Viewpoint | Research on legal issues related to employer liability insurance

Employer liability insurance is a kind of liability insurance that covers risks by the insured person, I .e. the employer's employee, who is engaged in business during the period of employment due to accidental injury, disability, death or employee-related illness caused by the employee in accordance with the law or under the employment contract.

The risk of liability assumed by the insurer includes the intentional conduct of the insured (employer) as an exclusion, primarily covers damages for the procedural conduct of the insured (employer), or includes no-fault risk in the scope of insurance liability. The prerequisite for constituting the employer's liability is that there is a direct employment relationship between the employer and the employee.

Scope of responsibility:The insurance liability of the employer's liability insurance, including the employer's financial liability and related legal costs to the employee in the event of a liability accident, is mainly due to various unexpected work-related accidents and occupational diseases.

Beneficiary:In view of the employer liability insurance refers to that the employee employed by the insured is injured, disabled or disabled due to an accident when engaged in the work related to the insured's business specified in the insurance policy during the employment process. Occupational diseases related to business, disability or death, the insured shall bear medical expenses and financial compensation liability (including litigation expenses that should be paid) according to the law or employment contract, an insurance in which the insurer is responsible for compensation within the prescribed limits of compensation. Employer's liability insurance primarily covers disability or disability caused by an accident or death of an employee employed by the insured in the course of his or her employment in the course of his or her employment or by an occupational disease prescribed by the State in connection with the business. Therefore, the beneficiary of the insurance is actually the employer, exempting the employer from liability.

Employer's liability insurance period:Employer's liability insurance is usually for a period of one year and is renewed at the end of the period. However, if the needs of certain special employment contracts are taken into account, employer liability insurance for less than one year or more may also be insured for the duration of the employment contract. If the term of insurance is two years or more, the premium shall be charged on an annual basis to ensure that the financial accounting is commensurate with the annual risk liability assumed by the insurer.

employer liability insurance claims content:

In the event of an insurance accident, when the insured applies for compensation, the insured shall submit the insurance policy, the relevant accident certificate, the medical certificate issued by the medical institution recognized by the insurer, the original documents of the medical expenses and other expenses, and the valid documents that the insurer deems necessary. In the event of death of an employee, supporting documents such as a death certificate and account cancellation should also be provided. After a legal claim procedure and on the basis of a liability review by the insurer, the amount of compensation is calculated within the liability limit:

1, death compensation, to the policy agreed upon per person death compensation limit.

2. Disability compensation. According to the disability degree appraisal certificate issued by the disability appraisal institution, and in accordance with the "Employee Work Injury and Occupational Disease Disability Degree Appraisal Standard" issued by the state to determine the disability level and pay the corresponding compensation. The corresponding compensation limit is the proportion of the following "Disability Level Compensation Limit Ratio Table" corresponding to the disability level multiplied by the amount of compensation limit per person.

3. The compensation standard and amount of occupational disease shall be calculated according to relevant regulations.

4. The insurer only compensates for necessary and reasonable medical expenses, including registration fees, treatment fees, bed fees, examination fees, and medical expenses, and does not exceed the medical expenses compensation limit agreed in the policy. Does not include the cost of escort, meals, nutrition, transportation, heating, air conditioning, and the installation of prostheses, dentures, eyes and disabled appliances for injured employees.

Additional Risks:

(I) additional third party liability insurance

This additional insurance covers the legal liability of the insured (employer) for personal injury or property damage to others other than the employee due to his negligence or negligence, which is essentially covered by public liability insurance, but the insurer may extend the coverage if the employer requires additional coverage at the time of the employer's liability insurance.

(II) additional employee third party liability insurance

This additional insurance covers the economic liability of the employer for injury to a third party caused by the employee's negligence or negligence in the performance of his official duties.

(III) additional medical insurance

This additional insurance covers the medical expenses of the insured's employees during the insurance period due to illness, etc., which essentially falls within the scope of general life insurance or health insurance.

In addition, employer liability insurance can be added to insurance for dangers such as war and for personal injury or death of employees caused by additional diseases.

