专题21《人身保险》
以下为《2026商经法鄢梦萱系统精讲》中专题21《人身保险》（第163页至第174页）的全部逐字原文内容：
专题21 人身保险
一、人身保险合同
（一）人身保险合同的订立
知识点 145 人身保险合同的特征
人身保险合同，是指以人的寿命和身体为保险标的的保险合同。人身保险合同可以分为人寿保险合同、伤害保险合同、健康保险合同。人身保险合同具有下列两项特征：
1. 保险金定额支付
在发生约定的保险事故时，保险人向被保险人或者受益人，依照保险条款给付保险金。
2. 具有储蓄性
理论认为，人身保险合同并非债权债务关系，其性质为储蓄投资性法律关系。它是将现实收入的一部分通过保险的方式进行储存，以备急需或者年老时使用。因此，投保人不按照约定支付保险费的，推定为投保人放弃了保险这种“储蓄、投资理财”的方式。所以，保险人不得要求投保人承担违约责任，也不得以诉讼的方式要求投保人支付保险费。
知识点 146 人身保险合同订立时，需具有保险利益★★★
保险利益，是指投保人或者被保险人对保险标的具有的法律上承认的利益。
人身保险中，保险利益的对象和认定如下：
| 维度 | 内容 | 举例 |
| 保险利益的对象（法定） | 原则：投保人对下列人员具有保险利益： (1) 本人； (2) 配偶、子女、父母； (3) 其他与投保人有抚养、赡养或者扶养关系的家庭其他成员、近亲属； (4) 与投保人有劳动关系的劳动者。 | [例] 投保人对下列人员是否具有保险利益？ (1) 与投保人关系密切的邻居；（没有） (2) 已经与投保人离婚但仍一起生活的前妻；（没有） (3) 与投保人合伙经营的合伙人；（没有） (4) 投保人的表弟。（没有，无抚养、赡养、扶养等关系） |
| 例外：除上述人员外，被保险人同意投保人为其订立合同的，视为投保人对被保险人具有保险利益。 | ||
| 法院主动审查：法院审理人身保险合同纠纷案件时，应主动审查投保人订立保险合同时是否具有保险利益。 | ||
| 保险利益的认定 | (1) 人身保险合同订立时，需具有保险利益。 ① 订立合同时，投保人对被保险人不具有保险利益的，合同无效； ② 投保人可主张保险人退还扣减相应手续费后的保险费。 (2) 保险合同订立后，投保人丧失对被保险人的保险利益的，保险合同有效。 | [例] 张某为其妻A投保人身保险，保险期间为10年。现二人离婚，后A死亡。虽然在保险事故发生时二人已经离婚，但该份保险合同订立时二人是夫妻，具有合法的保险利益，因此，该保险合同有效，保险人需要支付保险金。 |
知识点 147 人身保险合同订立时，投保人的如实告知义务★★★
1. 投保人如实告知义务的内容
订立人身保险合同时，投保人应当如实告知：
(1) 保险合同订立时，投保人明知的与保险标的或者被保险人有关的情况，属于“应当如实告知”的内容。
(2) 投保人的告知义务限于保险人询问的范围和内容。我国采取“询问告知”，即投保人对保险人询问的问题进行回答，对于保险人未询问的问题，投保人无义务进行告知。
【萱站点睛】投保人如实告知的范围：“不问不答，有问必答”。
(3) 当事人对询问范围及内容有争议的，保险人负举证责任。
(4) 投保人对投保单询问表中所列概括性条款〔1〕没有尽到如实告知义务的，保险人不得解除合同；但该概括性条款有具体内容的除外。
(5) 保险合同订立时，被保险人根据保险人的要求在指定医疗服务机构进行体检，当事人主张投保人如实告知义务免除的，法院不予支持。
(6) 保险人知道被保险人的体检结果，仍以投保人未就相关情况履行如实告知义务为由要求解除合同的，法院不予支持。
2. 投保人违反如实告知义务的处理
| 类型 | 维度 | 处理 | 举例 |
| 故意未如实告知 | 合同 | 投保人故意未履行如实告知义务，足以影响保险人决定是否同意承保或者提高保险费率的，保险人有权解除合同。 | [例] 甲2年前曾做过心脏搭桥手术，但在填写投保单以及回答保险公司的相关询问时，甲均未如实告知。心脏搭桥手术为重大手术，甲的行为构成“故意未如实告知”。 |
| 保险费 | 保险人对于合同解除前发生的保险事故，不承担赔偿或者给付保险金的责任，且不退还保险费。 | ||
| 重大过失未如实告知 | 合同 | 投保人因重大过失未履行如实告知义务，足以影响保险人决定是否同意承保或者提高保险费率的，保险人有权解除合同。 | [例] 2019年6月，乙的常规体检报告单上写有“整体未见明显异常，疑似甲状腺有结节状，建议到医院作进一步检查”，但乙未检查。2020年3月，乙购买医疗健康险，投保单询问表上明确写有“被保险人是否有肿瘤、甲状腺或者甲状旁腺等疾病，若有，则不予提供保险”，乙填了“否”。乙的行为构成“重大过失未如实告知”。〔1〕 |
| 保险费 | 对保险事故的发生有严重影响的，保险人对于合同解除前发生的保险事故，不承担赔偿或者给付保险金的责任，但应当退还保险费。 |
ℹ 记忆：
(1) 故意未如实告知：解除合同+不赔+不退；
(2) 重大过失未如实告知：解除合同+不赔+要退。
1. 对上述保险人法定解除权的限制
保险人在保险合同成立后知道或者应当知道投保人未履行如实告知义务，仍然收取保险费的，不可以“投保人未如实告知”为由主张解除合同。
投保人订立合同时未如实告知的，保险人的合同解除权，自保险人知道有解除事由之日起，超过30日不行使而消灭。
投保人订立合同时未如实告知，自合同成立之日起超过2年的，保险人不得解除合同。
保险人在合同订立时已经知道投保人未如实告知的情况的，保险人不得解除合同；发生保险事故的，保险人应当承担赔偿或者给付保险金的责任。
保险人以投保人违反了对投保单询问表中所列概括性条款的如实告知义务为由请求解除合同的，法院不予支持；但该概括性条款有具体内容的除外。
保险人未行使合同解除权，直接以存在“投保人故意或因重大过失未履行如实告知义务”的情形为由拒绝赔偿的，法院不予支持；但当事人就拒绝赔偿事宜及保险合同存续另行达成一致的情况除外。
[总结] 订立合同时，投保人未如实告知的：
┌─ 故意 ──── 保险人有权解除合同、不赔偿，不退保费
处 理 ──┤
└─ 重大过失 ─ 保险人有权解除合同、不赔偿，退保费
┌─ 明知+收取保费→不可解除
├─ 明知+超过30日→不可解除
解除合同 ─┼─ 合同成立超过2年→不可解除
的 限 制 ├─ 投保人未如实告知概括性条款→不可解除
└─ 不解除合同+直接以未如实告知为由拒绝赔偿→非法
知识点 148 人身保险合同订立时，保险人的说明义务★
订立保险合同时，保险人应当对合同中免除保险人责任的条款如实告知。
1. 保险人如实告知义务的内容
(1) 保险人在订立合同时应当在投保单、保险单或者其他保险凭证上作出足以引起投保人注意的提示；
(2) 对该条款的内容以书面或者口头形式向投保人作出明确说明。
2. 违反如实告知义务的处理
(1) 对上述免责条款，保险人未作提示或者明确说明的，该条款不产生效力；
(2) 保险人对其履行了明确说明义务负举证责任。
（二）人身保险合同的中止、复效
知识点 149 人身保险合同的中止、复效★★
1. 适用前提
人身保险合同约定分期支付保险费，投保人支付首期保险费后，未支付当期保险费。
2. 处理规则
(1) 保险人对人寿保险的保险费，不得用诉讼方式要求投保人支付，且保险人不得收取违约金。
(2) 根据欠缴保险费的时间，按下列规则处理：
[图例]
┌── 宽限期-要赔 ──┬── 中止期-不赔可复效 ──┬── 保险人法定解除期 ──>
30日内 2年 超过2年
(或60日内)
─────────┼──────────────────────┼───────────────────────┼──────────
2020.01.01 2020.03.01 2022.03.01
当期保费日 (大概日期)
投保人未支付当期保险费，被保险人在宽限期内发生保险事故的，保险人应当按照合同约定给付保险金，但可以扣减欠交的保险费。
① 中止期内，投保人提出恢复效力申请并同意补交保险费的，除被保险人的危险程度在中止期间显著增加外，保险人不得拒绝恢复效力；
② 保险人在收到恢复效力申请后，30日内未明确拒绝的，应认定为同意恢复效力；
③ 保险合同自投保人补交保险费之日恢复效力，且保险人可以要求投保人补交相应利息。
【萱站点睛】【易错】同意恢复 ≠ 恢复。保费到位→效力恢复。
① 双方未达成协议的，保险人有权解除合同；
② 保险人解除合同的，应当按照合同约定退还保险单的现金价值。
（三）人身保险合同的解除
知识点 150 投保人的自愿解除权★★
1. 保险合同成立后，投保人可以解除合同，但《保险法》另有规定或者保险合同另有约定的除外。
(1) 保险人应当自收到解除合同通知之日起30日内，向投保人按照合同约定退还保险单的现金价值；
(2) 投保人与被保险人、受益人为不同主体，被保险人或者受益人要求退还保险单的现金价值的，法院不予支持，但保险合同另有约定的除外。
2. 投保人解除保险合同的，无需经被保险人或者受益人同意。
(1) 投保人是签订保险合同的主体，解除合同无需经关系人（被保险人、受益人）同意；
(2) 上述情形，被保险人或者受益人已向投保人支付相当于保险单现金价值的款项并通知保险人的除外。（合同不解除，合同解除权被赎买）
知识点 151 保险人的法定解除权★★
保险合同成立后，除非法律明确规定，保险人不得解除合同。
常见的保险人法定解除的情形包括：①订立保险合同时，投保人故意或者因重大过失未履行如实告知义务，足以影响保险人决定是否同意承保或者提高保险费率的，保险人有权解除合同；②分期支付保险费的人身保险合同，自合同效力中止之日起满2年双方未达成协议的，保险人有权解除合同，并应当按照合同约定退还保险单的现金价值；③投保人申报的被保险人年龄虚假+真实年龄不可保的，保险人可以解除合同，并按照合同约定退还保险单的现金价值；④投保人、被保险人故意制造保险事故的，保险人有权解除合同。
二、受益人制度
知识点 152 受益人指定和变更★★★
1. 概念
(1) 受益人，是指人身保险合同中由被保险人或者投保人指定的享有保险金请求权的人；
(2) 受益人的保险金请求权属于固有权，并非继受而来，因此受益人所应领取的保险金不能作为被保险人的遗产；
(3) 受益人只存在于人身保险合同中。
2. 指定和变更受益人的主体
| 主体 | 规则 |
| 被保险人 | 被保险人可以单独指定或者变更受益人。 |
| 投保人 | (1) 投保人指定或者变更受益人时须经被保险人同意； (2) 未经被保险人同意的，法院应认定指定行为或者变更行为无效； (3) 投保人为与其有劳动关系的劳动者投保人身保险，不得指定被保险人及其近亲属以外的人为受益人。 |
| 监护人 | 被保险人为无民事行为能力人或者限制民事行为能力人的，可以由其监护人指定受益人。 |
[例] 甲公司为员工A购买了“团体意外险”，虽然保险费由甲公司支付，但只能指定A或者A的近亲属为受益人。若A在保险责任期间内发生事故，保险金应由A或者A的近亲属领取。
1. 受益人的变更通知
(1) 投保人或者被保险人变更受益人未通知保险人的，保险人可以主张变更对其不发生效力；
(2) 投保人或者被保险人在保险事故发生后变更受益人的，变更后的受益人不得请求保险人给付保险金。
知识点 153 受益人约定不明的处理★★★
当事人对保险合同约定的受益人存在争议，有约定的，按照约定；没有约定的，按照以下情形分别处理：
| 约定情形 | 内容与处理 | 举例 |
| 受益人约定为“法定”或“法定继承人” | 以《民法典》规定的法定继承人为受益人。 | [例] 张三为自己购买保险金10万元的人身保险，受益人一栏仅写“法定”。后张三身故，唯一的一方法定继承人是妻子大A。张三的遗产总额为0元，但张三欠李四10万元。则：该10万元保险金不是张三的遗产，而是“受益人”大A的个人财产，债权人李四不得要求大A以该10万元保险金来清偿债务。 |
| 受益人仅约定为身份关系 | 同一主体：“为自己，自己死”：投保人与被保险人为同一主体时，根据保险事故发生时与被保险人的身份关系确定受益人。 | [例] 张三的妻子是大A。张三为自己购买人身保险，受益人一栏仅写“配偶”（无姓名）。后二人离婚，张三再婚，现妻子是小a。若张三（被保险人）身故，则：小a（事故发生时的配偶）是受益人，可以拿到保险金。 |
| 不同主体：“为他人，投保时”：投保人与被保险人为不同主体时，根据保险合同成立时与被保险人的身份关系确定受益人。 | [例] 张三为妻子大A购买人身保险，受益人一栏仅写“配偶”（无姓名）。后二人离婚，大A再婚，现丈夫是李四。若大A（被保险人）身故，则：张三（合同成立时的配偶）是受益人，可以拿到保险金。 | |
| 受益人约定为姓名和身份关系 | 保险事故发生时身份关系发生变化的，认定为未指定受益人。 | [例] 张三为自己购买人身保险，受益人一栏写明“妻子大A”（有身份有姓名）。后二人离婚，张三再婚，现妻子是小a。若张三（被保险人）身故，则：该案认定为无受益人，保险金是张三（被保险人）的遗产。 |
知识点 154 受益人先于被保险人死亡的处理★★★
| 受益顺序 | 受益份额 | 处 理 |
