Case Details: A garment factory entered into a property insurance contract with an insurance company on January 31, 2000. The insurance term was from February 1, 2000 to February 1, 2001, with an insured amount of 350,000 yuan, and the full premium was paid on the same day. On the evening of February 7, 2000, due to the Spring Festival, the duty officer Zhong from the factory left the premises without permission, went to a friend's house for dinner, and played mahjong until 3 PM the next afternoon when he returned to the factory. He discovered that the anti-theft door had been pried open and the factory's property stolen. After investigation, it was found that the property loss amounted to approximately 160,000 yuan. Since the case remained unsolved, the garment factory submitted a written claim report to the insurance company on May 11, 2000. On June 20 of the same year, the insurance company issued a "Denial of Claim Notice," stating that according to the insurance company's "Enterprise Property Insurance Terms Additional Theft Insurance Special Agreement" (hereinafter referred to as the "Special Agreement"), "Theft losses occurring due to no one guarding the insured address shall not be compensated by the insurer." The garment factory believed compensation should be provided, leading to a dispute. Finally, the garment factory sued the insurance company in court, demanding they bear responsibility for the property loss.
The first-instance court ruled that since the garment factory had processed enterprise property insurance with the insurance company and paid the insurance premium, the insurance contract was legally valid, and both parties should adhere to its execution. Although the theft occurred within the insurance period, it happened because there was no one guarding the insured address, which was confirmed by the written materials provided by the insured party. This act falls under the exclusion clause in the insurance terms. Therefore, the court made the following judgment: Dismissal of the garment factory's lawsuit. Dissatisfied with the first-instance court's decision, the garment factory appealed to the higher court. The second-instance court upheld the original verdict for the same reasons.
Analysis:
The focus of the controversy in this case is whether the exclusion clause in the property insurance additional theft insurance terms has legal binding force over the insured. I hold a positive view on this issue. The reasons are as follows: First, at the time of underwriting in this case, the insurer had already delivered the enterprise property insurance main policy and additional policy clauses stamped with a seam seal to the insured. Although the main policy clauses and additional policy clauses printed by the insurance company were not together, at the time of underwriting, these two types of clauses were stamped with a seam seal before being handed over to the insured. The insured received the additional policy terms and understood their content. Second, the exclusion clause in the "Special Agreement" has legal binding force over the insured. The establishment of an insurance contract goes through two stages: offer and acceptance. The application form filled out by the insured is the offer, and the insurance policy presented by the insurer is the acceptance. The content of the offer and acceptance combined forms a complete contract content, and the application form and insurance policy constitute a complete insurance contract. Therefore, the application form is an important part of the insurance contract, and the content agreed upon in the application form represents the true intention of the insured. From the signature of the insured on the application form, it can be seen that in this case, the insurer had fulfilled the interpretation and explanation obligations stipulated in Article 17 of the Insurance Law regarding the standard terms. Because when printing the application form, the insurance company specifically set up an "Insured (Signature/Seal)" section, agreeing that: The insured declares that the above-filled content is true, and has understood the contents and explanations of the basic property insurance terms and additional terms including the exclusions. Once the insured signs or seals in this section, it proves that the insurer has fulfilled the interpretation and explanation obligations of the insurance terms. In this case, the insurer used the method of signature confirmation and declaration to prove that it had fulfilled the clear explanation obligations of the exemption clauses, and the insured could not provide contrary evidence to counterprove. Therefore, the court determined that the insurer had fulfilled the clear explanation obligations of the exemption clauses.
Implications:
Firstly, before signing, the insured should carefully fill out the application form, hire a lawyer if necessary, and clearly see the relevant items in the application form and the contents of the insurance terms, then sign or stamp on the application form. If there are any questions, they should promptly request the business personnel of the insurance company to explain them. Because once the insured signs or stamps on the application form, it will be regarded as the insurer having fulfilled the interpretation and explanation obligations of the insurance terms at the time of underwriting, meaning that the insured already knows the contents of the exclusions in the insurance terms.
Secondly, with the strengthening of people's insurance awareness, the consciousness of abiding by the terms of the insurance contract and insurance laws must also be strengthened. After the insurance contract is signed, the insured should conscientiously perform their obligations according to the agreement of the insurance contract. Purchasing insurance is a means for the insured to disperse risks, but the insured should not feel secure after subscribing and neglect the insured property. Because if the property loss is caused by the insured failing to fulfill their obligations, the insurance company may refuse compensation based on the terms of the insurance contract.
Reference Materials:
Relevant thematic articles: Cases of securities fraud, insurance fraud - compulsory traffic insurance compensation scope; Establishment of limited liability companies - application procedures and required materials to be submitted; Can insurance companies always refuse claims when the insured flees after a traffic accident - crime of fleeing after a traffic accident.
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