Brief facts of the case:

Xia is an employee of Company A. On September 13, 2020, Xia had a traffic accident on his way to work and died after rescue. The accident was determined by a traffic police brigade that Xia was equally responsible for the accident. The Municipal People's Social Security Bureau determined that Xia was dead at work. After mediation by a municipal arbitration committee, Company A paid a one-time compensation to Xia's relative 770000 yuan. Company A signed a service contract agreement with Company B on April 22, 2020, in which Company B will handle the insurance business for Company A, and then Company B will entrust Company C to handle the insurance business. Company C and the insurance company signed the "Employer's Liability Insurance Project Insurance Cooperation Agreement" in May 2019, and reached an agreement on Company B's insurance of employer's liability insurance with Ping An Insurance Company. The first paragraph of Article 6 of the agreement stipulates that "When concluding this agreement, The insurer shall clearly explain the terms of this agreement to the insured, especially the exemption clause." The agreement is accompanied by "Ping An Employer's Liability Insurance Clause (Paragraph A)" and "Ping An Employer's Liability Insurance Additional Clause", in which the last paragraph of paragraph B of the disability grade compensation ratio special clause in the additional insurance clause states that "this additional insurance clause is inconsistent with the main insurance clause, this additional insurance clause shall prevail; Except that it is not covered, the main insurance clause shall prevail." August 31, 2020 Company B to Ping An Insurance Company to take out employer liability insurance, the policyholder, the insured and the beneficiary are Company B, the main insurance per death limit disability compensation limit of 800000 yuan, the insurance period from 0:00 on September 1, 2020 to 24:00 on September 30, 2020. Among them, article 15 of the special agreement clause of article 13 of the policy stipulates that "in case of traffic accident claims, all cases shall be compensated according to the traffic accident confirmation issued by the traffic police, and our company shall make compensation according to the accident proportion". article 14 the second list of insured persons includes company B and company a, and Xia mou is included in the list of liability insurance personnel of ping an employer. Therefore, Company A sued the people's court for Ping An Insurance Company, Company B and Company C to pay Company A 770000 yuan in compensation for work death.

Court decision results:

Ping An Property Insurance Company pays 770000 yuan to Company A, and Company B and Company C are not responsible.

Court decision point of view:

The focus of the dispute between the parties in this case is the validity of the proportional compensation clause advocated by Ping An Insurance Company. Regarding this focus issue, the above clause makes another agreement on insurance liability outside the scope of compensation of the insurance contract involved. According to this clause, when the employee of the insured is responsible for a certain proportion of the traffic accident, Ping An The liability of the insurance company will be exempted accordingly, so this clause is an exemption clause. In the case that Ping An Insurance Company cannot prove that it has fulfilled the obligation of prompt and clear explanation to the policyholder in respect of this clause, the clause does not belong to the content of the contract and is not binding on Company A. Ping An Insurance Company's claim to exempt 50% of the liability in this case cannot be established and the court will not support it.

Brief facts of the case:

On October 20, 2017, a company, as the insured, signed a "cooperation agreement" with the people's financial insurance company. a company insured its 51 employees with employer's liability insurance, of which the liability limit for casualties per person was 500000 yuan, and the total insurance premium was 10200 yuan. the insurance period was from 00: 00 on October 21, 2017 to 24: 00 on October 20, 2018. Article 3 of the Employer Liability Insurance Agreement of a City Security Service Company states: During the insurance period, the insured's staff members are disabled or disabled due to the following circumstances in the People's Republic of China (excluding Hong Kong, Macau and Taiwan). Death, in accordance with the People's Republic of China laws, the insured shall bear the economic compensation liability, and the insurer shall be responsible for compensation in accordance with this insurance contract: (1) During working hours and workplace, injured by an accident due to work reasons... (V) injured due to work reasons or missing in an accident during the period of going out of work... (IX) other circumstances that shall be recognized as work-related injuries as stipulated by laws and administrative regulations. Su is within the scope of insurance for a company. On October 24, 2017, the people's financial insurance company issued a 10200 yuan insurance premium invoice for a company. On November 14, 2019, the Human Resources and Social Security Bureau of a certain city issued a work-related injury determination decision, which determined that the accident injury suffered by Su was within the scope of work-related injury determination and was identified as a work-related injury. On May 13, 2020, a company filed an administrative lawsuit with a municipal court against the decision to identify a work injury, and on August 20, 2020, a municipal court issued an administrative judgment rejecting a company's claim. On January 4, 2021, the Labor and Personnel Dispute Arbitration Commission of a certain city issued an arbitration mediation agreement, and a family member of Su and a company of the respondent reached a mediation agreement: the respondent was 1. to pay the applicant a one-time work death subsidy for Su's family member, Funeral subsidies, dependent relatives pensions and other one-time work death benefits totaling 700000 yuan. A company sued to pay 500000 yuan to the people's insurance company.

