At present, the country has entered the rainy season, and it is common for vehicles to be damaged due to heavy rain and wading. If the insurance company stipulates in the insurance contract that there are two situations, heavy rain and wading in the water, can the damaged vehicle be compensated if the agreement is unclear? Recently, the Jiutai District People's Court of Changchun City, Jilin Province concluded an insurance claim dispute.
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In February 2024, Jia took out car damage insurance for his car with an insurance company with an insurance amount of 200,000 yuan. Article 1 of the insurance liability stipulates that "during the insurance period, the insurer shall be responsible for compensating for the loss of the insured vehicle caused by the following reasons in the course of using the insured vehicle by the insured or its permitted legal driver: "(4) Lightning strikes, storms, rainstorms, floods, ......etc." Article 6 of the exemption and exemption part states: "The insurer shall not be liable for compensation for the following losses and expenses: (3) The insured vehicle is flooded or the engine is damaged due to wading in water".
From the afternoon to the night of the day, there was strong convective weather such as heavy rain and strong winds, and the rainfall in the urban area was 83.9 mm, reaching the heavy rain standard. Due to the deep water, the engine stalled and was damaged during the driving of the vehicle involved in the case by Jia. After inspection, the damage to the vehicle engine was caused by water ingress in the cylinder, which cost 160854 yuan for vehicle maintenance and 8,000 yuan for maintenance man-hours.
A dispute arose between Jia and the insurance company over whether the related event that caused the loss of the insured vehicle was heavy rain or wading in water. Considering the whole case, the rainstorm and wading have a temporal sequence and reasonable continuity. Although wading in water is directly related to the damage to the insured vehicle, the antecedent of wading lies in the heavy rain, and the wading caused by the heavy rain is the decisive and fundamental cause of the damage to the insured vehicle, so the wading of the insured vehicle cannot block the causal relationship between the heavy rain and the damage to the insured vehicle, that is, the heavy rain is the proximate cause of the damage to the insured vehicle, and the defendant insurance company should compensate for the vehicle loss caused by the heavy rain within the scope of insurance.
The maintenance cost of Jia's vehicle is within the scope of the insurance amount, and a VAT invoice is issued, so the insurance company should bear the vehicle maintenance cost of 160854 yuan and the maintenance man-hour cost of 8,000 yuan, totaling 168854 yuan.
What the judge said
Article 30 of the Insurance Law of the People's Republic of China stipulates that if there is a dispute between the insurer and the policyholder, the insured or the beneficiary over the terms of an insurance contract concluded using the standard terms provided by the insurer, it shall be interpreted in accordance with the common understanding. If there are two or more interpretations of the terms of the contract, the people's court or arbitration institution shall make an interpretation in favor of the insured and the beneficiary.
In both wading and rainstorm cases, an interpretation should be made in favor of the insured and the beneficiary. Based on a comprehensive analysis, it should be determined that the vehicle was damaged due to heavy rainfall, and the insurance company should bear the insurance liability.
Proximate cause is not the cause that is closest to the loss in time or space, but refers to the cause that causes the loss most directly and effectively, and its dominant or dominant effect. Determining proximate causes should start from the initial event and logically reason what will happen next. If the first event leads to a second event, and the second event gives rise to a third event, and so on leads to the final event, then the initial is the proximate cause of the final event. If there is no obvious connection or interruption between two of the links, the other events are the proximate cause of the final event.
In this case, the initial dangerous event was a heavy rainstorm, which inevitably led to a water-related incident caused by the flooding of the road, and the increase in the amount of water on the road inevitably led to a short-term accumulation of water in a certain range and depth, and the vehicle would be flooded when it passed. Heavy rain, wading, and flooding were carried out continuously, and the initial dangerous event rainstorm was the proximate cause of the insured accident in this case, and the insurance company should compensate for it.
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Source: China Court Network