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Insurance lawyer interprets Zhang Zhijie's sudden death: accident insurance usually does not cover "sudden death", and the road to claim compensation will become difficult if the event loses heat

Dahe News · Yu video reporter Yin Haitao

Insurance lawyer interprets Zhang Zhijie's sudden death: accident insurance usually does not cover "sudden death", and the road to claim compensation will become difficult if the event loses heat

On June 30, at the 2024 Asian Youth Badminton Championships held in Indonesia, 17-year-old Zhang Zhijie suddenly collapsed on the court and never woke up, and more than 40 days later, his family posted that the child's body still could not return to China. On August 12, after Dahe Daily · Yu Video reported the news that "Zhang Zhijie's body has not yet returned to China", it once again attracted attention from all walks of life.

On August 15, a reporter from Dahe Daily · Yu Video "See" called the Zhejiang Provincial Sports Bureau, and the staff said that the Zhang Zhijie incident was still being processed, and an announcement would be officially issued after the handling was completed.

On the same day, Zhang Zhijie's aunt released the latest news: Zhang Zhijie's body will be cremated in Indonesia on the 20th, and he will return to China on the 25th to hold a memorial service in Hangzhou.

Insurance lawyer interprets Zhang Zhijie's sudden death: accident insurance usually does not cover "sudden death", and the road to claim compensation will become difficult if the event loses heat

Aunt Zhijie released the latest progress of Zhang Zhijie's body returning to China

At present, the cause of Zhang Zhijie's death has not been officially announced, and the announcement of the Chinese Badminton Association on July 1 mentioned that "the cause has not yet been clarified by local hospitals". The Indonesian Badminton Association said at a press conference on July 1 that treatment and examinations at the hospital showed that Zhang Zhijie died of sudden cardiac arrest.

Some medical experts have analyzed that according to the live video, Zhang Zhijie's condition seems to be sudden cardiac death. This incident has also triggered extensive discussions from all walks of life on issues such as medical security, rule enforcement and humanized management of sports events.

Professional athletes are generally covered by insurance

An industry insider told the Dahe Daily · Yu video "See" reporter that many domestic insurance companies have professional athlete insurance protection products, and professional athletes generally have insurance protection. According to public information, in recent years, Sun Life Everbright has become the chief sponsor of the Chinese national badminton team, providing exclusive insurance protection solutions and health management packages for badminton players.

According to media reports, since 2019, Sun Life Everbright Insurance has been the insurance provider of China's national badminton team, providing accidental injury and accidental medical services for national badminton athletes and coaches, covering daily training and domestic and international competitions, and has successively provided claims for injuries sustained by athletes such as Shi Yuqi, Chen Yufei and He Bingjiao.

Insurance lawyer interprets Zhang Zhijie's sudden death: accident insurance usually does not cover "sudden death", and the road to claim compensation will become difficult if the event loses heat

Zhang Zhijie

On August 14, the reporter of "Seeing" called the Tianjin branch and Zhejiang branch of Sun Life Everbright respectively, and the staff said that their head office was indeed providing relevant insurance services for national badminton athletes.

On August 16, the reporter called Sun Life Everbright Beijing Branch to ask Zhang Zhijie if he had insurance with Sun Life Everbright, and the staff said "no comment" on the grounds of protecting customer privacy.

The reporter noticed that Zhang Zhijie's uniform for this competition was printed with the names of the sponsors of "Everbright Bank" and "Everbright Cloud Payment". However, it is not yet known whether Zhang Zhijie's national youth team was insured by this insurance company.

Lawyer: Sudden death is not covered by accident insurance, but it can be litigated for rights and interests

On August 14, Zhou Zihao, a lawyer focusing on the field of insurance claims and a senior partner of Guangdong China Commercial (Wuhan) Law Firm, said in an interview with a reporter from Dahe Daily · Yu Video "See" that athletes of Zhang Zhijie's level may be insured with a huge amount of commercial insurance, but if there is no "special contract" in his critical illness insurance and accident insurance, as long as it is sudden death, 99% of insurance companies will refuse to pay.

"At present, the cause of Zhang Zhijie's death has not been disclosed, and once this story loses its social popularity, it will be very difficult for the family to settle the claim." Zhou Zihao believes that Zhang Zhijie's sudden death, without seeing the insurance policy, it is impossible to speculate on the specific type of insurance he may insure, and the accident insurance must include the special situation of "sudden death" before the insurance company will compensate.

The reporter's inquiry found that at present, the insurance terms applicable to personal accident insurance by various insurance companies generally stipulate that "accidental injury" refers to the injury to the body caused by external, sudden, unintentional, and non-disease objective events as direct and separate reasons, but the following situations belong to the category of diseases, and are not the accidental injuries referred to in this article, including: sudden death, high reaction, heat stroke, allergies, etc.