Court decision results:

The people's insurance company pays 500000 yuan to a company.

Court decision point of view:

According to the Supreme People's Court on the application<中华人民共和国保险法>Article 9 of the (II) for the Interpretation of Certain Issues stipulates that the clauses in the format contract text provided by the insurer that exempt or reduce the insurer's liability, such as the exemption clause, deductible, deductible, proportional payment or payment, may be recognized as the insurance law Article 17, paragraph 2, provides for the "exemption clause of the insurer's liability". According to the understanding of this article, the Human Financial Insurance Company stated that in accordance with the Employer's Liability Insurance Clause, in the event of an insurance accident, if there is other insurance with the same protection (including work injury insurance), regardless of whether the insurance compensation is or not, the insurer is only liable for the difference. This clause is an exemption clause, and the human financial insurance company has no evidence that it has prompted and clearly stated the exemption clause to a company when it is insured by a company, and there is no evidence that it has delivered the employer liability insurance clause to a company, so the clause has no effect on a company.

When the insured employee has a work-related accident, the insurer may not necessarily be liable for compensation, the key depends on the specific agreement of the employer's liability insurance contract and whether there is a statutory or/and agreed exemption.

1, respect for the autonomy of the parties, first of all, according to the employer liability insurance contract agreement to determine the insurer's liability for compensation.

In judicial practice, the agreement on insurance accidents in employer liability insurance contracts is generally consistent with the scope of industrial accidents stipulated in Article 14 and Article 15, paragraph 1, of the Regulations on Industrial Injury Insurance. However, there are also cases in which the corresponding scope is expanded or limited. For example, the time when the accident occurs is expanded from "working hours" to "all day", or the restriction of "workplace" is removed. For another example, in the case of traffic accidents, remove the limitation of "not my main responsibility" and the limitation of "on the way to and from work", so as to extend it to all-weather, various forms of traffic accidents. For the validity of such an agreement, based on the principle of autonomy of the parties, especially the agreement is mostly beneficial to the insured, so first of all, of course, the autonomy of the parties should be fully respected. In determining whether the insurer has the relevant obligation to pay, the relevant agreement of the employer's liability insurance contract should first be identified.

2. A side-by-side examination of whether there are relevant circumstances under which the insurer may be exempted in whole or in part.

(1) Statutory exemption: force majeure

According to the provisions of Article 180 of the Civil Code of my country, due to force majeure events, such as earthquakes, typhoons, floods and other natural disasters, as well as strikes, riots, military operations, wars and other abnormal social events, causing injuries to the insured's employees, In case of disability or death, the insurer may claim exemption from liability for compensation.

(2) The insurance contract provides for exemption.

Employer liability insurance contracts usually also provide for the full or partial exemption of the insurer's liability to reasonably exclude the possibility of the insurer assuming the risk of an unreasonable accident. As long as when the insurance contract is signed, the parties to the contract have the civil capacity to sign the contract, the signing of the contract is the expression of their true intention, and the content of the contract does not violate the mandatory provisions of laws and administrative regulations, the terms of the contract shall be valid.

In particular, it should be noted that, according to Article 496 of the Civil Code of China and Article 17 of the Insurance Law, if an insurance contract is concluded using the form of an insurance policy, insurance policy, etc. provided by the insurer, and the aforementioned provisions relating to the exemption of the insurer's liability are contained in such form clauses, the insurer shall, at the time of the conclusion of the contract, make a prompt sufficient to attract the attention of the policyholder on the insurance policy, insurance policy or other insurance certificate containing such exemption clause, and make a clear statement to the policyholder in writing or orally on the contents of such form and exemption clause, otherwise such clause shall have no effect.

Article 2 The term "insurance" as used in this Law refers to a commercial insurance act in which the applicant pays insurance premiums to the insurer in accordance with the contract, and the insurer is liable for compensation for property losses caused by the occurrence of an accident that may occur as stipulated in the contract, or when the insured is dead, disabled, sick, or reaches the age or period stipulated in the contract.