| ✕ | ✕ | 受益顺序、受益份额均未约定的，由其他受益人平均享有。 [例] 若无约定，张A（受益人）先于张老伯（被保险人）死亡，则：张A的受益份额由张B、张C、张D平分。 |
| ✓ | ✓ | 约定受益顺序，并约定受益份额的： (1) 由同顺序的其他受益人按照相应比例享有； (2) 同一顺序没有其他受益人的，由后一顺序的受益人按照相应比例享有。 [例] 若约定张A、张B是第一顺序，张C、张D是第二顺序，则：张A的受益份额由同一顺序的张B享有，第二顺序的张C、张D无法分享。 |
| ✕ | ✓ | 未约定受益顺序但约定受益份额的，由其他受益人按照相应比例享有。 [例] 若未约定顺序，视四人为同一顺序；若约定张A的受益份额为40%、张B为25%、张C为20%、张D为15%，则：张B、张C、张D依据比例享有张A的受益份额。 |
| ✓ | ✕ | 约定受益顺序但未约定受益份额的： (1) 由同顺序的其他受益人平均享有； (2) 同一顺序没有其他受益人的，由后一顺序的受益人平均享有。 [例] 若约定张A、张B、张C是第一顺序，张D是第二顺序，则：张A的受益份额由张B、张C平均享有；张D为后一顺序，无权享有。 |
三、人身保险事故的处理
提示 易混概念
1. 保险费：依照保险合同的约定，投保人应缴纳的金额。
2. 保险金：保险事故发生后，保险公司理赔支付的金额。
3. 保险单的现金价值：在保险期限较长的人寿保险中，被保险人要求退保时，保险人从责任准备金中扣除一定量的退保手续费，余额退还给被保险人或者投保人。可以理解为，保险单的现金价值，是指投保人退保能领取的金额。保险合同内部附有现金价值表。需要注意的是，保险单的现金价值 ≠ 保险费 ≠ 保险金。
知识点 155 年龄错误★★
年龄错误，是指投保人申报的被保险人年龄不真实。
| 类 型 | 处 理 | 举 例 |
| 投保人申报的被保险人年龄不真实，并且其真实年龄不符合合同约定的年龄限制 | (1) 保险人可以解除合同，并按照合同约定退还保险单的现金价值。 (2) 下列情况下，保险人不可解除合同： ① 知道或者应当知道投保人未履行如实告知义务，仍然收取保险费的； ② 自保险人知道有解除事由之日起，超过30日不行使合同解除权的； ③ 自合同成立之日起超过2年的。 | 某保险公司开设了一种人寿险，70岁以下的投保人可参加该险种。71岁的张某在向该保险公司投保时谎称自己为69岁。此为“真实年龄（71岁）不符合合同约定的年龄限制（70岁）”。 |
| 投保人申报的被保险人年龄不真实，但其真实年龄符合合同约定的年龄限制 | (1) 保险人不可解除合同； (2) 致使投保人支付的保险费少于应付保险费的，保险人有权更正并要求投保人补交保险费，或者在给付保险金时按照实付保险费与应付保险费的比例支付； (3) 致使投保人支付的保险费多于应付保险费的，保险人应当将多收的保险费退还投保人。 | 某保险公司开设了一种人寿险：投保人逐年缴纳一定保费，至60岁时可获得20万元保险金，保费随起保年龄的增长而增加。41岁的李某精心计算后发现，若从46岁起投保，可最大限度降低保费，遂在向该保险公司投保时谎称自己为46岁。此为“真实年龄（41岁）符合合同约定的年龄限制（60岁）”。 |
知识点 156 死亡险★★
1. 概念
(1) 死亡险，是指投保人以被保险人死亡为给付保险金条件的人身保险合同；
(2) 死亡包括宣告死亡情形；
(3) 被保险人被宣告死亡之日在保险责任期间之外，但有证据证明下落不明之日在保险责任期间之内的，当事人可以要求保险人按照保险合同约定给付保险金。
[例] 2010年，A为自己投保，约定如意外身故，由妻子获得保险金，保险期间为10年。2018年3月1日，A下落不明。2022年4月，法院宣告A死亡。保险公司应当给付保险金。
2. 对投保死亡险的限制
死亡险合同极有可能诱发受益人杀害被保险人的事故。为了降低该类合同的道德风险，保险法对该类合同进行了严格的限制。
| 规则维度 | 具体规定 |
| 原则 | 投保人不得为无民事行为能力人投保以死亡为给付保险金条件的人身保险，保险人也不得承保。 [例] 张三不得为患有精神疾病，不能辨认和控制自己行为的妻子大A购买该类保险。 以死亡为给付保险金条件的合同，未经被保险人同意并认可保险金额的，合同无效。（法院应当主动审查） (1) 被保险人可以采取书面、口头或者其他形式同意；可以在合同订立时作出，也可以在合同订立后追认。 (2) 被保险人明知他人代其签名同意而未表示异议的，视为同意订立保险合同并认可保险金额。 (3) 被保险人同意投保人指定的受益人的，视为同意订立保险合同并认可保险金额。 |
| 例外（父母-未成年子女之间） | (1) 父母可以为其未成年子女投保死亡险，无需经过被保险人同意并认可保险金额。 [例1] 张小三今年22岁，其父是否可以不经张小三同意为其投保死亡险？（不可以。未成年人是指未满18周岁的自然人，张小三不是未成年人。） [例2] 张三为自己的父亲张老三投保死亡险，是否可以不经张老三同意？（不可以。限于“父母为未成年子女”投保。） (2) 因被保险人死亡给付的保险金总和不得超过国务院保险监督管理机构规定的限额。 未成年人父母之外的其他履行监护职责的人不得为未成年人订立以死亡为给付保险金条件的合同；但经未成年人父母同意的除外。 [例] 祖父母不得为未成年的孙子张小三投保含有死亡给付条款的人身保险。 |
| 保险单的转让 | 按照以死亡为给付保险金条件的合同所签发的保险单，未经被保险人书面同意，不得转让或者质押。 |
易错：
(1) 是否同意订立死亡险以及认可保险金额：被保险人可书面同意，也可口头同意；
(2) 死亡险保险单转让或质押：书面同意。
知识点 157 费用补偿型的医疗费用保险★
1. 概念
费用补偿型的医疗费用保险，是指当被保险人因生病治疗产生医疗费用时，被保险人支付医疗费用后，再由保险人事后给付医疗费用保险金的保险。（≈ 事后报销）
2. 和公费医疗、社保的关系
| 纠纷类型 | 处 理 | 举 例 |
| 保险人主张扣减被保险人从公费医疗或社会医疗保险取得的赔偿金额 | (1) 应当证明该保险产品在厘定医疗费用保险费率时已经将公费医疗或社会医疗保险部分相应扣除，并按照扣减后的标准收取保险费； (2) 由保险人承担上述举证责任。 | 被保险人甲治疗时用了某进口消炎药，该药虽然不在基本医疗保险（社保）的报销名单内，但A保险公司对该自费药仍要支付保险金，支付标准按照基本医疗保险药品目录内同类标准支付。 |
| 约定按照基本医疗保险（社保）的标准核定医疗费用 | (1) 被保险人的医疗支出超出基本医疗保险范围的，保险人不得拒绝给付保险金； (2) 被保险人支出的费用超过基本医疗保险同类医疗费用标准的，保险人可以对超出部分拒绝给付保险金。 |
易错：支出超范围，要支付；费用超标准，可拒付。
1. 是否在定点医院接受治疗
(1) 保险人以被保险人未在保险合同约定的医疗服务机构接受治疗为由拒绝给付保险金的，法院应予支持；
(2) 被保险人因情况紧急必须立即就医的除外。
知识点 158 特殊保险事故的处理★★
1. 投保人故意造成被保险人死亡、伤残或者疾病的
(1) 保险人有权解除合同，不承担给付保险金的责任；
(2) 投保人已交足2年以上保险费的，保险人应当按照合同约定向其他权利人退还保险单的现金价值。
2. 受益人故意造成被保险人死亡、伤残、疾病的，或者故意杀害被保险人未遂的
(1) 该受益人丧失受益权，保险人向其他受益人给付保险金；
(2) 没有其他受益人的，保险金作为被保险人的遗产。
【萱站点睛】【易错】A是投保人且是受益人的，若A故意杀害被保险人B，则保险人不给付保险金。
3. 被保险人故意犯罪或者抗拒依法采取的刑事强制措施的
(1) 被保险人因上述行为导致自己伤残或者死亡的，保险人不承担给付保险金的责任；
(2) 投保人已交足2年以上保险费的，保险人应当按照合同约定退还保险单的现金价值；
(3) 保险人主张不承担给付保险金责任的，应当证明被保险人的死亡、伤残结果与其实施的故意犯罪或者抗拒依法采取的刑事强制措施的行为之间存在因果关系；
(4) 被保险人在羁押、服刑期间因意外或者疾病造成伤残或者死亡，保险人应当承担给付保险金的责任。
【萱站点睛】【易错】要区分因果：①因罪而死：不赔；②有罪，但因病或意外而死：赔。
4. 被保险人自杀
以被保险人死亡为给付保险金条件的合同中，被保险人自杀的，要区分情形：
(1) 自合同成立或者合同效力恢复之日起2年内，被保险人自杀的：
| 情形 | 给付责任 | 举证责任 | 举 例 |
| 原则 | (1) 保险人不承担给付保险金的责任； (2) 保险人应当按照合同约定退还保险单的现金价值。 | 保险人以被保险人自杀为由拒绝给付保险金的，由保险人承担举证责任。 | 合同成立2年内，被保险人A因意外坠楼死亡的，保险公司应当给付保险金；但若A系自杀坠楼死亡，则不给付。 |
| 例外 | 被保险人自杀时为无民事行为能力人的，保险人承担给付保险金的责任。 | 受益人或者被保险人的继承人对被保险人自杀时无民事行为能力承担举证责任。 | 合同成立2年内，被保险人A因不能辨别或者控制自己的行为而自杀的，保险公司应当给付保险金。 |
(2) 被保险人2年后自杀：
自合同成立或者合同效力恢复之日起满2年后被保险人自杀的，保险人应当按照合同约定承担给付保险金的责任。
1. 第三者造成的人身保险事故
被保险人因第三者的行为而发生死亡、伤残或者疾病等保险事故的：
(1) 保险人向被保险人或者受益人给付保险金后，不享有向第三者追偿的权利；
(2) 被保险人或者受益人仍有权向第三者请求赔偿；
(3) 保险事故发生后，被保险人或者受益人起诉保险人，保险人以被保险人或者受益人未要求第三者承担责任为由抗辩不承担保险责任的，法院不予支持。
【萱站点睛】【提示】代位求偿权在人身保险中禁止适用。
[例] 甲为其妻购买了一份人身保险。后甲妻患病住院，因医院误诊误治致残。甲向保险公司索赔的同时，可要求医院承担侵权赔偿责任。
知识点 159 保险金的给付★★
人身保险中，被保险人死亡后，保险金按下列规则给付：
| 规则维度 | 对应处理 | 具体说明 |
| 原则 | 保险金不作为被保险人的遗产 | 有合格的受益人时，保险金应当支付给受益人。 |
| 例外 | 保险金作为被保险人的遗产 | (1) 没有指定受益人，或者受益人指定不明无法确定的； (2) 受益人先于被保险人死亡，没有其他受益人的； (3) 受益人依法丧失受益权或者放弃受益权，没有其他受益人的。 继承关系，推定受益人死亡在先：受益人与被保险人存在继承关系，在同一事件中死亡且不能确定死亡先后顺序的，推定受益人死亡在先，并按照保险法的相关规定确定保险金归属。 |
| 请求权的转让 | — | 保险事故发生后，受益人将与本次保险事故相对应的全部或者部分保险金请求权转让给第三人的，该转让行为有效；但根据合同性质、当事人约定或者法律规定不得转让的除外。 |
易错：保险金不是遗产，故推定死亡顺序不是依据《民法典》第1121条第2款的规定，为“辈份不同的，推定长辈先死亡”。
[例] 甲为父亲老甲购买了人身保险，指定其子小甲为受益人。后老甲与小甲在同一事件中死亡，但不能确定二人的死亡先后顺序。则：推定受益人（小甲）死亡在先，而非推定长辈（老甲）先死亡。
21 常考角度总结 SUMMARIZE
1. 理解保险利益原则，掌握人身保险利益的判定。
2. 投保人未如实告知的处理。
3. 受益人的产生及约定不明的处理。
4. 保险合同效力中止期的处理。（复效规则）
5. 人身保险合同能否解除及解除后如何处理。
6. 特殊保险事故的处理。（故意犯罪、自杀、死亡险）
7. 保险金给付给谁及是否作为遗产。
致努力中的你
你知道人类最大的武器是什么吗？
是豁出去的决心。
〔1〕（知识点147对应注释1）概括性条款，如“是否得过其他疾病……”，在法律体系及法律规范中具有“框架搭建”的功能，起到“总括兜底”的作用。
〔1〕（知识点147对应注释2）另外一个例子可供参考：乙在投保前有高血压病史多年，其高血压病表现不稳定，血压忽高忽正常，乙多年来未规律服药，血压未规律监测。乙投保时对“是否患有高血压”作出了否定的回答。保险公司可以“重大过失未如实告知”为由解除保险合同。
专题22《财产保险合同》
以下为《2026商经法鄢梦萱系统精讲》中专题22《财产保险合同》（第175页至第181页）的全部逐字原文内容：
专题22 财产保险合同
一、财产保险事故的处理
财产保险，是指以财产及其有关利益为保险标的的保险。
财产保险合同，是指以特定的财产或者与财产有关的利益为保险标的的，标的物可以转让的合同。
知识点 160 财产保险的理赔规则★
1. 保险利益的认定
(1) 保险利益的成立要件：合法性+经济性+确定性。
| 内 容 | 举 例 | |
| 合法性 | 该种利益必须是法律上承认的利益，即合法的利益。 | 财产的所有人、经营人、保管人、质押权人、抵押权人，对投保财产具有保险利益。 |
| 经济性 | 该种利益必须是经济上的利益，即可以用金钱评估的利益。 | |
