisal agency issued a judicial appraisal opinion, it was assessed that Wang met the requirements of the long-term death of multiple organ failure after minor injuries caused by traffic accidents, and recommended that the participation in causation should be 10% to 15%.
After the incident, in order to compensate for the incident, the family of the plaintiff Wang sued the defendant Pan and the insurance company insured by the vehicle involved to the Huangyan District Court, demanding compensation for his medical expenses, death compensation and other losses totaling 472,587.08 yuan.
Should the liability of compulsory liability insurance take into account the participation in damages?
After hearing the case, the Huangyan District Court held that the focus of the dispute in this case was whether the tortfeasor's liability should be determined based on the causal relationship between Wang's death and traffic accident injury, and whether the issue of participation should be considered from the aspects of compulsory traffic insurance and commercial insurance.
The court held that the liability of compulsory liability is a statutory liability, and the scope, standard and exemption of liability are all mandatorily stipulated by law, while the legislation and insurance law of mainland China do not stipulate that when determining the insurance liability, the corresponding deduction shall be made according to the impact of the victim's physical condition on the consequences of damage, and there is no such agreement on the reasons for exemption and reduction of liability of the insurance company. As long as it can be determined that there is a causal relationship between the traffic accident and the damage, the insurance company should bear the liability for the payment of the compulsory liability insurance. Therefore, damage participation should not be considered in the liability of compulsory liability insurance.
The court held that the impact of injury participation should be considered as to whether losses in excess of the compulsory liability insurance limit should be considered. As a concept of forensic science, injury participation is essentially to confirm the specific impact of the causative factors on the damage consequences, and then reproduce the damage process in a quantitative and scientific proportional relationship, objectively weigh the rights and obligations of all parties, and the corresponding legal concept should be the proportion of causal forces.
The court held that the second paragraph of Article 3 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 stipulates that if two or more persons do not have common intent or joint negligence, but several acts carried out by them indirectly combine to produce the same harmful consequence, they shall each bear the corresponding liability for compensation according to the degree of negligence or the proportion of causal force. The perpetrator is only liable for the victim's losses caused by his own fault, and for the same damage suffered by the victim, the different causes of the damage should be identified, and the effect of each cause on the occurrence or expansion of the damage should be specifically analyzed, and then different liability for compensation should be determined.
The court held that in the case of injury participation in a traffic accident, the impact of injury participation should be considered according to the specific compensation items for the victim's loss beyond the liability of the compulsory traffic insurance after deducting the liability of the compulsory traffic insurance. Since the victim's hospitalization was solely due to the traffic accident, the medical expenses, hospital meal allowances, nutrition expenses, nursing expenses, and transportation expenses directly incurred by the hospitalization should not be considered as a result of the accident's injury participation. For indirect property losses such as death compensation and solatium for moral damages, the participation in the injury should be taken into account, and the liability should be borne according to the proportion of the respective causal forces of both parties.
Court: The part exceeding the compulsory traffic insurance should consider the injury participation in terms of specific compensation items
According to reports, according to Wang's medical records and expert opinions, it can be proved that the traffic accident in this case only caused Wang's right ankle fracture and other injuries, and the injury was still a minor injury, and after conservative treatment, the general condition of discharge was good, which was not enough to constitute the direct cause of his long-term death in a nursing home after discharge, combined with his own existence of a variety of senile degenerative underlying diseases, poor systemic nutritional status, advanced age and physical weakness The cause of death was considered to be consistent with the morphological characteristics of long-term multi-organ failure after minor injury caused by traffic accidents. Traffic accident injuries have a certain degree of adverse impact on the quality of life of his life, and have a slight effect on his subsequent death in nursing homes, so the compensation for indirect property losses in the commercial insurance part should be determined based on the causal relationship between Wang's death and the traffic accident injury, and the causal relationship participation should be determined to be 15%.
The court held that the vehicle driven by the defendant Pan had been insured by the defendant insurance company with compulsory motor vehicle traffic accident liability insurance and commercial third-party liability insurance, and the accident occurred within the insurance period, so the insurance company should compensate in advance within the scope of insurance liability.
To sum up, the court ruled that the defendant insurance company should pay the plaintiff a total of 192,871.25 yuan for medical expenses, hospital meal subsidies, nutrition expenses, nursing expenses, funeral expenses, transportation expenses, mental injury solatium, and death compensation within the compensation limit of the compulsory traffic insurance, and pay the plaintiff the remaining death compensation of 33,245.10 yuan after the payment of the above-mentioned compulsory traffic insurance within the compensation limit of the commercial insurance based on the causal participation and liability ratio, that is, the defendant insurance company should compensate the plaintiff with a total of 226,116.35 yuan within the scope of insurance.
After the judgment, the insurance company appealed. The Taizhou Intermediate People's Court rendered a judgment rejecting the appeal and upholding the original judgment.
Observe and think
Compulsory liability insurance claims should comply with the legislative purpose and basic functions
The so-called injury participation refers to the proportional relationship between the injury and the occurrence of personal death, disability and sequelae in the event that the human body is harmed by factors such as trauma and disease (including aging and physical differences) that act together on the human body and damage the human body. Injury participation often appears in personal injury cases such as traffic accidents and medical disputes, and the determination of injury participation is generally determined by the tortfeasor's professional judicial appraisal and defense through participation, so as to exempt or reduce its liability for compensation.
In a motor vehicle traffic accident liability dispute, even if the victim's damage is caused by the victim's own illness and the traffic accident, and the traffic accident accounts for a certain proportion of the victim's participation in the damage result, the insurance company's liability for compulsory traffic insurance cannot be reduced or exempted with reference to the injury participation. Because the compulsory traffic insurance system is based on the social reality of the large increase in accident risk and the possibility of compensation liability, and the increasing damage caused by accidents, its legislative purpose and basic function is to ensure that the third party who suffers from motor vehicle traffic accidents receives prompt and effective compensation. If the total amount of losses of the injured party is limited by referring to the injury participation in determining the liability of the compulsory traffic insurance, then the result of the court's judgment can only be to reduce the amount of compensation received by the injured party and reduce the liability of the insurance company and the injured party caused by the traffic accident, which is obviously contrary to the legislative purpose and basic function of the compulsory traffic insurance system, and lacks legitimacy and reasonableness.
Source丨People's Court Daily
Author丨Yao Qingqing, Chen Susu
Editor丨Lin Xiaoyu
Produced by the new media team of Yulin Intermediate Court
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