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Zhao Qing and Zhu Yufang v. Sino-US United MetLife Insurance Co., Ltd. (A case about dispute over an accidental injury insurance contract)
赵青、朱玉芳诉中美联泰大都会人寿保险有限公司意外伤害保险合同纠纷案
【法宝引证码】
 
  
Zhao Qing and Zhu Yufang v. Sino-US United MetLife Insurance Co., Ltd. (A case about dispute over an accidental injury insurance contract) 赵青、朱玉芳诉中美联泰大都会人寿保险有限公司意外伤害保险合同纠纷案
[Judgment Abstract] [裁判摘要]
“Accidental injury” refers to an objective event in which a person suffers from bodily injury for any external, unexpected, involuntary, and non-disease causes. It is common sense that excessive drinking is harmful to health. As a person with full capacity for civil conduct, the insured has the capacity to fully control and avoid excessive drinking. Therefore, the bodily injury caused by excessive drinking is not an external, unexpected, and involuntary factor and it was not an accidental injury. If the insured claims for the payment of insurance proceeds with the insurance company based thereon, the people's court should not uphold such claim. 意外伤害是指由于外来的、突发的、非本意的、非疾病的原因导致身体受到伤害的客观事件。饮酒过量有害身体健康属生活常识,被保险人作为完全民事行为能力人,对此完全可以控制、避免,故饮酒过量导致身体损害不是基于外来的、突发的和非本意的因素,不属于意外伤害,被保险人据此申请保险公司支付保险金的,人民法院不予支持。

BASIC FACTS
 
...... 原告:赵青。
 原告:朱玉芳。
 被告:中美联泰大都会人寿保险有限公司。
 法定代表人:戴兰芳,该公司董事长。
 原告赵青、朱玉芳因与中美联泰大都会人寿保险有限公司(以下简称联泰保险公司)发生意外伤害保险合同纠纷,向江苏省南京市鼓楼区人民法院提起诉讼。
 

原告赵青、朱玉芳起诉称:赵青、朱玉芳分别系死者赵开先的女儿和妻子。赵开先生前所在的基泰物业开发管理(南京)有限公司(以下简称基泰物业公司)为其在被告联泰保险公司投保了团体意外伤害保险。2016年1月28日,赵开先酒后意外死亡,南京市公安局法医中心开具死亡证明,证明系意外死亡,根据保险合同约定,联泰保险公司应给付赵开先的继承人保险金12万元。因原告理赔未果,故诉至法院,请求判令联泰保险公司给付原告赵开先意外身故保险金12万元。

 被告联泰保险公司辩称:1.原告赵青、朱玉芳称赵开先系酒后意外死亡,但其提供的证据并不足以证明该事实;2.根据被告提供的《南京市急救中心院前医疗急救病历》、《接处警工作登记表》及基泰物业公司提供的《证明》显示,赵开先系严重醉酒导致死亡;3.被保险人赵开先作为一名成年人,要不要饮酒以及饮酒多少,完全可以控制,但其放任醉酒结果的发生,系其主观因素所致,不属于意外身故。综-上,虽然被告对赵开先的死亡表示同情,但是应尊重法律和合同的严谨性,请求依法驳回原告的诉讼请求。
 南京市鼓楼区人民法院一审查明:
 2015年12月24日,基泰物业公司为赵开先等26人向被告联泰保险公司投保了《团体意外伤害保险(F款)条款》,主要内容为:保险期间自2015年12月18日零时起至2016年12月17日24时止,其中普通意外身故指被保险人遭受意外伤害事故,且自该意外伤害事故发生之日起180日内因该事故为直接且单独原因导致身故的,联泰保险公司将按合同约定的保险金额12万元给付意外身故保险金;保险合同中关于意外伤害的释义为:是指遭受外来的、突发的、非本意的、非疾病的使身体受到伤害的客观事件;保险合同没有指定受益人,意外身故保险金视为被保险人之遗产。基泰物业公司在投保前已取得被保险人同意,联泰保险公司已就保险合同中保险责任、责任免除等条款向基泰物业公司进行了提示说明。
 ......



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