| 确定性 | 该种利益必须是可以确定的利益。 |
(2) 保险事故发生时，被保险人对保险标的应当具有保险利益；否则，不得向保险人请求赔偿保险金。
[例] 2020年1月，张三为汽车投保了财产险，后其将该汽车卖给了李四。2020年8月，该汽车发生保险事故，此时，新车主李四对该汽车享有保险利益。原车主张三虽然在订立保险合同时具有保险利益，但保险事故发生时张三不再是所有权人，因此，张三无法得到保险公司的赔偿金。
【易错】
人身保险：保险合同订立时具有保险利益。
1. 保险人赔偿的“双重限制”
【提示】【易混概念】
(1) 保险金额：保险人承担赔偿或者给付保险金责任的最高限额。
(2) 保险价值：投保人和保险人约定保险标的的保险价值并在合同中载明的，保险标的发生损失时，以约定的保险价值为赔偿计算标准；未约定保险价值的，以保险事故发生时保险标的的实际价值为赔偿计算标准。
(3) 赔偿金额：依据保险标的的损失，保险人支付的金额。
(1) 保险人的赔偿金额不得超过保险金额。
(2) 保险金额不得超过保险价值。例如，为新购的汽车购买车险的，车款10万元是该车的保险价值。
❶ 保险金额超过保险价值的，超过部分无效，保险人应当退还相应的保险费；
❷ 保险金额低于保险价值的，除合同另有约定外，保险人按照保险金额与保险价值的比例承担赔偿保险金的责任。
(3) 保险事故发生后，保险人以被保险人或者受益人未要求第三者承担责任为由抗辩不承担保险责任的，法院不予支持。（可直接起诉保险人）
[例] 一套家具的保险价值是10万元，约定的保险金额是3万元。现其发生属于保险责任范围内的损害，定损为4万元。则：保险人的赔偿金额为3/10×4=1.2万元。
1. 由保险人负担的费用
发生财产保险事故后，保险人除了支付损失赔偿金额外，还要负担下列费用：
(1) 保险事故发生后，被保险人为防止或者减少保险标的的损失所支付的必要的、合理的费用。该费用数额在保险标的的损失赔偿金额以外另行计算，最高不超过保险金额的数额。被保险人采取的措施未产生实际效果，保险人以此为由抗辩的，法院不予支持。
[例] 纺织厂组织人员灭火的施救费用为1万元，最终遭受的火灾损失为3万元，保险金额为100万元。则：保险人要支付3+1=4万元。
(2) 保险人、被保险人为查明和确定保险事故的性质、原因和保险标的的损失程度所支付的必要的、合理的费用。
知识点 161 保险标的的转让、危险程度变化★★
1. 保险标的的转让
(1) 保险标的转让的，被保险人或者受让人应当及时通知保险人，但货物运输保险合同和另有约定的合同除外；
(2) 被保险人或者受让人依法及时向保险人发出保险标的的转让通知后，保险人作出答复前，发生保险事故的，保险人应当按照保险合同承担赔偿保险金的责任；
(3) 保险标的的受让人承继被保险人的权利和义务。
2. 受损保险标的的权利的转移
(1) 保险事故发生后，保险人已支付了全部保险金额，并且保险金额等于保险价值的，受损保险标的的全部权利归于保险人；
(2) 保险金额低于保险价值的，保险人按照保险金额与保险价值的比例取得受损保险标的的部分权利。
[例] 栗子为汽车投保财产险，后因突发泥石流导致汽车全损。
(1) 若该汽车的保险价值为10万元，保险金额也为10万元（足额保险），发生事故后保险公司支付给栗子10万元，则该汽车的全部权利均归保险公司；
(2) 若该汽车的保险价值为10万元，保险金额为5万元（不足额保险），发生事故后保险公司支付给栗子5万元（赔偿金额不得超过保险金额），则该汽车1/2的权利归保险公司。
3. 保险标的的危险程度显著增加
| 维度 | 内容 | 举 例 |
| 认定 | 应综合考虑的因素： (1) 保险标的的用途的改变、使用范围的改变、所处环境的变化、因改装等原因引起的变化； (2) 保险标的的使用人或者管理人的改变； (3) 危险程度增加持续的时间； (4) 其他可能导致危险程度显著增加的因素。 不包括“可预见”因素： 不包括“可预见的危险增加”。保险标的的危险程度虽然增加，但增加的危险属于保险合同订立时保险人预见或者应当预见的保险合同承保范围的，不构成危险程度显著增加。 | [例1] 投保车辆的使用性质分为营运和非营运，两种性质的车辆在使用频次、使用范围、所处环境等方面均存在不同，故而保险费率设置亦有显著区别。若被保险车辆以非营运性质投保，持续性从事以获取利润为目的的营运性客运活动，则构成危险程度显著增加。 [例2] 范某有固定职业和收入，其在上下班期间利用顺风车网约平台搭载乘客进行顺风车服务，加入顺风车网约平台的541天内，接单39次，出行17次，危险程度不具有持续性；事故发生日，范某的行驶路径与搭乘乘客路线一致，相同路线不导致危险程度显著增加。 |
| 处理 | 情形1：通知： 被保险人应当按照合同约定及时通知保险人，保险人可以按照合同约定增加保险费或者解除合同。解除合同的，应当将已收取的保险费（扣除应收的部分后）退还投保人。 | |
| 情形2：未通知： 被保险人未履行通知义务的，因保险标的的危险程度显著增加而发生的保险事故，保险人不承担赔偿保险金的责任。 |
1. 保险标的的危险程度明显减少
据以确定保险费率的有关情况发生变化，保险标的的危险程度明显减少的，除合同另有约定外，保险人应当降低保险费，并按日计算退还相应的保险费。
知识点 162 重复保险
1. 概念
重复保险，是指投保人对同一保险标的、同一保险利益、同一保险事故分别与2个以上保险人订立保险合同，且保险金额总和超过保险价值的保险。
2. 处理
(1) 投保人应当将重复保险的有关情况通知各保险人；
(2) 各保险人赔偿保险金的总和不得超过保险价值；
(3) 除合同另有约定外，各保险人按照其保险金额与保险金额总和的比例承担赔偿保险金的责任；
(4) 投保人可以就保险金额总和超过保险价值的部分，请求各保险人按比例返还保险费。
[例] 栗子将汽车向A保险公司和B保险公司投保财产险。该汽车的保险价值为10万元，A保险公司和B保险公司的保险金额也均为10万元。现该汽车全损。则：A保险公司的赔偿金额为10×1/2=5万元，B保险公司的赔偿金额也为5万元。
知识点 163 责任保险★★
1. 概念
责任保险，又称“第三者责任险”，是指以被保险人对第三者依法应负的赔偿责任为保险标的的保险。
(1) 责任保险的标的为一定范围内的侵权损害赔偿责任；
(2) 责任保险不能及于被保险人的人身及其财产。
【原理】
“责任险，保他人”。因为责任保险的目的在于转移被保险人过重的赔偿责任，所以责任保险合同是为第三人的利益而订立的保险合同。
1. 处理
(1) 被保险人给第三者造成损害，被保险人对第三者应负的赔偿责任确定的，根据被保险人的请求，保险人应当直接向该第三者赔偿保险金。
(2) 被保险人怠于请求的，第三者有权就其应获赔偿部分直接向保险人请求赔偿保险金。
(3) 在被保险人向第三者赔偿之前，保险人向被保险人赔偿保险金的：
❶ 第三者就其应获赔偿部分直接向保险人请求赔偿保险金时，保险人不得以其已向被保险人赔偿为由拒绝赔偿保险金；
❷ 保险人向第三者赔偿后，可以请求被保险人返还相应保险金。
[图例] “请求-支付”规则
请求 不请求 怠于请求 才可请求
┌─────────────┐ ┌─────────────┐ ┌─────────────┐ ┌─────────────┐
│ ↓ │ ↓ │ ↓ │ ↓
保险人 ───→ 被保险人 保险人 ───✕──→ 第三人(受害人) 保险人 ───→ 被保险人 保险人 ───→ 第三人(受害人)
│ │
支付保险金 支付保险金 └─────────────┘
图1 被保险人请求情形 图2 被保险人怠于请求情形
【原理】
按照“直接支付”的规则，保险人应当向第三者支付赔偿金，而不是向“被保险人”支付赔偿金。
1. 责任保险的诉讼
(1) 责任保险诉讼中，被保险人支付的仲裁或者诉讼费用以及其他必要的、合理的费用，除合同另有约定外，由保险人承担；
(2) 商业责任险的被保险人向保险人请求赔偿保险金的诉讼时效期间，自被保险人对第三者应负的赔偿责任确定之日起计算。
【随堂小测】
甲参加乙旅行社组织的沙漠一日游，乙旅行社为此向红星保险公司购买了旅行社责任保险。丙客运公司受乙旅行社之托，将甲运送至沙漠，丙公司为此向白云保险公司购买了承运人责任保险。丙公司在运送过程中发生交通事故，致甲死亡，丙公司负事故全责。甲的继承人为丁。在通常情况下，下列哪些表述是正确的？(2012/3/75)〔1〕
A. 乙旅行社有权要求红星保险公司直接对丁支付保险金
B. 丙公司有权要求白云保险公司直接对丁支付保险金
C. 丁有权直接要求红星保险公司支付保险金
D. 丁有权直接要求白云保险公司支付保险金
二、（财产）保险人的代位求偿权
知识点 164 代位求偿权的概念和特征★★★
1. 概念
代位求偿权，是指因第三者对保险标的的损害而造成保险事故的，保险人自向被保险人赔偿保险金之日起，在赔偿金额范围内代位行使被保险人对第三者请求赔偿的权利。
2. “第三者”的范围
(1) 第三者，是指除被保险人与保险人之外，其他造成保险标的的损害的人；
(2) 被保险人的家庭成员或者其组成人员非故意造成保险事故的，保险人不得对被保险人的家庭成员或者其组成人员行使代位请求赔偿的权利；
(3) 投保人和被保险人为不同主体，因投保人对保险标的的损害而造成保险事故的，保险人可以主张代位行使被保险人对投保人请求赔偿的权利，但法律另有规定或者保险合同另有约定的除外。
[例1] 张某为自己的设备投保财产险后，张某的儿子不慎造成该设备损坏。此时，保险公司赔偿后，不得向张某的儿子代位求偿。但是，如果张某的儿子故意损坏该设备，则保险公司向张某赔偿后仍可向张某的儿子代位求偿。
[例2] 甲园区为进驻本园区的所有小企业向A保险公司投保财产火灾险。现甲园区因管理不善发生火灾，烧毁小企业的财产。此时，甲园区是“投保人+侵权人”，小企业是被保险人，A保险公司向小企业（被保险人）赔偿保险金。由于侵权人是甲园区（投保人），因此，A保险公司赔偿后，可向甲园区代位求偿。
3. 对“损害”的理解
(1) 第三者“损害”保险标的的行为，既包括侵权行为，也包括违约行为；
(2) 保险人主张代位行使被保险人因第三者侵权或者违约等享有的请求赔偿的权利的，法院应予支持。
[例] A公司准备整体搬迁，遂和甲公司签订厂房整体搬迁和安装合同，并约定“承包人（甲公司）不得将本工程进行分包”。A公司就此搬迁向B保险公司投保“安装工程一切险”。现有一台设备需要运输，甲公司委托当地的乙运输公司负责运输。在乙运输公司运输时，该设备滑落，造成货损100万元。B保险公司向A公司（被保险人）赔偿后，仅向甲公司（违约方）主张代位求偿权，该诉讼请求得到了法院的支持。
知识点 165 代位求偿权的诉讼，放弃求偿权、获得双份赔偿/部分赔偿的处理★★★
1. 代位求偿权的诉讼
(1) 保险人应以自己的名义行使保险代位求偿权；
(2) 保险人自向被保险人赔偿保险金之日起，在赔偿金额范围内代位行使被保险人对第三者请求赔偿的权利；
(3) 保险人代位求偿权的诉讼时效期间应自其取得代位求偿权之日起计算；
(4) 保险人提起代位求偿权之诉的，以被保险人与第三者之间的法律关系确定管辖法院。
[例1] 保险事故发生日是1月1日，被保险人于当日通知保险公司，保险公司定损后的赔偿日期是1月10日，则保险人向第三者主张代位求偿权的诉讼时效期间自1月10日开始计算，因为自赔偿之日起且在赔偿金额范围内，保险人享有“代位求偿权”。
[例2] 栗子向平安保险公司投保车险。现栗子在驾驶途中被李某驾驶的车辆追尾，李某负事故全责。事故发生地为甲市A区，该被保险车辆登记地为甲市B区，李某的住所地为乙市C区。平安保险公司向栗子赔偿保险金后，向李某提起代位求偿权诉讼。此时，甲市A区法院和乙市C区法院有管辖权，因为栗子和李某之间是侵权法律关系，管辖法院为侵权行为发生地或被告住所地法院。
2. 放弃代位求偿权的处理
| 类别 | 情形 | 处理 |
| 订立前放弃 | 保险合同订立前，被保险人放弃对第三者的求偿权的 | (1) 法院认定上述放弃行为合法有效的，保险人不得就相应部分主张行使代位求偿权。即保险人向被保险人赔偿后，不可向第三者追偿。 (2) 保险合同订立时，保险人询问是否存在上述放弃情形，投保人未如实告知，导致保险人不能代位行使请求赔偿的权利的，保险人可以请求“被保险人”返还相应保险金；但保险人不可向第三者追偿。 (3) 投保人未如实告知，但保险人知道或者应当知道上述情形仍同意承保的，不可请求“被保险人”返还相应保险金，也无代位求偿权。 |
| 赔偿前放弃 | 保险人赔偿保险金前，被保险人放弃的 | 保险事故发生后，保险人未赔偿保险金之前，被保险人放弃对第三者请求赔偿的权利的，保险人不承担赔偿保险金的责任。 |
| 赔偿后放弃 | 保险人赔偿保险金后，被保险人放弃的 | 保险人向被保险人赔偿保险金后，被保险人未经保险人同意放弃对第三者请求赔偿的权利的，该（放弃）行为无效。 |
[例] 甲快餐公司和B运输公司签订运输合同，约定如果每车货损超过1000元，B运输公司承担赔偿责任；对1000元以下的货损，B运输公司不承担赔偿责任。之后，甲快餐公司就全部财产向A保险公司投保。某次运输中，因B运输公司冷冻车设备故障，造成甲快餐公司配送的盒饭变质。该车货损为800元。
