The nature of the accident determines the success or failure of insurance contract dispute litigation

On July 30, 2012, the company insured its cranes with a certain insurance company for compulsory traffic insurance and third-party liability insurance. The insurance period was from July 30, 2012 to July 30, 2013. The company paid the corresponding insurance premiums, and the insurance company issued and delivered the insurance policy to the company. The company signed and stamped the disclaimer notice on the insurance policy.

At about 1:00 pm on June 8, 2013, Ding Mou, the person in charge of the company, was driving the insured crane to carry out the construction of a truss steel structure at a certain building materials company, causing Yang Mou, an installation worker, to fall from a 20-meter-high truss walkway and die after rescue. The safety supervision bureau determined that the company violated the safety production operation regulations and failed to adequately educate employees, resulting in hoisting operations with people on the hoisting components. The company was mainly responsible for the accident, and Ding Mou was mainly responsible for the accident. Administrative penalties were imposed on both Nian Mou and Ding Mou.

On June 9, 2013, Jie Mou, the person in charge of the project involved, signed the "Yang Mou Death One-time Compensation Agreement" with the victim's family at the police station, agreeing that Jie Mou would compensate the victim's family a total of 680,000 yuan for death compensation, funeral expenses, and child support. This accident was handled once and for all. On June 12, Jie Mou paid the compensation by bank transfer.

On November 1, 2013, the company sued the insurance company to the people's court, claiming that it was the actual infringer of the accident involved and that the outsider Jie Mou compensated the victim's family 680,000 yuan, requesting compensation of 110,000 yuan for compulsory traffic insurance and 500,000 yuan for third-party liability insurance.

I. Points of Dispute

The main points of dispute in this case are two: First, does this accident constitute the conditions for compensation under compulsory traffic insurance? Second, does this accident fall within the scope of compensation for special vehicle third-party liability insurance?

II. Court Judgment

After trial, the court found that the "Regulations on Compulsory Insurance for Motor Vehicle Traffic Accidents" is intended to ensure that victims of motor vehicle accidents are compensated according to law and to promote road traffic safety. In this accident, the motor vehicle violated regulations during construction, resulting in a safety accident. This accident was defined by the safety production supervision and management department, not by the traffic police department, and does not belong to the damage compensation caused by motor vehicles driving outside the road which can be compensated in reference to traffic accidents; therefore, this case does not fall within the scope of compensation for compulsory traffic insurance.

The "Administrative Penalty Decision" of the safety production supervision and management department clearly defines this case as a safety production responsibility accident, and this type of accident is a responsibility exemption in the special vehicle third-party liability insurance clause. Moreover, the evidence supporting that the company entrusted Jie Mou to pay compensation lacks support, so the company's request cannot be supported.

Based on the above reasons, the court of first instance rejected all the litigation requests of the company. The plaintiff of the first instance did not appeal, and the judgment became legally effective.

III. Legal Analysis

(1) Not all accidents related to motor vehicles are traffic accidents; compulsory traffic insurance only compensates for losses caused by road traffic accidents.

The "Regulations on Compulsory Insurance for Motor Vehicle Traffic Accidents" is intended to ensure that victims of motor vehicle traffic accidents are compensated according to law and to promote road traffic safety, and is formulated in accordance with the "Road Traffic Safety Law of the People's Republic of China" and the "Insurance Law of the People's Republic of China." The motor vehicle traffic accident liability insurance referred to in these Regulations refers to compulsory liability insurance in which the insurance company compensates for the death or injury of people and property damage other than the insured vehicle and the insured, caused by a traffic accident of the insured vehicle, within the limit of liability. This accident was a safety accident caused by violation of regulations during hoisting operations at a construction site, and was defined by the safety production department, not a traffic accident identified by the traffic police department, and it does not fall within the scope of damage compensation caused by a motor vehicle driving outside the road and compensated in reference to traffic accident compensation. Therefore, compulsory traffic insurance cannot compensate for safety accidents in this case.

(2) Insurance contract claims must be handled strictly in accordance with the provisions of the insurance contract.