In other words, "sudden death" is an exclusion clause in accident insurance and is not covered by claims, and generally speaking, sudden death is death due to illness, not accidental death.

Insurance lawyer interprets Zhang Zhijie's sudden death: accident insurance usually does not cover "sudden death", and the road to claim compensation will become difficult if the event loses heat

However, Zhou Zihao believes that even if the insured does not buy the "sudden death supplementary insurance" and is refused compensation by the insurance company, he can still fight for his rights and interests through litigation.

According to Article 30 of the Insurance Law, "Principle of Adverse Interpretation", when there is a dispute over the terms of an insurance contract, an interpretation shall be made in favor of the insured and the beneficiary. On the other hand, the legal provisions for the settlement of insurance disputes also provide a tendentious protection for insurance consumers, which is a common practice in mainland courts, and the courts will default to the fact that the insurance company will have some irregularities in the process of conducting business, and will give consumers a tendentious protection when settling claims.

The reporter's inquiry found that in 2010, a court in Nanjing heard an insurance claim case of "sudden death of a female passenger in a hotel after being stranded at the airport due to flight delays". On July 31, 2009, Chen, a woman from Rugao City, Jiangsu Province, spent 20 yuan to purchase a public transportation accident insurance for herself before boarding. Later, due to the delay of the plane, after 7 hours of waiting, Chen collapsed in the hotel arranged by the airport, and after forensic identification, Chen died accidentally. Afterwards, the family asked the insurance company to pay 400,000 yuan for accident insurance, but the insurance company refused to pay for the compensation on the grounds that Chen died suddenly and did not suffer any external injuries at the time of death, so it was not an accidental injury. After several court sessions and mediation, the two parties made concessions on the amount of compensation, and the defendant agreed to compensate the plaintiff 300,000 yuan.

What other compensation can I claim?

Zhou Zihao added that regardless of whether he died of illness or accident, according to Article 15 of the Regulations on Work-related Injury Insurance, Zhang Zhijie can be recognized as a work-related injury.

In addition, the reporter's inquiry found that in accordance with the relevant policies, the sports department will also provide corresponding fund guarantees to athletes. According to the notice issued by the Personnel Department of the General Administration of Sports of the People's Republic of China on December 15, 2017, the Measures for Mutual Insurance for the Disability of Elite Athletes (Trial) shall be deemed to be within the scope of mutual disability insurance for athletes who are injured, disabled or killed during training and competitions.

After an athlete has a disability accident, the insured unit shall provide timely treatment. In the event of a fatal accident, the sports foundation shall be notified as soon as possible.

Insurance lawyer interprets Zhang Zhijie's sudden death: accident insurance usually does not cover "sudden death", and the road to claim compensation will become difficult if the event loses heat

Article 17 of the Measures also specifically states that athletes who participate in other social or commercial insurance at home (abroad) and receive insurance compensation can still enjoy the insurance benefits stipulated in these Measures.

Article 26 of the Measures stipulates that if an athlete suffers a disability accident during the national team, the national sports association in charge of the national team shall submit an application for insurance benefits to the sports foundation.

Some companies have launched casualty insurance for customers in sports venues

So, what should you pay attention to if you want to buy accident insurance for the general population engaged in sports activities?

The customer service of a large domestic insurance company told the "See" reporter that the accident insurance of professional athletes is different from that of ordinary people, and they can be insured according to their professional status.

Insurance lawyer interprets Zhang Zhijie's sudden death: accident insurance usually does not cover "sudden death", and the road to claim compensation will become difficult if the event loses heat

Accident insurance usually states an exclusion of liability

The reporter saw from an article on the official WeChat of another life insurance company that the insurance of athletes is different from the insurance purchased by ordinary people, which is due to the particularity of athletes' work, and many ordinary people can purchase and claim accident insurance and medical insurance, but they are directly "excluded from liability".

For example, accident insurance will usually state that "the insured person is a professional athlete during training or competition" as an exclusion from liability; Medical insurance will mention "participation in high-risk sports" in the exclusion of liability.

The customer service of the above-mentioned insurance company also said that sudden death is not within the scope of accidental injury insurance, and individuals are generally engaged in confrontational strenuous sports, such as playing basketball, taekwondo and other activities.

In addition, the reporter found that there are now insurance companies that have launched exclusive insurance for business sports venues, covering customer personal injury and property damage caused by various reasons, and a variety of sports venues can be covered to protect customers with peace of mind. (For news reports, please send a private message to the WeChat public account "Dahe See")

Source: Dahe News · Yu Video Editor: You Xiaopeng