则：A保险公司依据保险合同向甲快餐公司赔偿保险金，但A保险公司无权向B运输公司代位求偿，因为在甲快餐公司和A保险公司签订保险合同之前，甲快餐公司已经在运输合同中放弃了对B运输公司的求偿权。
1. 获得双份赔偿的处理
保险人获得代位请求赔偿权后（即保险人已经向被保险人赔偿），第三者又向被保险人赔偿的，此时，被保险人得到双份赔偿。而基于财产保险的“填补原则”，被保险人只能就其保险标的的损失获得赔偿，不能获得额外的利益。对此，应当分两种情况处理：
2. 获得部分赔偿的处理
(1) 保险事故发生后，被保险人已经从第三者取得损害赔偿的，保险人赔偿保险金时，可以相应扣减被保险人从第三者已取得的赔偿金额；
(2) 保险人行使代位请求赔偿的权利，不影响被保险人就未取得赔偿的部分向第三者请求赔偿的权利。
22 常考角度总结 SUMMARIZE
1. 保险标的的危险程度变化的处理。
2. 责任保险的“请求-支付”规则及诉讼问题。
3. 第三者造成财产事故的处理（代位求偿权）。其又可细分为： (1) 保险人能否向第三者追偿？在哪些情况下，第三者可以拒绝？ (2) 代位求偿权的诉讼时效如何计算？ (3) 保险人行使代位求偿权的，应向哪个法院提起诉讼？ (4) 第三者部分赔偿的，保险人是否要支付赔偿金？ (5) 被保险人放弃对第三者的求偿的，保险人是否要支付赔偿金？
致努力中的你
只要在路上，
就没有到不了的远方。
〔1〕 AB。C、D选项错误，本题中未出现“乙旅行社、丙客运公司怠于请求”的情形，所以第三者（丁）无权直接要求保险公司支付保险金。
专题21《人身保险》
专题21 人身保险
考点 64 保险利益、订立合同投保人的如实告知义务、保险人的说明义务
第1题 甲为自己投保一份以死亡为给付保险金的人身保险合同，在体检时发现自己患有不能承保的慢性疾病，保险公司业务员乙知情后，仍然想办法为甲办理了该保险并收取了保险费，受益人栏目中注明“法定”，未约定受益的顺序和份额。一年后，甲发病身亡，法定继承人为其妻子和儿子。下列说法正确的是：(2019-回忆版-单)
A 受益人约定为“法定”，该受益人的指定无效
B 保险赔偿金由甲的妻子和儿子平均分配
C 甲未履行如实告知义务，保险公司可以解除合同
D 保险公司无需给付保险赔偿金
第2题 甲在工地承接工程，雇用自己的表弟乙干活，并为其购买了人身意外险，指定受益人为乙妻。乙对此知情但未提出异议。后乙离职，离职当天遭遇车祸死亡。甲和乙妻均向保险公司申请理赔。据此，下列说法正确的是：(2022-回忆版-单)
A 甲是乙的表哥，故对乙具有保险利益
B 乙已经离职，故保险公司无需赔付保险金
C 乙未提出异议，故乙妻可以申请理赔
D 该保险合同无效，故甲和乙妻均不能申请理赔
第3题 2019年6月，甲陪丈夫乙去做常规体检，体检报告单上写有“整体未见明显异常，疑似甲状腺有结节状，建议进一步检查”。2020年3月，甲为乙购买医疗健康险，投保单询问表上明确写有“被保险人是否有肿瘤、甲状腺或甲状旁腺等疾病？若有，则不予提供保险”。甲填了“否”。后乙患甲状腺癌去世，甲申请保险理赔。据此，下列哪一选项是正确的？(2022-回忆版-单)
A 因保险公司未明确询问被保险人是否患有甲状腺疾病，故应当承担赔偿责任
B 保险公司有权以存在重大误解为由撤销合同，并返还保险费
C 保险公司有权解除保险合同，并退还保险费
D 保险公司有权解除保险合同，无需退还保险费
考点 65 人身保险合同的中止、复效、解除
第4题 2005年，甲和保险公司约定为其妻子乙投保重疾险，保险合同约定，交费期间为20年，保险金为30万元。甲依据保险合同按期交纳了10年保费。因经济困难，2015年8月以后不再交纳保费，保险公司催缴无果。2016年2月，乙检查出肝癌，住院期间花费医疗费共计60万元。甲向保险公司提出补交保费并申请赔偿。下列哪一选项是正确的？(2021-回忆版-单)
A 保险公司应当按约定支付保险金30万元
B 保险公司应当按实际医疗费支付赔偿金60万元
C 保险公司在收到甲提出的恢复保险合同效力申请后，30日内未明确拒绝的，应认定为同意恢复合同效力
D 因甲未支付当期保险费，保险公司有权解除保险合同
第5题 甲为其妻乙投保人身保险，受益人是其子丙。保险合同成立后，因为甲所任职公司裁员，甲不想再缴纳保费，于是提出解除该保险合同。据此，下列哪一选项是正确的？(2021-回忆版-单)
A 甲可以解除保险合同，但需要经被保险人乙同意
B 甲可以解除保险合同，但需要经受益人丙同意
C 保险合同解除后，甲可以领取保险单的现金价值
D 保险合同解除后，丙可以领取保险单的现金价值
第6题 张某和甲公司签订劳动合同，负责清洁工作。2023年9月1日，甲公司为张某投保意外伤害险，保险期间为1年，保险费按月支付。张某口头同意，并指定其妻为受益人。2024年1月1日，甲公司停止支付保险费。2024年3月1日，张某在进行高空清洁工作中发生意外不幸身亡。2024年3月10日，张某的妻子向保险公司主张理赔。对此，下列说法正确的是：(2024-回忆版-单)
A 保险公司有权按照合同约定的条件减少保险金额
B 保险公司应当向张某的妻子给付保险金，但可以扣减欠交的保险费
C 甲公司未经张某书面同意，无权解除保险合同
D 甲公司欠交保险费，保险公司有权解除保险合同
考点 66 受益人（指定、变更、约定不明的处理）
第7题 甲为他的妻子投保以死亡为给付条件的人身保险，受益人是甲。在保险责任存续期间，甲欲毒害妻子，但妻子被救活。后甲妻因精神受到刺激，某日精神恍惚，不慎掉进河里溺水身亡。随后，甲通知保险公司变更受益人为甲母。对此，下列哪一表述是正确的？(2020-回忆版-单)
A 甲变更甲母为受益人，保险人不可拒绝
B 甲订立该份保险合同的保险金额要经甲妻同意
C 甲是受益人，有权主张保险金
D 甲母是受益人，有权主张保险金
第8题 2020年初，高某为妻子方某投保了个人身保险，保险合同约定，如果方某60岁前意外死亡，则保险公司需赔偿100万元，指定方某的母亲作为唯一受益人。2020年4月，高某与方某的孩子小高出生。2021年1月，方某的母亲去世。不久后，高某未告知方某便将受益人改为小高。2021年4月，方某因车祸死亡（方某无其他亲属）。关于本案，下列哪些说法是正确的？(2023-回忆版-多)
A 受益人更改无效，因为小高是无民事行为能力人
B 受益人更改无效，因为未经方某同意
C 保险金应当由高某和小高均分
D 保险金应当支付给方某母亲的继承人
考点 67 特殊人身保险事故的处理（年龄错误、死亡险、自杀、故意犯罪等）
第9题 杨某为其妻王某购买了某款人身保险，该保险除可获得分红外，还约定若王某意外死亡，则保险公司应当支付保险金20万元。关于该保险合同，下列哪一说法是正确的？(2016/3/34-单)
A 若合同成立2年后王某自杀，则保险公司不支付保险金
B 王某可让杨某代其在被保险人同意处签字
C 经王某口头同意，杨某即可将该保险单质押
D 若王某为无民事行为能力人，则无需经其同意该保险合同即有效
第10题 李某于2000年为自己投保，约定如其意外身故则由妻子王某获得保险金20万元，保险期间为10年。2009年9月1日起李某下落不明，2014年4月法院宣告李某死亡。王某起诉保险公司主张该保险金。关于本案，下列哪些选项是正确的？(2017/3/76-多)
A 保险合同应无效
B 王某有权主张保险金
C 李某死亡日期已超保险期间，故保险公司不承担保险责任
D 如李某确系2009年9月1日下落不明，则保险公司应承担保险责任
第11题 陈某为妻子方某投保以死亡为给付条件的人身保险，指定儿子陈小某为受益人，投保时陈某未告知方某。保险公司回访时，方某口头表示知情并认可保险金额。2017年，陈某与方某离婚，陈小某由方某抚养。2018年2月，方某带陈小某外出时，发生意外事故，方某和陈小某双双遇难，无法确定死亡先后顺序。关于本案，下列哪一说法是正确的？(2018-回忆版-单)
A 投保时未征得方某书面同意，该保险合同无效，保险公司无需承担赔偿责任
B 保险合同有效，陈小某的继承人继承保险赔偿金
C 保险合同有效，方某的继承人继承保险赔偿金
D 保险合同有效，保险赔偿金应当支付给陈某
专题22《财产保险合同》
专题22 财产保险
考点 68 保险标的的转让、危险程度变化
第12题 甲运输公司购买了一辆客车用于跨城镇运输，并为其投保了车辆财产险。后因运输行情不佳，甲运输公司将车卖给了蔚蓝公司，该车已经交付但未办理过户登记。蔚蓝公司将该车作为通勤班车，接送市内员工上下班。现在上下班途中发生车祸。经查，该车尚在保险责任期间，但双方均未将车辆转让情况通知保险公司。对此，下列哪些说法是正确的？(2021-回忆版-多)
A 该车辆转让没有经过保险公司同意，保险公司可以解除合同
B 蔚蓝公司可以以改变用途为由要求降低保费
C 保险公司应当承担给付保险金的责任
D 保险公司可以以车辆没有办理过户手续为由拒绝向蔚蓝公司赔偿
第13题 甲为自己的私家车投保商业车辆财产险。后甲把车借给了乙用于开网约车，甲对此知情。乙在开车的时候不小心掉进了河里，造成车损10万元。甲向保险公司索赔，保险公司调查后拒赔。关于本案，下列哪一选项是正确的？(2022-回忆版-单)
A 保险合同无效
B 保险公司不承担赔偿保险金的责任
C 保险公司有权解除保险合同并不退还保险费
D 甲有权主张约定的保险金
第14题 甲花50万元买了一辆高档摩托车并投保了财产损失险，后甲花2万元对摩托车进行改装升级，改装后速度比之前大大提升，但甲未将改装事宜告知保险公司。在保险责任期间，甲驾驶该摩托车发生车祸，导致车辆损坏。现甲向保险公司主张赔偿。下列哪一说法是正确的？(2023-回忆版-单)
A 就这次保险事故，保险公司可以拒绝赔付
B 就这次保险事故，保险公司必须先解除保险合同，然后才能拒绝赔付
C 就这次保险事故，保险公司应当赔偿50万元的损失
D 就这次保险事故，保险公司有权解除保险合同并不退还保险费
第15题 2023年7月，王某为自己的私家车向甲保险公司投保机动车综合商业险（非营运）。2024年1月6日，王某将该车出售给乙汽车租赁公司，同日签订买卖合同，并约定于1月8日办理过户登记。当日，乙公司将该车租赁给周某。1月7日，周某在驾驶该车游玩时发生交通事故，周某承担全部责任，车辆损失5万元。1月30日，王某通知甲保险公司该车转让事宜，并主张赔偿车辆损失。针对该次事故，下列说法正确的是：(2024-回忆版-多)
A 甲保险公司不可拒绝赔偿，但有权要求增加保险费
B 甲保险公司有权拒绝赔偿
C 因该车已经交付给乙公司，乙公司可以行使被保险人的权利
D 因该车尚未办理过户登记，乙公司无权行使被保险人的权利
【English Version】
Commercial and Economic Law
Topic 21: Personal Insurance
Topic 22: Property Insurance Contracts
The following is the full verbatim text of Topic 21, "Personal Insurance", from the 2026 Commercial and Economic Law Systematic Lecture Series by Yan Mengxuan (pp. 163–174):
Topic 21 Personal Insurance
I. Personal Insurance Contracts
(1) Formation of Personal Insurance Contracts
Knowledge Point 145 Characteristics of Personal Insurance Contracts
A personal insurance contract is an insurance contract under which a person's life and body are the subject matter insured. Personal insurance contracts may be divided into life insurance contracts, accident insurance contracts, and health insurance contracts. A personal insurance contract has the following two characteristics:
1. Payment of insurance proceeds in a fixed amount
Where an agreed insured event occurs, the insurer shall pay insurance proceeds to the insured or the beneficiary in accordance with the insurance terms.
