保险合同中猝死及其免责条款的若干思考

Thoughts on Sudden Death and Its Exemption Provisions in Insurance Contracts

保险合同中猝死及其免责条款的效力争议是近年来司法审判中的热点和难点之一。国内多数保险合同中关于猝死的定义均亟需修正。猝死包括心源性猝死与非心源性猝死两类,即使是心源性猝死也不必然属于疾病。保险合同中猝死免责条款有效的前提是对猝死有准确定义且保险人已尽到对该条款的提示和明确说明义务。法院在审理猝死类保险纠纷时存在裁判标准不统一、裁判结果迥异的问题。问题的解决有赖于对意外伤害保险中意外理论的厘清、对猝死免责条款有效性的准确认定、对猝死原因确定依据的准确分析,以及对猝死原因确定过程中保险人义务与举证责任分配规则的明晰。

The effectiveness of the sudden death clause and its exemption provisions in insurance contracts has been a focal point and challenge in recent judicial trials.The definition of sudden death in the majority of domestic insurance contracts requires revi-sion urgently.Sudden death can be categorized into two types:cardiac and non-cardiac,and even cardiac sudden death does not necessarily fall under the category of illness.The prerequisite for the validity of the exclusion clause for sudden death in insurance contracts is an accurate definition of sudden death,and the insurer must fulfill the obligation to provide clear and explicit explana-tions of the clause.There are inconsistent standards and divergent outcomes when adjudicating insurance disputes related to sud-den death in the courts.Resolving this issue requires clarification of the accident theory in accidental injury insurance,precise de-termination of the validity of sudden death exclusion clauses,accurate analysis of the criteria for determining the cause of sudden death,and a clear delineation of the rules governing the insurer's obligations and burden of proof in the process of determining the cause of sudden death.