Article 17 With regard to the clauses in the insurance contract that exempt the insurer from liability, the insurer shall, when concluding the contract, make a prompt sufficient to attract the attention of the applicant on the insurance policy, insurance policy or other insurance certificate, and make a clear explanation to the applicant in writing or oral form of the content of the clause; if there is no prompt or clear explanation, the clause shall not be effective.

Article 18 Where there is an exemption clause on insurance liability in an insurance contract, the insurer shall make it clear to the applicant when concluding the insurance contract, and if it is not clearly stated, the clause shall not take effect.

Article 143 A civil juristic act that meets the following conditions shall be valid:

The (I) actor has the corresponding capacity for civil conduct;

(II) meaning is true;

The (III) does not violate the mandatory provisions of laws and administrative regulations, and does not violate public order and good customs.

Article 496 A standard clause is a clause drawn up in advance by the parties for the purpose of repeated use and not negotiated with the other party at the time of conclusion of the contract.

Where a contract is concluded by standard terms, the party providing the standard terms shall follow the principle of fairness to determine the rights and obligations between the parties, and take reasonable measures to remind the other party to pay attention to the terms that have a significant interest in the other party, such as the exemption or reduction of its responsibilities, and explain the terms in accordance with the requirements of the other party. If the party providing the format clause fails to perform its obligation to prompt or explain, resulting in the other party failing to pay attention to or understand the clause in which it has a material interest, the other party may claim that the clause does not become the content of the contract.

Article 14 Any of the following circumstances of an employee shall be recognized as a work-related injury:

(I) are injured by accidents due to work during working hours and in the workplace;

Those who are injured by accidents while engaged in work-related preparatory or finishing work in the workplace before and after (II) working hours;

(III) suffer accidental injuries such as violence due to the performance of work duties during working hours and in the workplace;

(IV) suffering from occupational diseases;

When a (V) is out of work, he is injured due to work or his whereabouts are unknown in an accident;

On the way to and from work, the (VI) is injured by a traffic accident or urban rail transit, passenger ferry or train accident that is not his main responsibility;

Other circumstances that shall be recognized as work-related injuries in (VII) with the provisions of laws and administrative regulations.

Article 15 Any of the following circumstances shall be regarded as a work-related injury:

(I) died of sudden illness during working hours or at the post, or died within 48 hours after emergency treatment failed;

(II) being harmed in activities such as emergency rescue and disaster relief to safeguard national or public interests;

(III) employees who originally served in the army and were disabled due to war or duty injuries, have obtained a revolutionary disabled soldier certificate, and their old injuries recurred after they arrived at the employer.

General Provisions

Article 1 This insurance contract consists of insurance terms, insurance policies, insurance policies and approval forms. All agreements relating to this insurance contract shall be in writing.

Article 2 All joint stock limited companies, limited liability companies, state-owned enterprises, institutions, foreign-funded enterprises, private enterprises, collective enterprises and all kinds of enterprises contracted by collectives or individuals that are registered with the administrative departments for industry and commerce of the People's Republic of China (except Hong Kong, Macao and Taiwan, the same below) with business licenses can be regarded as the insured of this insurance contract.

Insurance Liability

Article 3 During the insurance period, the employees employed by the insured who are engaged in the business work of the insured during the employment process (including commuting) suffer accidental injury or suffer from disability or death caused by occupational diseases prescribed by the state. In accordance with the People's Republic of China laws (excluding the laws of Hong Kong, Macao and Taiwan, the same below), the insured shall bear the economic compensation liability, and the insurer shall be responsible for compensation in accordance with this insurance contract.

The employees employed by the insured refer to those who have reached the age of 16 and other special personnel who have been approved in accordance with national regulations and legal channels who provide services for the insured and receive remuneration within a certain or indefinite period of time. Registered employees, short-term workers, temporary workers, seasonal workers and apprentices, except for those who are not insured at the time of an insured accident. Unless otherwise specified, the insured employee does not include the insured's contractor and other third party employees.

Article 4 After the occurrence of an insurance accident, if the insured is filed for extension or litigation due to the enemy of the insurance, the arbitration or litigation expenses paid by the insured and other necessary and reasonable expenses paid with the written consent of the insurer in advance (Hereinafter referred to as "legal expenses"), the insurer shall also be responsible for compensation in accordance with this insurance contract.