2. Savings character
In theory, a personal insurance contract is not a creditor–debtor relationship; its nature is that of a savings-and-investment legal relationship. It stores a portion of present income by means of insurance, to be used in case of urgent need or in old age. Therefore, where the policyholder fails to pay premiums as agreed, it is presumed that the policyholder has abandoned this "savings and investment" method of insurance. Accordingly, the insurer may not require the policyholder to bear liability for breach of contract, nor may it demand payment of premiums by way of litigation.
Knowledge Point 146 At the Formation of a Personal Insurance Contract, an Insurable Interest Is Required ★★★
Insurable interest means an interest, recognised by law, that the policyholder or the insured has in the subject matter insured.
In personal insurance, the object of insurable interest and the rules for determining it are as follows:
| Dimension | Content | Examples |
| Object of insurable interest (prescribed by statute) | General rule: The policyholder has an insurable interest in the following persons: (1) himself or herself; (2) his or her spouse, children, and parents; (3) other family members and close relatives who have a relationship of support, maintenance, or upbringing with the policyholder; (4) employees who have a labour relationship with the policyholder. | [Example] Does the policyholder have an insurable interest in the following persons? (1) A neighbour with whom the policyholder has a close relationship; (no) (2) A former wife who has divorced the policyholder but still lives with him; (no) (3) A business partner with whom the policyholder operates a partnership; (no) (4) The policyholder's cousin. (No, there is no relationship of support, maintenance, or upbringing.) |
| Exception: Apart from the persons listed above, where the insured consents to the policyholder's entering into a contract for the insured, the policyholder shall be deemed to have an insurable interest in the insured. | ||
| Court's ex officio review: When hearing a dispute over a personal insurance contract, the court shall, on its own initiative, examine whether the policyholder had an insurable interest when entering into the insurance contract. | ||
| Determination of insurable interest | (1) A personal insurance contract requires an insurable interest at the time of its formation. ① Where, at the time of formation, the policyholder has no insurable interest in the insured, the contract is invalid; ② The policyholder may claim a refund of the premiums paid, less the corresponding handling charges. (2) Where, after the formation of the insurance contract, the policyholder loses his or her insurable interest in the insured, the insurance contract remains valid. | [Example] Zhang insures his wife A under a personal insurance contract with an insurance period of 10 years. The two later divorce, and A subsequently dies. Although the two were already divorced when the insured event occurred, they were husband and wife when the insurance contract was formed and there was a lawful insurable interest; therefore, the insurance contract is valid and the insurer must pay the insurance proceeds. |
Knowledge Point 147 At the Formation of a Personal Insurance Contract, the Policyholder's Duty of Disclosure ★★★
1. Content of the policyholder's duty of disclosure
When forming a personal insurance contract, the policyholder shall make truthful disclosure of:
(1) At the time the insurance contract is formed, matters known to the policyholder relating to the subject matter insured or the insured fall within the scope of matters that "shall be truthfully disclosed".
(2) The policyholder's duty of disclosure is limited to the scope and content of the insurer's enquiries. China adopts "disclosure upon enquiry": the policyholder answers the questions asked by the insurer, and has no duty to disclose matters about which the insurer has not enquired.
The scope of the policyholder's truthful disclosure: "Do not answer what is not asked; answer everything that is asked."
(3) Where the parties dispute the scope and content of the enquiries, the insurer bears the burden of proof.
(4) Where the policyholder has failed to make truthful disclosure in respect of a general clause [1] listed in the proposal form's questionnaire, the insurer may not rescind the contract; except where such general clause has specific content.
(5) Where, at the formation of the insurance contract, the insured undergoes a medical examination at a designated medical service institution at the insurer's request, and a party asserts that the policyholder's duty of disclosure is thereby discharged, the court shall not support such assertion.
(6) Where the insurer knows the results of the insured's medical examination and still seeks to rescind the contract on the ground that the policyholder failed to make truthful disclosure of the relevant circumstances, the court shall not support it.
2. Consequences of the policyholder's breach of the duty of disclosure
| Type | Dimension | Consequence | Example |
| Intentional failure to make truthful disclosure | Contract | Where the policyholder intentionally fails to perform the duty of truthful disclosure, to an extent sufficient to affect the insurer's decision whether to agree to underwrite or to raise the premium rate, the insurer is entitled to rescind the contract. | [Example] A underwent coronary artery bypass surgery 2 years ago, but when filling in the proposal form and answering the insurance company's relevant enquiries, A failed to make truthful disclosure in each case. Coronary artery bypass surgery is major surgery, and A's conduct constitutes "intentional failure to make truthful disclosure". |
| Premium | The insurer shall not be liable to pay compensation or insurance proceeds in respect of an insured event occurring before the rescission of the contract, and shall not refund the premium. | ||
| Failure to make truthful disclosure through gross negligence | Contract | Where the policyholder fails to perform the duty of truthful disclosure through gross negligence, to an extent sufficient to affect the insurer's decision whether to agree to underwrite or to raise the premium rate, the insurer is entitled to rescind the contract. | [Example] In June 2019, B's routine medical examination report stated "no obvious abnormality overall; suspected nodular thyroid, further examination at a hospital recommended", but B did not undergo further examination. In March 2020, B purchased medical and health insurance; the proposal form questionnaire expressly stated "whether the insured has any tumour, thyroid, or parathyroid disease; if so, cover will not be provided", and B answered "No". B's conduct constitutes "failure to make truthful disclosure through gross negligence". [1] |
| Premium | Where the failure has a serious effect on the occurrence of the insured event, the insurer shall not be liable to pay compensation or insurance proceeds in respect of an insured event occurring before the rescission of the contract, but shall refund the premium. |
ℹ Memory aid:
(1) Intentional failure to make truthful disclosure: rescind the contract + no payment + no refund;
(2) Failure to make truthful disclosure through gross negligence: rescind the contract + no payment + refund required.
1. Limitations on the insurer's statutory right of rescission described above
Where, after the formation of the insurance contract, the insurer knows or ought to know that the policyholder has failed to perform the duty of truthful disclosure and still collects the premium, it may not claim to rescind the contract on the ground that "the policyholder failed to make truthful disclosure".
Where the policyholder failed to make truthful disclosure when entering into the contract, the insurer's right to rescind the contract extinguishes if it is not exercised within 30 days from the date on which the insurer knew of the ground for rescission.
Where the policyholder failed to make truthful disclosure when entering into the contract, the insurer may not rescind the contract after 2 years have elapsed from the date of its formation.
Where the insurer already knew of the policyholder's failure to make truthful disclosure at the time the contract was formed, the insurer may not rescind the contract; where an insured event occurs, the insurer shall bear liability for compensation or payment of insurance proceeds.
Where the insurer requests rescission of the contract on the ground that the policyholder breached the duty of truthful disclosure in respect of a general clause listed in the proposal form's questionnaire, the court shall not support the request; except where such general clause has specific content.
Where the insurer, without exercising its right to rescind the contract, directly refuses to pay compensation on the ground that there is a case of "intentional or grossly negligent failure by the policyholder to perform the duty of truthful disclosure", the court shall not support it; except where the parties have separately reached agreement on the refusal of payment and the continuation of the insurance contract.
[Summary] Where, at the time of formation, the policyholder failed to make truthful disclosure:
┌─ Intentional ──── The insurer is entitled to rescind the contract, not to pay compensation, and not to refund the premium Consequences ──┤ └─ Gross negligence ─ The insurer is entitled to rescind the contract, not to pay compensation, but to refund the premium ┌─ Knowledge + collection of premium → no rescission ├─ Knowledge + more than 30 days elapsed → no rescission Limitations on ─┼─ More than 2 years since formation of the contract → no rescission rescission ├─ Policyholder's failure to make truthful disclosure of a general clause → no rescission └─ No rescission of the contract + direct refusal of payment on the ground of failure to make truthful disclosure → unlawful
Knowledge Point 148 At the Formation of a Personal Insurance Contract, the Insurer's Duty of Explanation ★
When forming an insurance contract, the insurer shall truthfully inform the policyholder of the clauses exempting the insurer from liability.
1. Content of the insurer's duty of truthful disclosure
(1) At the time of formation, the insurer shall, on the proposal form, the insurance policy, or other insurance certificate, make a prominent indication sufficient to draw the policyholder's attention;
(2) It shall explain the content of such clauses to the policyholder in written or oral form.
2. Consequences of breach of the duty of truthful disclosure
(1) In respect of the above exemption clauses, where the insurer has failed to give a prominent indication or a clear explanation, the clause shall have no effect;
(2) The insurer bears the burden of proving that it has performed its duty of clear explanation.
(2) Suspension and Reinstatement of Personal Insurance Contracts
Knowledge Point 149 Suspension and Reinstatement of Personal Insurance Contracts ★★
1. Prerequisites for application
The personal insurance contract provides for payment of premiums in instalments; the policyholder has paid the first instalment but has failed to pay the current instalment.
2. Rules on handling
(1) The insurer may not demand payment of life insurance premiums by way of litigation, and the insurer may not collect liquidated damages.
(2) The following rules apply according to the length of time during which premiums are in arrears:
[Diagram]
┌── Grace period — payment required ──┬── Suspension period — no payment, reinstatement possible ──┬── Insurer's statutory rescission period ──> 30 days 2 years More than 2 years (or 60 days) ─────────┼──────────────────────┼───────────────────────┼────────── 2020.01.01 2020.03.01 2022.03.01 Current premium due date (approximate dates)
Where the policyholder has failed to pay the current premium, and the insured event occurs in respect of the insured during the grace period, the insurer shall pay the insurance proceeds in accordance with the contract, but may deduct the premiums in arrears.
Effect of the contract: Where the policyholder has failed to pay the current premium, the effect of the contract is suspended, or the insurer may reduce the sum insured in accordance with the conditions agreed in the contract. Rules on reinstatement:
① During the suspension period, where the policyholder applies for reinstatement and agrees to make up the premiums, the insurer may not refuse reinstatement except where the degree of risk of the insured has increased significantly during the suspension period;
② Where the insurer fails to expressly refuse within 30 days after receiving the application for reinstatement, it shall be deemed to have consented to reinstatement;
③ The insurance contract resumes effect from the date on which the policyholder makes up the premiums, and the insurer may require the policyholder to make up the corresponding interest.
Consent to reinstatement ≠ reinstatement. Payment of the premium in place → effect is restored.
① Where the parties have not reached agreement, the insurer is entitled to rescind the contract;
② Where the insurer rescinds the contract, it shall refund the cash value of the insurance policy in accordance with the contract.
(3) Rescission of Personal Insurance Contracts
Knowledge Point 150 The Policyholder's Voluntary Right of Rescission ★★
1. After the formation of the insurance contract, the policyholder may rescind the contract, except where the Insurance Law provides otherwise or the insurance contract provides otherwise.
(1) The insurer shall, within 30 days from the date of receiving the notice of rescission, refund to the policyholder the cash value of the insurance policy in accordance with the contract;
(2) Where the policyholder and the insured or beneficiary are different persons, and the insured or beneficiary requests a refund of the cash value of the insurance policy, the court shall not support the request, except where the insurance contract provides otherwise.
2. The policyholder's rescission of the insurance contract requires no consent from the insured or the beneficiary.
(1) The policyholder is the party who entered into the insurance contract, and rescission requires no consent from the related persons (the insured, the beneficiary);
(2) Except where the insured or the beneficiary has paid to the policyholder an amount equivalent to the cash value of the insurance policy and has notified the insurer. (The contract is not rescinded; the right of rescission has been bought out.)
Knowledge Point 151 The Insurer's Statutory Right of Rescission ★★
After the formation of the insurance contract, the insurer may not rescind the contract unless the law expressly so provides.
Common cases of statutory rescission by the insurer include: ① at the formation of the insurance contract, the policyholder intentionally or through gross negligence failed to perform the duty of truthful disclosure, to an extent sufficient to affect the insurer's decision whether to agree to underwrite or to raise the premium rate, in which case the insurer is entitled to rescind the contract; ② under an instalment-premium personal insurance contract, where 2 years have elapsed from the date on which the effect of the contract was suspended and the parties have not reached agreement, the insurer is entitled to rescind the contract and shall refund the cash value of the insurance policy in accordance with the contract; ③ where the age of the insured as declared by the policyholder is false and the true age is uninsurable, the insurer may rescind the contract and refund the cash value of the insurance policy in accordance with the contract; ④ where the policyholder or the insured intentionally causes an insured event, the insurer is entitled to rescind the contract.