1. The claimant under the property insurance contract must be the insured, and there must be an insurance liability event as agreed in the insurance contract.

Article 12, Paragraph 5 of the Insurance Law stipulates that "the insured is the person whose property or person is protected by the insurance contract and who has the right to claim insurance money. The policyholder can be the insured." According to the "One-time Compensation Agreement," the obligor in this case is Jie Bingxiang, who is the project manager of Zhejiang Yunlong Construction Co., Ltd. The payment method of the agreement is direct remittance to the account of the victim's relatives. It can be seen that the plaintiff in this case is not the compensation obligor, and Jie Bingxiang's compensation is based on compensation under his labor contract, which is completely different from the compensation liability borne by the plaintiff's insured third-party liability insurance. Combining this insurance contract, Jie Bingxiang is neither the policyholder nor the insured under this insurance contract, so he does not have the right to claim insurance money. The plaintiff in this case did not suffer losses caused by this accident, and the insurance contract compensation event did not occur, so the claim procedure cannot be initiated. Therefore, the plaintiff's filing of an insurance contract lawsuit based on the compensation for work-related injuries by an outsider is a serious waste of litigation resources and their own finances.

2. Assuming that the defendant has the right to claim compensation, the accident in this case does not fall within the scope of compensation stipulated in the "Special Vehicle Insurance Clause".

(1) This case does not constitute an "accident" as defined in the contract.

An accident is an unexpected event that occurs during people's production and life activities. Among the various definitions of accidents, Berckhoff is a well-known definition.

Berckhoff believes that an accident is a sudden event that violates the will of a person (individual or collective) in the process of carrying out activities to achieve a certain purpose, forcing the activity to stop temporarily or permanently. Its core characteristics are suddenness and unpredictability, and it does not fall within the category of intent or negligence.

The driver of the vehicle operating in violation of regulations in this case was a mobile crane driver who had received special equipment professional training. It is a basic safety knowledge and requirement that no one is allowed to stand on the crane boom or the items being hoisted. In this case, the deceased stood on the steel frame being hoisted by the crane without taking any safety protection measures, and the continuous hoisting and movement of the boom kept the steel frame in constant motion. As a professional technician, the driver should have immediately stopped hoisting and persuaded the person on the steel frame to get down, but he did not. As a professional, the consequences should have been foreseen at this time. Therefore, in this situation, people or unsecured items may fall down at any time, which is not an accident, but something expected with a fluke mentality.

(2) The deceased does not belong to a third party in relation to the insured vehicle, and should not be compensated according to the terms of third-party liability insurance. The third party stipulated in the insurance contract does not include personnel on the insured motor vehicle at the time of the insurance accident. In this case, the deceased stood on the moving steel frame and was hoisted by the crane together, so they were considered on board personnel for the crane. For the damage to personnel on board, the insurance contract clearly stipulates that regardless of whether the insured should bear the compensation liability legally, the insurer is not responsible for compensation.

(3) This case falls under the exclusion of liability in the insurance clause.

Article 9, Paragraph (8) of the insurance contract stipulates that "the insurer is not liable for compensation for damage to property, land, and buildings caused by vibration, movement, or weakening of support during operation, and for any resulting personal injury or death"; Paragraph (2) of the same article stipulates that the insurer does not compensate for mental distress; and Paragraph (3) of Article 12 stipulates that the insurer does not bear the liability for compensation for insurance accidents caused by violation of safe loading regulations."

In this case, the deceased violated regulations by standing on the moving hoisting steel frame without taking any protective measures; the crane operator, knowing that someone was standing on it, continued the hoisting operation, and the resulting loss falls under the circumstances where the insurer is not liable for compensation as stipulated in the aforementioned clauses.

V. Lessons from the Case

From the outcome of this case, it can be seen that not all cases related to insurance contracts are insurance contract disputes. As the agent for the plaintiff, one should carefully study the case and the clauses of the insurance contract in order to be targeted and truly effectively protect the rights and interests of one party.