Liability Exemption

Article 5 The insurer shall not be liable for compensation for losses, expenses and liabilities caused by the following reasons:

(I) the intentional acts of the insured, the insured and their representatives;

(II) war, hostilities, military acts, armed conflicts, strikes, riots, insurrections, terrorist activities;

(III) nuclear radiation, nuclear explosions, nuclear contamination and other radioactive contamination;

(IV) air pollution, land pollution, water pollution and other kinds of pollution;

(V) administrative or judicial acts;

(VI) the intentional or illegal acts of the employees employed by the Insured;

(VII) the employees employed by the insured receive medical treatment and diagnosis and treatment due to diseases other than occupational diseases, infectious diseases, childbirth, abortion and the above reasons;

(VIII) the employees employed by the insured from self-harm, self-injury, suicide, fighting, fighting and driving various motor vehicles without a legal and valid driving license; (IX) the employees employed by the insured are affected by alcohol or drugs due to non-professional reasons.

Article 6 The insurer shall not be liable for the following losses, expenses and liabilities:

(I) the contractual liability that the insured should bear, except for the economic liability that should still be borne by the insured when there is no contract;

(II) fines, penalties and punitive damages;

(III) compensation for mental damage;

(IV) indirect losses;

(V), unless otherwise agreed, the disability or death of the employee employed by the Insured occurring outside the the People's Republic of China;

Unless otherwise agreed by the (VI), medical expenses other than the catalogue of basic medical insurance and work-related injury insurance diagnosis and treatment items, drug catalogue, scope of medical service facilities and payment standards of the employees employed by the insured;

(VII) the deductible stated in this insurance contract.

Article 7 The insurer shall not be liable for other losses, expenses and liabilities that do not fall within the scope of insurance liability.

Limits of liability and deductibles

Article 8 The limit of liability includes the cumulative limit of liability and the limit of liability per person, of which the limit of liability per person is divided into the limit of liability for casualties per person, the limit of liability for medical expenses per person and the limit of liability for litigation expenses per person, which shall be determined by the applicant and the insurer in consultation and set out in the insurance contract.

Article 9 The deductible amount of medical expenses per person for each accident shall be determined by the insured and the insurer in consultation at the time of signing the insurance contract and shall be stated in the insurance contract.

Insurance period

Article 10 Unless otherwise agreed, the period of insurance shall be one year, subject to the starting and ending time specified in the insurance policy.

Obligations of the Insurer

Article 11 When concluding this insurance contract, if the standard terms provided by the insurer are adopted, the insurance policy provided by the insurer to the insured shall be accompanied by the standard terms, and the insurer shall explain the contents of this insurance contract to the insured. For the clauses in this insurance contract that exempt the insurer from liability, the insurer shall, when concluding the contract, make a reminder on the insurance policy, insurance policy or other insurance certificate that is sufficient to attract the attention of the applicant, and the content of the clause in written or oral form The policyholder makes a clear explanation; if there is no prompt or clear explanation, the clause shall not be effective.

Article 12 After the establishment of this insurance contract, the insurer shall promptly issue an insurance policy or other insurance certificate to the policyholder.

Article 13 If, in accordance with the agreement of Article 24, the insurer considers that the proof and information on the claim provided by the insured is incomplete, it shall promptly notify the insured and the insured of the supplementary provision.

Article 14 After receiving the insured's request for compensation insurance money, the insurer shall promptly make a verification of whether it is an insurance liability; if the situation is complicated, it shall make a verification within 30 days, unless otherwise agreed in this insurance contract.

The insurer shall notify the insured of the result of the verification; if it is an insurance liability, it shall perform the obligation of compensation insurance within ten days after reaching an agreement with the insured on compensation insurance. If there is an agreement in this insurance contract on the period of compensation for insurance money, the insurer shall perform the obligation of compensation for insurance money in accordance with the agreement. The insurer shall, in accordance with the provisions of the preceding paragraph, issue a notice of refusal to compensate for the insurance benefits to the insured within three days from the date of the approval, and explain the reasons.

Article 15 If the insurer cannot determine the amount of the compensation insurance within 60 days from the date of receipt of the request for compensation insurance and relevant certificates and materials, it shall first compete for payment in accordance with the amount determined by the existing certificates and materials; after the insurer finally determines the amount of compensation, it shall pay the corresponding difference.

