Decoding Controversial Life Insurance Claims (Chinese Article)

Estimated reading time 5 minutes

10Life Team

14 Aug 2021
呢啲情況下,保險公司可以唔賠人壽保險?
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10Life Team

14 Aug 2021

Estimated reading time 5 minutes

人壽保險雖然不保事項甚少,但並不代表沒有受爭議的賠償個案——部份甚至鬧上法庭,最終法院判保險公司勝訴,毋須作出賠償。要了解人壽保險的賠償準則,除了細閱壽險產品資料、條款及細則,也可以參考真實案例。10Life為大家準備4個人壽保險個案,並向法律專家請教,以深入淺出的形式,分享當中的法律爭拗點和技術位。未來,我們亦會分析其他種類保險個案,大家記得密切留意!

個案1:陳先生買了一份人壽保險。6個月之後,他因抹窗時失足而墮樓身故。保險公司能否以陳先生自殺為由,拒絕賠償?

目前,大部份保險公司將壽險生效首年或首兩年內的自殺,列作不保事項(除外責任,exclusion)。換言之,倘若上述個案中的陳先生真的是自殺身故,保險公司可以不作賠償。然而,證明死亡是由自殺引起的舉證責任須由保險公司負責。若死者沒有留下遺書等明顯佐證,保險公司要證明死者死於自殺亦非易事。若然受益人對保險公司賠償有爭議,最後可向保險業監管局投訴,要求局方檢視個案。

個案2:王女士於5年前買了一份人壽保險,受益人是她的5歲女兒。最近,王女士因醉酒駕駛而發生交通意外,留院一個星期之後死亡。保險公司會否以王女士醉酒駕駛為由,拒絕賠償?

正如我們早前文章指出,人壽保險幾乎不着重受保危險(身故原因),因此死因通常對人壽索償沒有太大的影響。事實上,市面上大部份定期壽險產品皆涵蓋死於愛滋病、非法活動、自殺(保單生效日一至兩年後)、過量服用藥物、酒精及毒品等情況。不過,某些定期人壽產品,有別於慣常做法,加入了不保事項。因此,在選購定期壽險時,消費者不能只比較保費,亦要開始留意不保事項,多做一點功課。就王女士個案而言,需視乎其保單不保事項,才能決定保險公司會否受理。

個案3:一位曾被定罪的恐怖分子買了人壽保險,其後因癌病逝世。他的人壽保險受益人(妻子)會否得到賠償呢?

這是一個發生於加拿大的真實個案。簡而言之,安大略省上訴法院裁定保險公司毋須向受益人賠償,原因是受益人已逝世的丈夫(投保人)購買保險時候,並無向保險公司披露自己過去曾在其他國家涉及恐怖活動而被定罪的紀錄,包括早年向以色列航空一列客機射擊實彈及投擲手榴彈,導致最少一人死亡。後來他在一宗人質談判中獲釋,並移居黎巴嫩,再輾轉偷渡至加拿大。

法庭文件顯示,該名受保人在加拿大購買壽險後不久,曾向當地政府指出假若他被遣返至以色列,生命將會受到威脅。由此可見,該名人士清楚明白其過往從事的活動,以及以虛假名字非法入境加拿大,足以對自己人身安全構成嚴重威脅;亦反映該投保人蓄意向保險公司隱瞞過往活動紀錄,未有披露重大事實,足以構成欺詐,最終法院判保險公司勝訴。

值得思考的是,是否犯了罪的人就不能買人壽保險?如果犯了罪就不獲賠償,恐怕與事實不符。事實上,我們早前的文章亦提到,絕大部份的定期人壽保險涵蓋非法活動,甚至戰爭。

個案4:一名糖尿病人利用外國醫院的假醫學證明,向保險公司成功買人壽保險。當病人離世後,保險公司處理理時,發現事有可疑,最終東窗事發,拒絕賠償。保險公司的做法是否合理?

保險合約受「最高誠信」(Utmost Good Faith)原則所約束,即使保險公司沒有向投保人查問資料,投保人都要向保險公司披露任何重要資料。因此,投保人如果虛報或漏報健康狀況,導致保險公司當初無法作出公平和準確的核保決定,受益人或會因而不獲賠償。

如閣下有任何保險相關的法律問題,歡迎將問題電郵至legalcorner@10life.com。10Life會將問題轉交至律師為大家解答,讓大家了解法律賦予您的保障。

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註:以上資訊由10Life提供,更新至2021年8月13日,僅供參考,並不是銷售建議。 

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梁芷萁

10Life Financial Manager, Insurance Specialist

4.8
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Jack, Ng Wai Lap

黃維立

AXA Unit Manager

4.7
4096
626

Arthur, Law Wing Kai

羅永楷

10Life Financial Manager of Business Development

5
253
80

Winnie, Ng Wai King

吳惠琼

FTLife Agency Manager

4.8
1859
312

Even, Shum Miu Chu

岑妙珠

恆泰 高級理財顧問

4.6
1349
249

Philip, Lee Hon Lun

李漢麟

YF Life Branch Manager

4.4
1656
265

Tony, Yeung Chun Fung

楊俊鋒

FWD Life Wealth Planner

4.7
1807
314

Mabel, Siu Sin Wan

蕭善尹

FTLife Wealth Management Director

5
1070
318

Edward, Lam Wing Chuen

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Convoy Senior Wealth Management Advisor

4.6
1558
263

Noble, Suen Chit Yuen

孫哲遠

AIA Associate Director, Wealth Management and Protection

4.4
1119
249