Recently, A Insurance Company consulted us about a claim case: on September 23, 2022, while driving a special work vehicle, they collided with an ordinary two wheeled motorcycle driven by Wang. After being determined by the traffic police, Yu is fully responsible for the accident, while Wang is not responsible. After the accident, Wang incurred more than 2000 yuan in medical expenses, as well as expenses for vehicle maintenance and testing. Wang applied for personal accident insurance at B Life Insurance Company. After a traffic accident occurred, B Life Insurance Company settled a claim of over 2000 yuan.

Question: Does Wang have the right to demand compensation from A Insurance Company for his medical expenses when the vehicle he is driving has been insured against compulsory traffic insurance?

Legal analysis

After research, we believe that Wang has the right to demand compensation from A Insurance Company for medical expenses.

Legal basis: Article 46 of the Insurance Law of the People's Republic of China: (Personal Insurance Contract) If the insured suffers from insurance accidents such as death, disability, or illness due to the behavior of a third party, the insurer shall not have the right to recover from the third party after paying the insurance benefits to the insured or beneficiary, but the insured or beneficiary still has the right to request compensation from the third party.

According to the above legal provisions, if Yu has insured against personal accident insurance, he belongs to the insured under the personal accident insurance. Under the personal accident insurance contract, Yu and B Life Insurance Company are parties to the insurance contract, while Wang is a third party responsible for the occurrence of the insurance accident under the personal accident insurance. After B Life Insurance Company compensates for medical expenses to Yu according to the personal accident insurance contract, Yu still has the right to request compensation for medical expenses from Wang. If Yu applies for compulsory insurance with A insurance company, A insurance company should first compensate within the scope of compulsory insurance.

After searching, in cases similar to this case, the court not only cited the above legal basis, but also provided reasons including: the victim's personal accident insurance is an individual business act, which does not reduce the liability of the motor vehicle insurance company for compensation; The fees obtained by the rights holder based on commercial insurance are essentially the contract consideration obtained based on the payment of insurance premiums in commercial insurance contracts. The insured pays the premium in accordance with the requirements of the insurance contract, thus giving rise to the right to demand the insurer to pay the consideration when the contract meets the conditions, which is different in nature from the tort debt generated by the insured based on third-party infringement. Contract debts based on commercial insurance relationships and tort debts based on infringement relationships should not and need not be offset against each other.

A question

After we provided the above answers, insurance companies still face a question: compulsory traffic insurance belongs to property insurance, and the principle of loss compensation is the basic principle of property insurance. In this case, Wang's medical expenses have been compensated. Does Wang's medical expense loss still exist under compulsory insurance? Alternatively, can the benefits obtained by Wang in the personal accident insurance contract (medical expense compensation) offset his medical expense losses in motor vehicle traffic accidents?

We believe that according to the "profit and loss offset" rule, it cannot be offset. The so-called "profit and loss offset" refers to the rule that when the right holder obtains benefits based on the same compensation reason for the damage, they should deduct the benefits from the damage suffered to determine the scope of compensation for the damage. In this case, Wang did not obtain benefits based on the same compensation reason. His compensation from B Life Insurance Company was based on the insurance contract relationship with B Insurance Company, and his compensation from A Insurance Company was based on infringement between Wang and Yu. Therefore, A Insurance Company cannot offset Wang's medical expense losses in motor vehicle traffic accident liability disputes with B Life Insurance Company's medical expense compensation claim. Since it cannot be offset, Wang's medical expense loss still exists in the traffic accident case.

If the loss of medical expenses in a traffic accident case is eliminated due to the insurance compensation of outsiders, it means that Wang's act of purchasing commercial insurance has instead become a cause for reducing and dispersing the liability of the infringer, and the ultimate beneficiary of Wang's purchase of commercial insurance has become the infringer. This explanation is clearly not in line with common sense.

unfinished comments

Finally, it should be pointed out that under the current law, the principle of loss compensation is not applicable to personal insurance (including life insurance, health insurance, and accident insurance). However, we have noticed that there are indeed loss compensation types of insurance in personal insurance, such as reimbursement based medical insurance, which aims to compensate for the specific medical expenses losses of the insured. In judicial practice, some courts have also recognized the loss compensation type of medical insurance.

The Higher People's Court of Jiangxi Province pointed out in the case of Ganminshen No. 686 (2020) that, The additional medical insurance in this case belongs to a product developed in a personal insurance contract to compensate for the expenses incurred by the insured in treating diseases or medical injuries, and has special characteristics. The insurance subject is medical expenses, which refers to the economic losses actually incurred by the insured and can be measured by monetary amount. Although they are based on personal injury, they are essentially economic losses, different from disability compensation and death Fixed life insurance compensation items such as death compensation. And the insurance contract involved in the case stipulates that "the principle of compensation applicable to this additional insurance contract", which does not have any of the circumstances stipulated in Article 54 of the Contract Law of the People's Republic of China and is legal and effective. The defense of PICC Nanchang Company's refusal to settle the claim complies with legal provisions and contractual agreements. The first and second instance courts determined that the case involved insurance and applied the principle of compensation, and then ruled to reject Cai Baolian's lawsuit request. The application of law was not inappropriate

We believe that under current legal provisions, victims who have purchased compensatory medical insurance still have the right to request compensation for medical expenses from the infringer after receiving medical insurance benefits. At the same time, we believe that the viewpoint that the principle of loss compensation is not applicable to personal insurance will be further improved with the development of insurance practice.