II. The Beneficiary System
Knowledge Point 152 Designation and Change of Beneficiaries ★★★
1. Concept
(1) A beneficiary means a person designated by the insured or the policyholder in a personal insurance contract who enjoys the right to claim insurance proceeds;
(2) The beneficiary's right to claim insurance proceeds is an original right, not one derived by succession; therefore, the insurance proceeds receivable by the beneficiary cannot form part of the insured's estate;
(3) Beneficiaries exist only in personal insurance contracts.
2. Parties who may designate and change a beneficiary
| Party | Rule |
| The insured | The insured may designate or change a beneficiary on his or her own. |
| The policyholder | (1) When the policyholder designates or changes a beneficiary, the consent of the insured is required; (2) Without the consent of the insured, the court shall find the designation or change invalid; (3) Where the policyholder insures employees with whom he or she has a labour relationship under personal insurance, the policyholder may not designate as beneficiary any person other than the insured and the insured's close relatives. |
| Guardian | Where the insured is a person without capacity for civil conduct or with limited capacity for civil conduct, his or her guardian may designate a beneficiary. |
[Example] Company A purchased "group accident insurance" for its employee A. Although the premiums were paid by Company A, it may designate only A or A's close relatives as beneficiary. If A suffers an accident during the period of cover, the insurance proceeds shall be received by A or A's close relatives.
1. Notice of change of beneficiary
(1) Where the policyholder or the insured changes a beneficiary without notifying the insurer, the insurer may assert that the change has no effect as against it;
(2) Where the policyholder or the insured changes a beneficiary after the occurrence of the insured event, the beneficiary as changed may not claim insurance proceeds from the insurer.
Knowledge Point 153 Handling Where the Beneficiary Is Not Clearly Agreed ★★★
Where the parties dispute the beneficiary agreed in the insurance contract, the agreement shall prevail if there is one; if there is none, the following cases shall be handled separately:
| Circumstances of the agreement | Content and handling | Example |
| Beneficiary agreed as "statutory" or "statutory heir" | The statutory heirs as provided in the Civil Code shall be the beneficiaries. | [Example] Zhang San purchases personal insurance with insurance proceeds of 100,000 yuan for himself, writing only "statutory" in the beneficiary column. After Zhang San's death, his only statutory heir is his wife, Da A. Zhang San's total estate is 0 yuan, but Zhang San owes Li Si 100,000 yuan. Then: the 100,000 yuan of insurance proceeds is not Zhang San's estate, but the personal property of the beneficiary Da A, and the creditor Li Si may not require Da A to use the 100,000 yuan of insurance proceeds to repay the debt. |
| Beneficiary agreed only by identity relationship | Same person: "for oneself, oneself dies": Where the policyholder and the insured are the same person, the beneficiary is determined by the identity relationship with the insured at the time the insured event occurs. | [Example] Zhang San's wife is Da A. Zhang San purchases personal insurance for himself, writing only "spouse" (no name) in the beneficiary column. The two later divorce, and Zhang San remarries; his present wife is Xiao a. If Zhang San (the insured) dies, then: Xiao a (the spouse at the time of the event) is the beneficiary and may receive the insurance proceeds. |
| Different persons: "for another, at the time of formation": Where the policyholder and the insured are different persons, the beneficiary is determined by the identity relationship with the insured at the time the insurance contract was formed. | [Example] Zhang San purchases personal insurance for his wife Da A, writing only "spouse" (no name) in the beneficiary column. The two later divorce, and Da A remarries; her present husband is Li Si. If Da A (the insured) dies, then: Zhang San (the spouse at the time the contract was formed) is the beneficiary and may receive the insurance proceeds. | |
| Beneficiary agreed by name and identity relationship | Where the identity relationship changes at the time the insured event occurs, it is deemed that no beneficiary has been designated. | [Example] Zhang San purchases personal insurance for himself, writing "wife Da A" (with both identity and name) in the beneficiary column. The two later divorce, and Zhang San remarries; his present wife is Xiao a. If Zhang San (the insured) dies, then: the case is deemed to have no beneficiary, and the insurance proceeds are the estate of Zhang San (the insured). |
Knowledge Point 154 Handling Where a Beneficiary Dies Before the Insured ★★★
| Order of benefit | Share of benefit | Handling |
| ✕ | ✕ | Where neither the order of benefit nor the share of benefit is agreed, the other beneficiaries shall share equally. [Example] If there is no agreement, and Zhang A (a beneficiary) dies before Old Zhang (the insured), then: Zhang A's share of the benefits shall be shared equally by Zhang B, Zhang C, and Zhang D. |
| ✓ | ✓ | Where both the order of benefit and the share of benefit are agreed: (1) It shall be enjoyed by the other beneficiaries of the same order in the corresponding proportions; (2) Where there is no other beneficiary of the same order, it shall be enjoyed by the beneficiaries of the next order in the corresponding proportions. [Example] If it is agreed that Zhang A and Zhang B are of the first order, and Zhang C and Zhang D are of the second order, then: Zhang A's share of the benefits shall be enjoyed by Zhang B of the same order, and Zhang C and Zhang D of the second order cannot share it. |
| ✕ | ✓ | Where the order of benefit is not agreed but the share of benefit is agreed, it shall be enjoyed by the other beneficiaries in the corresponding proportions. [Example] If no order is agreed, the four persons are treated as being of the same order; if it is agreed that Zhang A's share of the benefits is 40%, Zhang B's is 25%, Zhang C's is 20%, and Zhang D's is 15%, then: Zhang B, Zhang C, and Zhang D shall enjoy Zhang A's share of the benefits in proportion. |
| ✓ | ✕ | Where the order of benefit is agreed but the share of benefit is not agreed: (1) It shall be shared equally by the other beneficiaries of the same order; (2) Where there is no other beneficiary of the same order, it shall be shared equally by the beneficiaries of the next order. [Example] If it is agreed that Zhang A, Zhang B, and Zhang C are of the first order, and Zhang D is of the second order, then: Zhang A's share of the benefits shall be shared equally by Zhang B and Zhang C; Zhang D, being of the next order, has no right to share it. |
III. Handling of Personal Insurance Events
Note: easily confused concepts
1. Premium: the amount the policyholder shall pay in accordance with the insurance contract.
2. Insurance proceeds: the amount paid by the insurance company in settlement after an insured event occurs.
3. Cash value of the insurance policy: In long-term life insurance, where the insured requests surrender of the policy, the insurer deducts a certain amount of surrender handling charges from the reserve and refunds the balance to the insured or the policyholder. It may be understood that the cash value of the insurance policy is the amount the policyholder can receive upon surrender. A cash value table is attached inside the insurance contract. It should be noted that the cash value of the insurance policy ≠ premium ≠ insurance proceeds.
Knowledge Point 155 Errors as to Age ★★
An error as to age means that the age of the insured as declared by the policyholder is not true.
| Type | Handling | Example |
| The age of the insured as declared by the policyholder is not true, and the true age does not satisfy the age limit agreed in the contract | (1) The insurer may rescind the contract and refund the cash value of the insurance policy in accordance with the contract. (2) In the following circumstances, the insurer may not rescind the contract: ① knowing or having reason to know that the policyholder failed to perform the duty of truthful disclosure, yet still collecting the premium; ② more than 30 days having elapsed since the insurer knew of the ground for rescission without exercising the right to rescind the contract; ③ more than 2 years having elapsed since the formation of the contract. | A certain insurance company offers a type of life insurance in which persons under 70 years of age may participate. Zhang, aged 71, falsely claimed to be 69 when applying for insurance with the company. This is a case of "the true age (71) not satisfying the age limit agreed in the contract (70)". |
| The age of the insured as declared by the policyholder is not true, but the true age satisfies the age limit agreed in the contract | (1) The insurer may not rescind the contract; (2) Where the premium paid by the policyholder is less than the premium payable, the insurer is entitled to correct it and require the policyholder to make up the premium, or to pay the insurance proceeds in proportion to the premium actually paid and the premium payable when paying the insurance proceeds; (3) Where the premium paid by the policyholder is more than the premium payable, the insurer shall refund the excess premium to the policyholder. | A certain insurance company offers a type of life insurance: the policyholder pays a certain premium each year, and may receive 200,000 yuan of insurance proceeds at the age of 60; the premium increases with the age at which cover begins. Li, aged 41, calculated carefully and found that taking out insurance from the age of 46 would minimise the premium to the greatest extent, and so falsely claimed to be 46 when applying for insurance with the company. This is a case of "the true age (41) satisfying the age limit agreed in the contract (60)". |
Knowledge Point 156 Death Insurance ★★
1. Concept
(1) Death insurance means a personal insurance contract under which the policyholder takes the death of the insured as the condition for payment of insurance proceeds;
(2) Death includes cases of declared death;
(3) Where the date on which the insured is declared dead falls outside the period of insurance cover, but there is evidence proving that the date on which the insured went missing falls within the period of insurance cover, a party may require the insurer to pay insurance proceeds in accordance with the insurance contract.
[Example] In 2010, A insured himself, agreeing that if he died by accident, his wife would receive the insurance proceeds, with an insurance period of 10 years. On 1 March 2018, A went missing. In April 2022, the court declared A dead. The insurance company shall pay the insurance proceeds.
2. Restrictions on insuring death insurance
A death insurance contract is highly likely to induce a beneficiary to kill the insured. To reduce the moral hazard of such contracts, the Insurance Law has imposed strict restrictions on them.
| Dimension of the rule | Specific provision |
| General rule | The policyholder may not insure a person without capacity for civil conduct under personal insurance under which death is the condition for payment of insurance proceeds, and the insurer may not underwrite it. [Example] Zhang San may not purchase such insurance for his wife Da A, who suffers from a mental illness and cannot discern and control her own conduct. A contract under which death is the condition for payment of insurance proceeds is invalid unless the insured has consented and approved the sum insured. (The court shall review this on its own initiative.) (1) The insured may give consent in written, oral, or other form; it may be given at the time the contract is formed, or ratified after the contract is formed. (2) Where the insured knows that another person signed on his or her behalf to give consent and does not express objection, he or she is deemed to have consented to the formation of the insurance contract and approved the sum insured. (3) Where the insured consents to the beneficiary designated by the policyholder, he or she is deemed to have consented to the formation of the insurance contract and approved the sum insured. |
| Exception (between parents and minor children) | (1) Parents may insure their minor children under death insurance without the consent of the insured or approval of the sum insured. [Example 1] Zhang Xiao San is 22 years old this year. May his father insure him under death insurance without Zhang Xiao San's consent? (No. A minor means a natural person under the age of 18; Zhang Xiao San is not a minor.) [Example 2] Zhang San insures his father, Old Zhang San, under death insurance. May he do so without Old Zhang San's consent? (No. It is limited to "parents insuring minor children".) (2) The total insurance proceeds payable upon the death of the insured may not exceed the limit prescribed by the insurance regulatory authority under the State Council. Persons other than the parents of a minor who perform guardianship duties for the minor may not enter into a contract for the minor under which death is the condition for payment of insurance proceeds; except with the consent of the minor's parents. [Example] Grandparents may not insure their minor grandson Zhang Xiao San under personal insurance containing a death benefit clause. |
| Transfer of the insurance policy | Under a contract under which death is the condition for payment of insurance proceeds, the insurance policy issued thereunder may not be transferred or pledged without the written consent of the insured. |
Common errors:
(1) Whether the insured consents to the formation of death insurance and approves the sum insured: the insured may consent in writing or orally;
(2) Transfer or pledge of a death insurance policy: written consent required.
Knowledge Point 157 Expense-Reimbursement Medical Expense Insurance ★
1. Concept
Expense-reimbursement medical expense insurance means insurance under which, where the insured incurs medical expenses for treatment due to illness, the insured pays the medical expenses and the insurer subsequently pays medical expense insurance proceeds. (≈ Reimbursement afterwards)
2. Relationship with public medical care and social insurance
| Type of dispute | Handling | Example |
| The insurer asserts a deduction of the amount of compensation received by the insured from public medical care or social medical insurance | (1) It shall prove that, when the rate for medical expense insurance was determined for the insurance product, the portion of public medical care or social medical insurance had already been deducted accordingly, and that the premium was charged at the standard after such deduction; (2) The insurer bears the burden of proof in respect of the above. | The insured, A, used a certain imported anti-inflammatory drug during treatment. Although the drug is not on the reimbursement list of basic medical insurance (social insurance), Company A Insurance must still pay insurance proceeds for this self-paid drug, at the standard for similar drugs in the basic medical insurance drug catalogue. |
| Agreement to determine medical expenses in accordance with the standards of basic medical insurance (social insurance) | (1) Where the insured's medical expenditure exceeds the scope of basic medical insurance, the insurer may not refuse to pay insurance proceeds; (2) Where the expenses incurred by the insured exceed the standards for similar medical expenses under basic medical insurance, the insurer may refuse to pay insurance proceeds in respect of the excess portion. |
Common error: Where expenditure exceeds the scope, payment must be made; where expenses exceed the standard, payment may be refused.
