Travel accident insurance claims case

On July 30, 2009, ten people, including Qian and his wife, a Hunan tourist, signed a 10-day travel contract with the travel agency. On August 19 of the same year, the travel agency and the insurance company signed a travel safety accident insurance policy. The insured amount and insured amount are 300,000 yuan for the main insurance travel accident insurance and 65,438+10,000 yuan for the additional insurance travel safety accident medical insurance.

On September 20th, Mr. and Mrs. Qian went to Yunnan with the tour group and were arranged to stay in their high-class business hotel18th floor. At 5 o'clock in the morning, Qian's wife found Qian falling from the hotel 18 floor and took him to the hospital. He died after being rescued. According to the investigation by the local public security department, Qian died of craniocerebral injury caused by falling from a height, and his death is not a criminal case.

The insurance company believes that Qian's wife failed to provide direct evidence to prove that Li's death was an accident stipulated in the travel safety accident insurance clause, and the insurance company should not bear the insurance liability.

In this case, the terms of the insurance contract stipulate that the insured suffers accidental injury and the insurer shall bear the responsibility of paying the insurance money. According to China's insurance law: When there is a dispute between the insurer and the applicant, the insured or the beneficiary on the terms of the insurance contract, the people's court or the arbitration organ shall make an explanation in favor of the insured and the beneficiary. ? At present, the two sides have different understandings of the meaning of accidental injury. According to the above-mentioned legal provisions, explanations should be made in favor of the insured and the beneficiary, and the insurance company failed to prove that Li's death was caused by his own intention or negligence, so the insurance company should pay insurance money and interest to Li. Therefore, the insurance company paid Li's relatives compensation of 300,000 yuan.