Obligations of the insured and the insured

Article 16 If an insurance contract is concluded and the insurer inquires about the subject matter of the insurance or the insured, the applicant shall inform him truthfully.

If the applicant intentionally or due to gross negligence fails to perform the obligation of truthful disclosure stipulated in the preceding paragraph, which is sufficient to affect the insurer's statutory consent to underwrite or increase the insurance rate, the insurer shall have the right to terminate the insurance contract.

The right to rescind a contract provided for in the preceding paragraph shall be extinguished without exercise for more than 30 days from the date on which the insurer becomes aware of the cause of rescission. If more than two years have passed since the date of the establishment of the contract, the insurer shall not terminate the contract; if an insurance accident occurs, the insurer shall bear the responsibility of paying the insurance money.

If the insured intentionally fails to perform the obligation of truthful disclosure, the insurer shall not be liable for the insurance premium and shall not refund the insurance premium for the insurance accident that occurred before the termination of the contract.

If the insured fails to perform the obligation of truthful notification due to gross negligence, which has a serious impact on the occurrence of an insurance accident, the insurer shall not be liable for compensation for the insurance accident that occurred before the termination of the contract, but shall refund the insurance premium.

If the insurer has known at the time of the conclusion of the contract that the insured has not truthfully informed the insured, the insurer shall not terminate the contract.

Article 17 Unless otherwise agreed, the insurance applicant shall pay the insurance premium at the time of the establishment of the insurance contract.

If the policyholder fails to pay the insurance premium in full and on time as agreed, the insurer shall have the right to terminate this insurance contract, and the insurance contract shall be terminated when the written notice of the insurer's termination of this insurance contract is served on the policyholder, and the insurer shall have the right to collect the insurance premium from the policyholder for the period from the date of commencement of the insurance liability to the date of termination of this insurance contract. The insurer shall be liable for compensation for the insurance accident that occurred before the termination of the contract in accordance with the proportion of the insurance premium paid by the insured at the time of the insurance accident and the insurance premium payable in this insurance contract.

Article 18 The insured and the insured shall properly record the name of each employed employee and his salary/salary, overtime, bonus and other allowances, and agree to the insurer's inspection when necessary.

Article 19 the insured shall strictly abide by the the People's Republic of China Labor Law, the the People's Republic of China Labor contract Law and the state regulations on fire control, safety, production operation and labor protection, strengthen management, take reasonable preventive measures, and try to avoid or reduce the occurrence of liability accidents.

The insurer may inspect the insured's compliance with the provisions of the preceding paragraph and make written suggestions to the insured and the insured to eliminate unsafe factors and hidden dangers, and the insured and the insured shall earnestly implement them.

If the insured or the insured fails to perform the above-mentioned safety obligations in accordance with the agreement, the insurer shall have the right to request an increase in the insurance premium or terminate the contract.

Article 20 During the validity period of the insurance contract, if the important matters specified in the insurance contract, including the list of employees employed by the insured, change or the degree of danger of the subject matter of the insurance increases significantly, the insured shall promptly notify the insurer in writing, and the insurer may increase the insurance premium or terminate the contract.

If the insured fails to perform the notification obligation stipulated in the preceding paragraph, the insurer shall not be liable for compensation for the insurance accident that occurs due to the significant increase in the risk of the subject matter of the insurance.

Article 21 Upon knowledge of the occurrence of an insured accident, the insured shall:

The (I) shall make every effort to take necessary and reasonable measures to prevent or reduce the loss, otherwise, the insurer shall not be liable for compensation for the further loss;

The (II) shall notify the insurer in time, and explain the cause, course and loss of the accident in writing; if the nature, cause and loss of the insured accident are difficult to determine due to intentional or gross negligence, the insurer shall not be liable for compensation for the part that cannot be determined, except that the insurer has known or should have known the occurrence of the insured accident in time through other channels;

(III) protect the accident site, allow and assist the insurer in the accident investigation. If the insurer refuses or obstructs the investigation of the accident, resulting in the inability to determine the cause of the accident or verify the loss, the insurer shall not be liable for the part that cannot be verified.

