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Chapter 380 Insurance Contract Disputes (4)

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    ?

    Du Kefan said: "The defendant pleads."

    Chen Youjun defended on behalf of Life Insurance Company A: "Defendant A Life Insurance Company believes that the plaintiff's malignant tumor developed during the waiting period, and defendant A Insurance Company should not be liable for compensation. The purpose of setting the waiting period in the insurance contract is to prevent the policyholder from knowingly  An insured accident will occur, and the act of immediately applying for insurance to obtain insurance money. In this case, the insurance contract expressly stated that the waiting period is 90 days.  Ms. Yanyan explained the waiting period clause, that is, the start time of the party¡¯s insurance liability is inconsistent with the effective time of the insurance contract. The plaintiff confirmed and signed the waiting period clause. During the waiting period, the plaintiff was unfortunately found to be suffering from cancer, and the insurance liability has not yet started.  The defendant does not need to bear the insurance liability. Please the court dismiss all the plaintiff's claims."

    ? Du Kefan asked Wu You and Li Yike: "Does the attorney for the plaintiff have anything to add to the defense of the attorney for the defendant?"

    Li Yike: "Not yet."

    Du Kefan said: "The next step is to enter the stage of producing evidence and cross-examination. The plaintiff will first produce evidence. Before the trial, did the defendant receive the plaintiff's evidentiary materials in advance?"

    Defendant A Life Insurance Company said: "Received the evidence submitted by the plaintiff."

    Du Kefan attaches great importance to procedures, and he believes that only procedural justice can guarantee substantive justice.

    Du Kefan lightly raised his right hand, signaling the plaintiff to present evidence first.

    Li Yike received instructions and said: "The plaintiff submits the following evidence to the court: The first evidence, the insurance contract signed by the plaintiff Ma Yanyan and the defendant a life insurance company, proves that there is an insurance relationship between the plaintiff and the defendant, and the plaintiff has paid according to the contract.  The insurance money has been paid, and the insurance contract has come into effect, which is absolutely binding on both parties. The second evidence, the plaintiff Ma Yanyan¡¯s diagnosis certificate, the insurance contract was established on June 1, and a waiting period of 90 days was agreed.  That is to say, on August 30, the waiting period ended and the insurance contract began to be performed. The plaintiff Ma Yanyan was diagnosed on September 6, which has exceeded the waiting period. Therefore, the defendant should bear the insurance liability. The third evidence is that the defendant a Life Insurance  The statement of refusal to pay insurance issued by the insurance company proves the fact that the defendant refused to pay the insurance money.¡±

    Li Yike: "The plaintiff has finished presenting evidence."

    Du Kefan said: "The defendant is cross-examining."

    Chen Youjun said: "There is no objection to the authenticity and object of proof of the first insurance contract and the third evidence rejection statement submitted by the plaintiff; there is no objection to the authenticity of the second evidence, but there is objection to the object of proof.  The time of illness was much earlier than the waiting period, even earlier than the date of signing the contract, but the plaintiff was diagnosed with the disease on September 15th, therefore, according to the legal provisions of the waiting period and the contract, the defendant is not liable for compensation.¡±

    Du Kefan said to the defendant's attorney, Chen Youjun: "The defendant, please provide evidence."

    Chen Youjun said: "The defendant submitted the following evidence to the court: The first evidence is the insurance contract signed by the plaintiff Ma Yanyan and the defendant a life insurance company.  , during the waiting period, the plaintiff suffers from a serious disease or a mild or serious disease specified in the contract, and the defendant a life insurance company does not bear the insurance liability. The second evidence: the plaintiff Ma Yanyan participated in the unit¡¯s medical examination on August 20.  The third piece of evidence: from August 23rd to 27th, the plaintiff¡¯s medical certificates and medical records at the Affiliated Hospital of Huaihai Medical University. The second and third pieces of evidence together prove that the plaintiff Ma Yanyan was already sick during the waiting period  , the defendant does not need insurance liability.¡±

    "The defendant has finished presenting evidence." Chen Youjun said.

    The first evidence of the plaintiff and the defendant is the same, both are insurance contracts, but the plaintiff claims that the insurance relationship is established, the defendant needs to fulfill the insurance liability and settle the claim for the plaintiff, but the defendant claims that the insurance is exempt, this is the point of legal confrontation  place.

    On the same piece of evidence, the views advocated by the plaintiff and the defendant are diametrically opposed.

    Du Kefan said: "The plaintiff, please start cross-examination."

    Li Yike nodded to Du Kefan, and then said: "I have no objection to the authenticity of the first evidence, but I have objections to the object of proof. Please pay attention to the presiding judge. The 'waiting period of 90 days' stipulated in the insurance contract is the time for diagnosis.  And the diagnosis needs to be confirmed by the diagnosis report of the tertiary first-class hospital; however, the plaintiff, Ms. Ma Yanyan, only found suspected lesions through the ordinary physical examination center during the waiting period, and did not confirm the diagnosis of the diseases specified in the contract, so she did not meet the plaintiff¡¯s insurance.  The waiting period exemption condition stipulated in the contract is not applicable. There is no objection to the authenticity of the second piece of evidence, but there is objection to the object of proof.  The plaintiff and the third evidence have no objection to the authenticity of the evidence, but have objections to the object of proof. During the physical examination, the plaintiff, Ms. Ma Yanyan, found that "the right milk duct is limitedly dilated, the right breast is hypoechoic, and the two breasts are hypoechoic."??Hyperplasia, double axillary lymph nodes are visible", this is just a suspicion, and it has not been confirmed.  The disease specified in the annex to the contract was diagnosed during the period, but the plaintiff was not diagnosed during the waiting period, so the defendant a life insurance company cannot be exempted from liability. There is no objection to the authenticity of the third evidence, such as the diagnosis form of the Affiliated Hospital of Huaihai Medical University  , the object of proof has objections. This evidence is that the plaintiff entered the Affiliated Hospital of Huaihai Medical University for treatment after a physical examination, and was diagnosed with breast cancer after a 90-day waiting period (that is, September 6). The plaintiff¡¯s breast cancer diagnosis was waiting  After the expiration date, if the conditions for settlement of claims agreed in the insurance contract are met, defendant A Life Insurance Company shall be liable for compensation.

    ? After the two sides had finished cross-examination of evidence, Du Kefan said: "Do the two sides have anything to add to the factual part?"

    "The plaintiff has nothing to add." Li Yike thought for a while and said.

    "The defendant did not add anything." Chen Youjun said.

    Du Kefan nodded slightly, and then said: "Then the focus of the dispute in this case is whether the insured discovers the disease during the waiting period and is diagnosed after the waiting period, whether the waiting period exemption clause applies, and whether the insurance company needs to bear the insurance liability according to the insurance contract.  .In the debate stage, both parties are invited to discuss the focus of the dispute."

    In order to improve the efficiency of court trials, the presiding judge usually summarizes a focus of dispute, and the lawyers of both parties conduct court debate around the focus of dispute.

    The focus of the dispute in this case should be relatively obvious.

    "Next, the plaintiff is invited to express his opinion first." Du Kefan said to Li Yike.  (Remember the site URL: www.hlnovel.com
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