1. Whether treatment was received at a designated hospital
(1) Where the insurer refuses to pay insurance proceeds on the ground that the insured did not receive treatment at a medical service institution agreed in the insurance contract, the court shall support the refusal;
(2) Except where the insured had to seek medical treatment immediately due to an emergency.
Knowledge Point 158 Handling of Special Insured Events ★★
1. Where the policyholder intentionally causes the death, disability, or disease of the insured
(1) The insurer is entitled to rescind the contract and is not liable to pay insurance proceeds;
(2) Where the policyholder has paid premiums in full for 2 years or more, the insurer shall refund the cash value of the insurance policy to the other right-holders in accordance with the contract.
2. Where the beneficiary intentionally causes the death, disability, or disease of the insured, or intentionally attempts to kill the insured without success
(1) Such beneficiary loses the right to benefit, and the insurer shall pay insurance proceeds to the other beneficiaries;
(2) Where there is no other beneficiary, the insurance proceeds shall form part of the insured's estate.
Where A is both the policyholder and the beneficiary, and A intentionally kills the insured B, the insurer shall not pay insurance proceeds.
3. Where the insured intentionally commits a crime or resists criminal coercive measures lawfully taken
(1) Where the insured suffers disability or death as a result of the above conduct, the insurer is not liable to pay insurance proceeds;
(2) Where the policyholder has paid premiums in full for 2 years or more, the insurer shall refund the cash value of the insurance policy in accordance with the contract;
(3) Where the insurer asserts that it is not liable to pay insurance proceeds, it shall prove a causal relationship between the death or disability of the insured and the insured's intentional crime or resistance to criminal coercive measures lawfully taken;
(4) Where the insured suffers disability or death in custody or while serving a sentence due to an accident or disease, the insurer shall be liable to pay insurance proceeds.
Distinguish causation: ① death caused by the crime: no payment; ② the insured is guilty, but dies of disease or accident: payment.
4. Suicide by the insured
In a contract under which the death of the insured is the condition for payment of insurance proceeds, where the insured commits suicide, the cases shall be distinguished:
(1) Where the insured commits suicide within 2 years from the formation of the contract or the reinstatement of its effect:
| Circumstance | Liability to pay | Burden of proof | Example |
| General rule | (1) The insurer is not liable to pay insurance proceeds; (2) The insurer shall refund the cash value of the insurance policy in accordance with the contract. | Where the insurer refuses to pay insurance proceeds on the ground that the insured committed suicide, the insurer bears the burden of proof. | Where, within 2 years of the formation of the contract, the insured A dies by falling from a height by accident, the insurance company shall pay insurance proceeds; but if A died by falling from a height by suicide, it shall not pay. |
| Exception | Where the insured was a person without capacity for civil conduct at the time of suicide, the insurer is liable to pay insurance proceeds. | The beneficiary or the insured's heir bears the burden of proving that the insured was without capacity for civil conduct at the time of suicide. | Where, within 2 years of the formation of the contract, the insured A commits suicide because he or she cannot discern or control his or her own conduct, the insurance company shall pay insurance proceeds. |
(2) Where the insured commits suicide after 2 years:
Where the insured commits suicide after 2 years have elapsed from the formation of the contract or the reinstatement of its effect, the insurer shall bear liability to pay insurance proceeds in accordance with the contract.
1. Personal insurance events caused by a third party
Where the insured suffers death, disability, or disease or another insured event as a result of the conduct of a third party:
(1) After the insurer pays insurance proceeds to the insured or the beneficiary, it does not enjoy a right of subrogation against the third party;
(2) The insured or the beneficiary still has the right to claim compensation from the third party;
(3) After the occurrence of the insured event, where the insured or the beneficiary sues the insurer, and the insurer argues that it is not liable for the insurance on the ground that the insured or the beneficiary has not required the third party to bear liability, the court shall not support it.
The right of subrogation is prohibited in personal insurance.
[Example] A purchased a personal insurance policy for his wife. His wife was later hospitalised for illness and was disabled as a result of the hospital's misdiagnosis and mistreatment. While claiming from the insurance company, A may also require the hospital to bear liability in tort.
Knowledge Point 159 Payment of Insurance Proceeds ★★
In personal insurance, after the death of the insured, insurance proceeds shall be paid under the following rules:
| Dimension of the rule | Corresponding handling | Specific explanation |
| General rule | Insurance proceeds do not form part of the insured's estate | Where there is a qualified beneficiary, the insurance proceeds shall be paid to the beneficiary. |
| Exception | Insurance proceeds form part of the insured's estate | (1) No beneficiary has been designated, or the beneficiary designated is unclear and cannot be determined; (2) The beneficiary died before the insured and there is no other beneficiary; (3) The beneficiary has lost the right to benefit in accordance with law or has waived the right to benefit, and there is no other beneficiary. Succession relationship — the beneficiary is presumed to have died first: Where the beneficiary and the insured have a succession relationship, and both die in the same event and the order of death cannot be determined, the beneficiary is presumed to have died first, and the ownership of the insurance proceeds shall be determined in accordance with the relevant provisions of the Insurance Law. |
| Transfer of the right to claim | — | After the occurrence of the insured event, where the beneficiary transfers all or part of the right to claim insurance proceeds corresponding to the insured event to a third party, the transfer is valid; except where transfer is prohibited by the nature of the contract, by agreement of the parties, or by law. |
Common error: Insurance proceeds are not part of the estate, so the presumed order of death is not determined under Article 1121(2) of the Civil Code, which provides that "where persons of different generations die, the elder is presumed to have died first".
[Example] A purchased personal insurance for his father, Old A, designating his son, Little A, as beneficiary. Old A and Little A later died in the same event, but the order of their deaths cannot be determined. Then: the beneficiary (Little A) is presumed to have died first, rather than the elder (Old A) being presumed to have died first.
Topic 21 — Summary of Commonly Tested Angles
1. Understand the principle of insurable interest and master the determination of insurable interest in personal insurance.
2. The handling of a policyholder's failure to make truthful disclosure.
3. The creation of beneficiaries and the handling of unclear agreements.
4. The handling of the suspension period of an insurance contract. (Rules on reinstatement)
5. Whether a personal insurance contract may be rescinded and how it is handled after rescission.
6. The handling of special insured events. (Intentional crime, suicide, death insurance)
7. To whom insurance proceeds are paid and whether they form part of the estate.
To you, who are striving
Do you know what humanity's greatest weapon is?
It is the determination to go all out.
[1] (Note 1 to Knowledge Point 147) General clauses, such as "whether you have suffered from any other disease...", have the function of "building a framework" in the legal system and legal norms, playing a role of "general catch-all".
[1] (Note 2 to Knowledge Point 147) Another example for reference: B had a history of hypertension for many years before taking out insurance; his hypertension was unstable, his blood pressure sometimes high and sometimes normal, he had not taken medication regularly for many years, and his blood pressure had not been regularly monitored. When taking out insurance, B gave a negative answer to the question "whether you suffer from hypertension". The insurance company may rescind the insurance contract on the ground of "failure to make truthful disclosure through gross negligence".
The following is the full verbatim text of Topic 22, "Property Insurance Contracts", from the 2026 Commercial and Economic Law Systematic Lecture Series by Yan Mengxuan (pp. 175–181):
Topic 22 Property Insurance Contracts
I. Handling of Property Insurance Events
Property insurance means insurance under which property and interests relating to property are the subject matter insured.
A property insurance contract means a contract under which specific property or interests relating to property are the subject matter insured, and the subject matter may be transferred.
Knowledge Point 160 Rules on Claims Settlement in Property Insurance ★
1. Determination of insurable interest
(1) Requirements for the establishment of insurable interest: lawfulness + economic character + determinacy.
| Content | Example | |
| Lawfulness | The interest must be an interest recognised by law, that is, a lawful interest. | The owner, operator, custodian, pledgee, or mortgagee of the insured property has an insurable interest in the insured property. |
| Economic character | The interest must be an economic interest, that is, an interest that can be assessed in money. | |
| Determinacy | The interest must be an interest that can be determined. |
(2) At the time the insured event occurs, the insured shall have an insurable interest in the subject matter insured; otherwise, he or she may not claim compensation of insurance proceeds from the insurer.
[Example] In January 2020, Zhang San insured a car under property insurance, and later sold the car to Li Si. In August 2020, an insured event occurred in respect of the car. At that time, the new owner Li Si had an insurable interest in the car. Although the former owner Zhang San had an insurable interest when the insurance contract was formed, Zhang San was no longer the owner when the insured event occurred; therefore, Zhang San cannot obtain compensation from the insurance company.
Personal insurance: an insurable interest is required at the time the insurance contract is formed.
1. The "dual limitation" on the insurer's compensation
(1) Sum insured: the maximum limit of the insurer's liability to pay compensation or insurance proceeds.
(2) Insurable value: where the policyholder and the insurer agree on the insurable value of the subject matter insured and record it in the contract, the agreed insurable value is the standard for calculating compensation where the subject matter insured suffers loss; where the insurable value is not agreed, the actual value of the subject matter insured at the time the insured event occurs is the standard for calculating compensation.
(3) Amount of compensation: the amount paid by the insurer on the basis of the loss of the subject matter insured.
(1) The amount of the insurer's compensation may not exceed the sum insured.
(2) The sum insured may not exceed the insurable value. For example, where a newly purchased car is insured under motor insurance, the price of 100,000 yuan is the insurable value of the car.
❶ Where the sum insured exceeds the insurable value, the excess part is invalid, and the insurer shall refund the corresponding premium;
❷ Where the sum insured is less than the insurable value, the insurer shall, except as otherwise agreed in the contract, bear liability for compensation of insurance proceeds in proportion to the sum insured and the insurable value.
(3) After the occurrence of the insured event, where the insurer argues that it is not liable for the insurance on the ground that the insured or the beneficiary has not required the third party to bear liability, the court shall not support it. (The insured may sue the insurer directly.)
[Example] The insurable value of a set of furniture is 100,000 yuan, and the agreed sum insured is 30,000 yuan. It now suffers damage within the scope of insurance cover, assessed at 40,000 yuan. Then: the insurer's compensation is 3/10 × 4 = 12,000 yuan.
1. Expenses borne by the insurer
After a property insurance event occurs, in addition to paying the amount of compensation for the loss, the insurer shall also bear the following expenses:
(1) Necessary and reasonable expenses paid by the insured to prevent or reduce the loss of the subject matter insured after the occurrence of the insured event. The amount of such expenses is calculated separately from the amount of compensation for the loss of the subject matter insured, and shall not exceed the sum insured at most. Where the measures taken by the insured have produced no actual effect, and the insurer argues on that ground, the court shall not support it.
[Example] The salvage expenses incurred by a textile factory in organising personnel to fight a fire were 10,000 yuan, and the fire loss ultimately suffered was 30,000 yuan, with a sum insured of 1,000,000 yuan. Then: the insurer must pay 3 + 1 = 40,000 yuan.
(2) Necessary and reasonable expenses paid by the insurer and the insured to ascertain and determine the nature and cause of the insured event and the extent of loss of the subject matter insured.
Knowledge Point 161 Transfer of the Subject Matter Insured and Change in the Degree of Risk ★★
1. Transfer of the subject matter insured
(1) Where the subject matter insured is transferred, the insured or the transferee shall promptly notify the insurer, except for goods in transit insurance contracts and contracts that provide otherwise;
(2) After the insured or the transferee has lawfully and promptly sent the insurer notice of the transfer of the subject matter insured, and before the insurer replies, where an insured event occurs, the insurer shall bear liability for compensation of insurance proceeds in accordance with the insurance contract;
(3) The transferee of the subject matter insured succeeds to the rights and obligations of the insured.
2. Transfer of rights in the damaged subject matter insured
(1) After the occurrence of the insured event, where the insurer has paid the full sum insured, and the sum insured equals the insurable value, all rights in the damaged subject matter insured vest in the insurer;
(2) Where the sum insured is less than the insurable value, the insurer acquires part of the rights in the damaged subject matter insured in proportion to the sum insured and the insurable value.
[Example] Li Zi insured a car under property insurance, and the car was later totally lost as a result of a sudden mudslide.
(1) If the insurable value of the car was 100,000 yuan and the sum insured was also 100,000 yuan (full insurance), and the insurance company pays Li Zi 100,000 yuan after the event, then all rights in the car vest in the insurance company;
(2) If the insurable value of the car was 100,000 yuan and the sum insured was 50,000 yuan (under-insurance), and the insurance company pays Li Zi 50,000 yuan after the event (the amount of compensation may not exceed the sum insured), then one-half of the rights in the car vest in the insurance company.