Article 22 When the insured receives the claim for damages from the employee or his family member, he shall notify the insurer immediately. Without the written consent of the insurer, the insurer shall not be bound by any promise, refusal, bid, agreement, payment or compensation made by the insured to the victim and his agent. The insurer shall have the right to re-approve the amount of compensation promised or paid by the insured on its own, and the insurer shall not be liable for compensation if it does not fall within the scope of this insurance liability or exceeds the limit of compensation. In the course of handling claims, the insurer has the right to handle any claim for which it is ultimately liable, and the insured is obliged to provide the insurer with the information and assistance it can provide.

Article 23 When the insured learns that litigation or arbitration may occur, he shall immediately notify the insurer in writing; after receiving the court summons or other legal documents, he shall send a copy of it to the insurer in a timely manner. The insurer shall have the right to handle the relevant litigation or arbitration matters in the name of the insured, and the insured shall provide relevant documents and give necessary assistance. The insurer shall not be liable for extended losses resulting from the failure to provide the above-mentioned notice or necessary assistance in a timely manner.

Article 24 When requesting compensation, the insured shall provide the insurer with the following certificates and information:

the original (I) insurance policy;

(II) written claims;

(III) the certificate of the employment relationship between the insured and the employed employee and the salary certificate of the employed employee;

Accident certificate, liability certificate or other relevant legal documents issued by the relevant institution recognized by the (IV) insurer, and industrial injury certificate issued by the labor security administrative department;

Disability certificate, death certificate or other certificates issued by relevant (V) departments or institutions;

List of (VI) losses and relevant payment vouchers;

(VII) medical expense receipts, diagnosis certificates, hospitalization certificates and medical records issued by hospitals at or above the county level (including the county level) or medical institutions recognized by the insurer;

(VIII) other certificates and information that can be provided by the insured and the insured to confirm the nature, cause and extent of loss of the insurance accident.

If the insured fails to perform the obligation to provide the claim materials stipulated in the preceding paragraph, resulting in the insurer being unable to verify the loss, the insurer shall not be liable for the part that cannot be verified.

Compensation processing

Article 25 The indemnity of the insurer shall be based on the indemnity liability of the insured determined in one of the following ways:

(I) consultation between the Insured and the employed employee or his or her family members who filed the claim for damages and confirmed by the Insurer;

(II) arbitral award;

judgments of (III) people's courts;

(IV) other means approved by the insurer.

Article 26 If the insured causes damage to a third party and the insured fails to compensate the third party, the insurer shall not compensate the insured for the insurance money.

Article 27 Within the scope of your insurance, the insured shall be liable for the economic compensation for the disability and death of its employees due to the reasons specified in this insurance contract, and the insurer shall be responsible for compensation in accordance with this insurance contract:

(I) death

If the employee employed by the insured dies due to the causes specified in this insurance contract, the insurer shall make compensation within the limit of liability for casualties per person stipulated in the insurance contract.

If the insurer has paid the disability compensation according to Item (II) of this Article before the death of the employed employee, the amount of death compensation shall be the balance after deducting the paid disability compensation.

(II) disability

1. Permanent loss of full capacity to work

If the employee employed by the insured permanently loses all working ability due to the reasons specified in this insurance contract, the insurer shall make compensation within the limit of liability for casualties per person stipulated in the insurance contract.

2, permanent loss of part of the ability to work

If the employee employed by the insured permanently loses part of the ability to work due to the reasons specified in this insurance contract, the insurer shall, in accordance with the certificate of disability issued by the medical institution approved by the insurer, multiply the percentage specified in Appendix II by the amount of the limit of liability for casualties per person.

When the employee employed by the insured causes more than one disability in Appendix II due to reasons within the same insurance liability, if the two disabilities correspond to different disability levels, the higher level is the disability level; if the two disabilities correspond to the same disability level, the upper level of this level is the disability level; if the disability item corresponds to more than three disability levels (including three), the highest level is the level of disability. However, in no case shall the level of disability be higher than that set out in Appendix II.

Article 28 The insured shall pay the medical expenses for the disability and death of the employees he employs due to the reasons specified in this insurance contract, and the insurer shall deduct the deductible amount of medical expenses per person for each accident. Compensation shall be made within the limit of liability for medical expenses. Medical expenses include registration fees, treatment fees, operation fees, bed fees, examination fees (limited to 300 yuan), and non-self-paid medicine expenses, but do not include accompanying fees, meals, nutrition, transportation, heating, air conditioning and installation of prostheses, dentures, artificial eyes and disabled appliances.

