An Empirical Study Of Sudden Death Compensation Disputes In Accident Insurance Based On Effective Judgment

Various group accident insurance have been the hot topic of academic research,but few studies have been conducted on disputes over sudden death payment in accident insurance.Nowadays,the pace of social life has been accelerating,and the number of accident insurance payment disputes caused by sudden death has increased significantly.The courts have taken different positions on such cases,and the phenomenon of different judgments in the same case is more serious.Based on the effective verdicts of the past five years,we found that the controversial focus of such cases is mainly on the determination of the validity of the "sudden death exclusion",the determination of causation and the allocation of the burden of proof."Sudden death" should be interpreted in the usual way,including caused by disease and not caused by disease,and cannot be directly excluded from the coverage of accident insurance.In examining the validity of the exclusion clause,the courts mainly determine the validity by examining the insurer’s fulfillment of the duty to prompt and explain.The court ignored the causation of the death of the insured,and instead judged who should bear the burden of proof according to the allocation of the burden of proof,and then judged whether the insured should bear the insurance liability.At present,the amendment of the Civil Code to the form clause will certainly affect the court’s consideration of the exclusion clause of "sudden death without compensation".The relationship between the Civil Code and the Insurance Law is not between ordinary general law and special law,but the Civil Code has more advanced legislative technology,so the "new law takes precedence" in applying the Civil Code.Therefore,in the future,when the court considers the exclusion clauses in insurance contracts,it should first examine the exclusion clauses for entry control,and then judge the "reasonableness" based on the content.After that,the causation of the insured’s death will be judged by combining the principles of proximate cause and proportional causation.Once the claimant has met its initial burden of proof,the burden of proof shifts to the insurer,who bears the burden of proof for its own defense that the disease caused the insured’s death.