3. Significant increase in the degree of risk of the subject matter insured
| Dimension | Content | Example |
| Determination | Factors to be considered comprehensively: (1) changes in the use, scope of use, or environment of the subject matter insured, and changes caused by modification or similar reasons; (2) changes in the user or manager of the subject matter insured; (3) the duration for which the increase in the degree of risk continues; (4) other factors that may lead to a significant increase in the degree of risk. "Foreseeable" factors are not included: Increases in "foreseeable risk" are not included. Where the degree of risk of the subject matter insured has increased, but the increased risk falls within the scope of cover that the insurer foresaw or ought to have foreseen when the insurance contract was formed, it does not constitute a significant increase in the degree of risk. | [Example 1] The use of an insured vehicle is classified as commercial or non-commercial, and vehicles of the two kinds differ in frequency of use, scope of use, and environment, so the premium rates are also set with significant differences. If a vehicle insured as non-commercial is persistently used for commercial passenger transport for the purpose of profit, this constitutes a significant increase in the degree of risk. [Example 2] Fan had a fixed occupation and income, and during his commute he used a ride-sharing platform to carry passengers on a ride-sharing basis. In the 541 days since he joined the ride-sharing platform, he took 39 orders and made 17 trips; the degree of risk was not continuous. On the day of the accident, Fan's route was the same as the route taken with the passenger, and the same route does not lead to a significant increase in the degree of risk. |
| Handling | Scenario 1: Notice given: The insured shall promptly notify the insurer in accordance with the contract; the insurer may increase the premium or rescind the contract in accordance with the contract. Where the contract is rescinded, the premium already collected (after deducting the portion receivable) shall be refunded to the policyholder. | |
| Scenario 2: No notice given: Where the insured fails to perform the duty of notice, the insurer is not liable to pay compensation of insurance proceeds in respect of an insured event occurring as a result of the significant increase in the degree of risk of the subject matter insured. |
1. Significant decrease in the degree of risk of the subject matter insured
Where the relevant circumstances on the basis of which the premium rate was determined change, and the degree of risk of the subject matter insured decreases significantly, the insurer shall, except as otherwise agreed in the contract, reduce the premium and refund the corresponding premium calculated on a daily basis.
Knowledge Point 162 Double Insurance
1. Concept
Double insurance means insurance under which the policyholder insures the same subject matter insured, the same insurable interest, and the same insured event with 2 or more insurers respectively, and the total sum insured exceeds the insurable value.
2. Handling
(1) The policyholder shall notify each insurer of the relevant circumstances of the double insurance;
(2) The total compensation of insurance proceeds by each insurer may not exceed the insurable value;
(3) Except as otherwise agreed in the contract, each insurer shall bear liability for compensation of insurance proceeds in proportion to its sum insured and the total sum insured;
(4) The policyholder may, in respect of the portion by which the total sum insured exceeds the insurable value, request each insurer to refund premiums in proportion.
[Example] Li Zi insured a car under property insurance with Company A Insurance and Company B Insurance. The insurable value of the car was 100,000 yuan, and the sum insured of both Company A Insurance and Company B Insurance was also 100,000 yuan. The car is now totally lost. Then: Company A Insurance's compensation is 10 × 1/2 = 50,000 yuan, and Company B Insurance's compensation is also 50,000 yuan.
Knowledge Point 163 Liability Insurance ★★
1. Concept
Liability insurance, also known as "third-party liability insurance", means insurance under which the insured's liability to pay compensation to a third party as required by law is the subject matter insured.
(1) The subject matter of liability insurance is liability for compensation for tort damage within a certain scope;
(2) Liability insurance cannot extend to the insured's person or property.
"Liability insurance insures others." Because the purpose of liability insurance is to transfer the insured's unduly heavy liability to pay compensation, a liability insurance contract is an insurance contract entered into for the benefit of a third party.
1. Handling
(1) Where the insured causes damage to a third party, and the insured's liability to pay compensation to the third party is determined, the insurer shall, at the insured's request, pay insurance proceeds directly to the third party.
(2) Where the insured delays in making the request, the third party is entitled to claim compensation of insurance proceeds directly from the insurer in respect of the portion of compensation to which he or she is entitled.
(3) Before the insured pays compensation to the third party, where the insurer pays insurance proceeds to the insured:
❶ Where the third party claims compensation of insurance proceeds directly from the insurer in respect of the portion of compensation to which he or she is entitled, the insurer may not refuse to pay insurance proceeds on the ground that it has already paid the insured;
❷ After the insurer pays the third party, it may request the insured to return the corresponding insurance proceeds.
[Diagram] The "request–payment" rule
Request No request Delay in requesting Then may request ┌─────────────┐ ┌─────────────┐ ┌─────────────┐ ┌─────────────┐ │ ↓ │ ↓ │ ↓ │ ↓ Insurer ───→ Insured Insurer ───✕──→ Third party (victim) Insurer ───→ Insured Insurer ───→ Third party (victim) │ │ Payment of insurance proceeds Payment of insurance proceeds └─────────────┘ Figure 1: Where the insured makes the request Figure 2: Where the insured delays in making the request
Under the "direct payment" rule, the insurer shall pay compensation to the third party, rather than to the "insured".
1. Litigation in liability insurance
(1) In liability insurance litigation, the arbitration or litigation costs paid by the insured and other necessary and reasonable expenses shall, except as otherwise agreed in the contract, be borne by the insurer;
(2) The limitation period for a claim by the insured under commercial liability insurance for compensation of insurance proceeds from the insurer shall be calculated from the date on which the insured's liability to pay compensation to the third party is determined.
A participates in a one-day desert tour organised by travel agency B. Travel agency B purchased travel agency liability insurance from Red Star Insurance Company for this purpose. Passenger company C, entrusted by travel agency B, transported A to the desert, and Company C purchased carrier liability insurance from White Cloud Insurance Company for this purpose. During the transport, Company C was involved in a traffic accident, causing A's death, and Company C bore full responsibility for the accident. A's heir is D. Under normal circumstances, which of the following statements are correct? (2012/3/75) [1]
A. Travel agency B is entitled to require Red Star Insurance Company to pay insurance proceeds directly to D
B. Company C is entitled to require White Cloud Insurance Company to pay insurance proceeds directly to D
C. D is entitled to require Red Star Insurance Company directly to pay insurance proceeds
D. D is entitled to require White Cloud Insurance Company directly to pay insurance proceeds
II. The Insurer's (Property Insurance) Right of Subrogation
Knowledge Point 164 Concept and Characteristics of the Right of Subrogation ★★★
1. Concept
The right of subrogation means that, where an insured event is caused by damage to the subject matter insured by a third party, the insurer, from the date on which it pays compensation of insurance proceeds to the insured, exercises, within the amount of compensation, the insured's right to claim compensation from the third party by subrogation.
2. Scope of "third party"
(1) A third party means, apart from the insured and the insurer, any other person who causes damage to the subject matter insured;
(2) Where a member of the insured's family or a member of the insured's organisation causes an insured event through non-intentional conduct, the insurer may not exercise the right to claim compensation by subrogation against such family member or member of the organisation;
(3) Where the policyholder and the insured are different persons, and an insured event is caused by damage to the subject matter insured by the policyholder, the insurer may assert the right to exercise by subrogation the insured's right to claim compensation from the policyholder, except where the law provides otherwise or the insurance contract provides otherwise.
[Example 1] After Zhang insured his equipment under property insurance for himself, Zhang's son carelessly caused damage to the equipment. In this case, after the insurance company pays compensation, it may not claim by subrogation against Zhang's son. However, if Zhang's son intentionally damages the equipment, the insurance company may still claim by subrogation against Zhang's son after paying compensation to Zhang.
[Example 2] Industrial Park A purchased property fire insurance from Insurance Company A for all small enterprises located in the park. Industrial Park A, through poor management, caused a fire that burned the property of the small enterprises. In this case, Industrial Park A is the "policyholder + tortfeasor", the small enterprises are the insured, and after Insurance Company A pays compensation of insurance proceeds to the small enterprises (the insured), since the tortfeasor is Industrial Park A (the policyholder), Insurance Company A may, after paying compensation, claim by subrogation against Industrial Park A.
3. Understanding of "damage"
(1) The act of a third party "damaging" the subject matter insured includes both tortious acts and acts of breach of contract;
(2) Where the insurer asserts the right to exercise by subrogation the insured's right to claim compensation arising from a third party's tort or breach of contract, the court shall support it.
[Example] Company A was preparing to relocate as a whole, and entered into a contract with Company A (the contractor) for the overall relocation and installation of its factory premises, agreeing that "the contractor (Company A) may not subcontract this project". Company A took out "erection all risks insurance" with Insurance Company B in respect of the relocation. A piece of equipment needed to be transported, and Company A entrusted a local transport company, Company B, to transport it. While Company B was transporting the equipment, the equipment slipped and fell, causing cargo damage of 1,000,000 yuan. After Insurance Company B paid compensation to Company A (the insured), it asserted the right of subrogation only against Company A (the breaching party), and the claim was supported by the court.
Knowledge Point 165 Litigation on the Right of Subrogation; Handling of Waiver of the Right to Claim, Double Compensation, and Partial Compensation ★★★
1. Litigation on the right of subrogation
(1) The insurer shall exercise the right of subrogation in its own name;
(2) The insurer, from the date on which it pays compensation of insurance proceeds to the insured, exercises, within the amount of compensation, the insured's right to claim compensation from the third party by subrogation;
(3) The limitation period for the insurer's right of subrogation shall be calculated from the date on which it acquires the right of subrogation;
(4) Where the insurer brings an action on the right of subrogation, the court with jurisdiction shall be determined by the legal relationship between the insured and the third party.
[Example 1] The date of the insured event is 1 January, the insured notifies the insurance company on the same day, and the date of compensation after the insurance company assesses the loss is 10 January. Then the limitation period for the insurer's claim of subrogation against the third party is calculated from 10 January, because the insurer enjoys the "right of subrogation" from the date of compensation and within the amount of compensation.
[Example 2] Li Zi took out motor insurance with Ping An Insurance Company. While Li Zi was driving, he was rear-ended by a vehicle driven by Li, and Li bore full responsibility for the accident. The place where the accident occurred is District A, City A; the place where the insured vehicle is registered is District B, City A; and Li's domicile is District C, City B. After Ping An Insurance Company pays compensation of insurance proceeds to Li Zi, it brings an action for subrogation against Li. In this case, the courts of District A, City A and District C, City B have jurisdiction, because the legal relationship between Li Zi and Li is one of tort, and the courts with jurisdiction are the courts of the place where the tort occurred or the defendant's domicile.
2. Handling of waiver of the right of subrogation
| Category | Circumstance | Handling |
| Waiver before formation | Before the formation of the insurance contract, the insured waived the right to claim compensation from the third party | (1) Where the court finds the above waiver lawful and valid, the insurer may not assert the right to exercise subrogation in respect of the corresponding portion. That is, after the insurer pays compensation to the insured, it may not claim against the third party. (2) Where, at the formation of the insurance contract, the insurer enquired whether such a waiver existed, and the policyholder failed to make truthful disclosure, with the result that the insurer cannot exercise the right to claim compensation by subrogation, the insurer may request the "insured" to return the corresponding insurance proceeds; but the insurer may not claim against the third party. (3) Where the policyholder failed to make truthful disclosure, but the insurer knew or ought to have known of the above circumstances and still agreed to underwrite, it may not request the "insured" to return the corresponding insurance proceeds, and it has no right of subrogation. |
| Waiver before compensation | Before the insurer pays compensation of insurance proceeds, the insured waives it | After the occurrence of the insured event and before the insurer pays compensation of insurance proceeds, where the insured waives the right to claim compensation from the third party, the insurer is not liable to pay compensation of insurance proceeds. |
| Waiver after compensation | After the insurer pays compensation of insurance proceeds, the insured waives it | After the insurer pays compensation of insurance proceeds to the insured, where the insured waives the right to claim compensation from the third party without the insurer's consent, the (waiver) act is invalid. |
[Example] Fast Food Company A and Transport Company B entered into a transport contract, agreeing that if the cargo damage per vehicle exceeded 1,000 yuan, Transport Company B would bear liability for compensation; for cargo damage of 1,000 yuan or less, Transport Company B would not bear liability for compensation. Fast Food Company A then insured all its property with Insurance Company A. During one transport, due to a malfunction of Transport Company B's refrigerated vehicle equipment, the boxed meals delivered by Fast Food Company A spoiled. The cargo damage for that vehicle was 800 yuan.
Then: Insurance Company A pays compensation of insurance proceeds to Fast Food Company A in accordance with the insurance contract, but Insurance Company A has no right to claim by subrogation against Transport Company B, because before Fast Food Company A entered into the insurance contract with Insurance Company A, Fast Food Company A had already waived its right to claim compensation from Transport Company B in the transport contract.
1. Handling of double compensation
After the insurer acquires the right to claim compensation by subrogation (that is, the insurer has already paid compensation to the insured), the third party pays compensation to the insured again. In this case, the insured receives double compensation. On the basis of the "principle of indemnity" in property insurance, the insured may only obtain compensation for the loss of the subject matter insured, and may not obtain additional benefit. In this regard, the following two cases shall be distinguished:
2. Handling of partial compensation
(1) After the occurrence of the insured event, where the insured has already obtained compensation for damage from the third party, the insurer, when paying compensation of insurance proceeds, may deduct the amount of compensation already obtained by the insured from the third party accordingly;
(2) The insurer's exercise of the right to claim compensation by subrogation does not affect the insured's right to claim compensation from the third party in respect of the portion of compensation not yet obtained.
Topic 22 — Summary of Commonly Tested Angles
1. The handling of changes in the degree of risk of the subject matter insured.
2. The "request–payment" rule in liability insurance and litigation issues.
3. The handling of property accidents caused by a third party (the right of subrogation). This may be further subdivided into: (1) Whether the insurer may claim against the third party? In which circumstances may the third party refuse? (2) How is the limitation period for the right of subrogation calculated? (3) To which court should the insurer bring an action to exercise the right of subrogation? (4) Where the third party has made partial compensation, must the insurer pay compensation? (5) Where the insured waives the right to claim compensation from the third party, must the insurer pay compensation?
To you, who are striving
As long as you are on the road,
there is no distant place you cannot reach.
[1] AB. Options C and D are wrong. In this question, there is no case of "travel agency B or passenger company C delaying in making a request", so the third party (D) has no right to require the insurance company directly to pay insurance proceeds.