Except for emergency rescue, the employees employed by the insured shall see a doctor in a hospital at or above the county level (including the county level) or a medical institution recognized by the insurer.

Article 29 if the employee employed by the insured is temporarily incapacitated for more than five days (excluding five days) due to the reasons specified in this insurance contract, the insurer shall be responsible for compensating the insured for the lost work expenses of the employee who is temporarily incapacitated.

The calculation method of lost work expenses is: the declared monthly salary standard of the employed employee who is temporarily incapacitated/30 x (the actual number of days of temporary incapacity of the employed employee who is temporarily incapacitated -5 days). The actual number of days of temporary incapacity is limited to the date of expiration of the employee's medical care and the date of determination of the degree of disability, up to a maximum of 365 days.

If the employee who is temporarily incapacitated by the insured is diagnosed by the medical institution as permanently incapacitated in whole/in part, the insurer shall determine the amount of compensation in accordance with the agreement of item (II) of Article 27, which shall be paid within the limit of liability for casualties per person in combination with the cost of lost work.

Article 30 the amount of compensation for the legal expenses of each accident shall be calculated separately by the insurer in accordance with the provisions of this insurance contract in addition to the amount of compensation calculated in articles 27, 28 and 29; among them, the amount of compensation for the employees employed by each insured shall not exceed the limit of liability for litigation expenses per person specified in the insurance policy.

Article 31 During the insurance period, the amount of sub-compensation for each employee employed by the insurer one or more times shall not exceed the liability limit for each person's casualty, the liability limit for medical expenses and the liability limit for each person's litigation expenses specified in the insurance policy, and the sub-liability limits shall not be used for mutual adjustment. When the amount of one or more indemnities by the insurer reaches the sub-item liability limit, the liability of the sub-item shall be terminated.

Article 32 if the insured needs to obtain the consent of the insurer according to the number of employees employed by the insured due to the nature of his work, if the actual number of employees exceeds the number of insured persons in the event of an insurance accident, the insurer shall be liable for compensation in accordance with the proportion of the number of insured persons to the actual number of employees; if the insured is insured according to the list of employees employed by the insured, the insurer shall only be liable for compensation for the employees listed.

Article 33 In the event of an insurance accident, if the insured's loss can also be compensated under other insurance with the same protection, the insurer shall be liable for compensation in accordance with the liability limit of this insurance contract and the liability limit of other insurance contracts and this contract. The ratio of the sum of the limits.

The amount of compensation to be borne by other insurers shall not be paid by the insurer. If the insured fails to truthfully inform the insurer that causes the insurer to pay more compensation, the insurer has the right to recover the portion of the overpayment from the insured.

Article 34 In the event of a loss within the scope of insurance liability, the responsible party shall be responsible for compensation, the insurer shall, from the date of compensation to the insured, exercise the insured's right to claim compensation from the responsible party within the scope of the amount of compensation, and the insured shall provide the insurer with the necessary documents and relevant information known to the insurer.

If the insured has already obtained compensation from the responsible party, the insurer may deduct the amount of compensation that the insured has obtained from the responsible party accordingly when the insurer compensates for the insurance premium.

After the occurrence of an insurance accident, if the insured waives the right to claim compensation from the relevant responsible party before the insurer fails to pay the insurance money, the insurer shall not bear the liability for compensation; after the insurer pays the insurance money to the insured, if the insured waives the right to claim compensation from the relevant responsible party without the consent of the insurer, the act shall be invalid; if the insurer is unable to exercise the right of subrogation to claim compensation due to the insured intentionally or due to gross negligence, the insurer may deduct or demand the return of the corresponding insurance premium.

Article 35 The limitation period for the insured to claim compensation from the insurer shall be two years, counting from the date on which the insured knew or should have known of the occurrence of the insurance accident.

Dispute Handling and Law Application

Article 36 Any dispute arising from the performance of this insurance contract shall be settled by the parties through consultation. If the negotiation fails, it shall be submitted to the arbitration institution specified in the insurance policy for arbitration; if the insurance policy does not specify the arbitration institution and no arbitration agreement has been reached after the dispute has occurred, the the People's Republic of China People's Court shall be sued in accordance with the law.

Article 37 the People's Republic of China laws shall apply to the settlement of disputes arising from this insurance contract.

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