Court Rules Insurance Company Must Pay Full Medical Costs in Eastern China Traffic Accident Case

Court Rules Insurance Company Must Pay Full Medical Costs in Eastern China Traffic Accident Case

Case Overview
A court in Eastern China has ordered an insurance company to pay full medical expenses of 85,411.02 yuan to a plaintiff injured in a traffic accident, rejecting the insurer’s argument that it should only cover costs within a sublimit and national basic medical insurance standards. The decision reinforces the principle that compulsory motor vehicle insurance aims to ensure victims receive timely compensation.

Case Background and Facts
On August 10, 2010, at approximately 4:12 PM, Mr. Huang was driving a truck owned by Hangzhou Kefu Machinery Company in Eastern China when he collided with an electric bicycle operated by Mr. Wang. The collision caused injuries to Mr. Wang and damage to his vehicle. The local traffic police determined that Mr. Huang bore primary responsibility for the accident, while Mr. Wang was found to have secondary fault.

Mr. Wang sustained multiple serious injuries, including third-degree skin burns on his right shoulder, buttocks, left buttock, both calves, and right hand. He also suffered fractures of the right second and third ribs, left clavicle, left superior pubic ramus, and pubic symphysis. Additional injuries included a lacerated lower lip, severe laceration of the left ankle, loss of the left central and lateral incisors, and multiple soft tissue contusions.

Court Proceedings and Evidence
Mr. Wang filed a lawsuit against Mr. Huang, Kefu Company, and the People’s Insurance Company of China Eastern China branch. He sought compensation for medical expenses of 86,187.37 yuan and reserved the right to claim other damages after treatment concluded. The court held a public hearing on January 11, 2011, using summary procedures.

The plaintiff submitted evidence including the traffic accident determination letter, medical records, medical expense receipts, and medication lists. The defendants did not dispute the accident facts or the traffic police’s liability determination. However, the insurance company argued that compensation should be limited to sublimit amounts within the compulsory insurance policy, specifically a 10,000 yuan cap for medical expenses. It also contended that medical costs should be reviewed against national basic medical insurance standards.

Evidence showed that Mr. Wang’s total medical expenses through December 2, 2010, amounted to 85,411.02 yuan, after deducting meal costs. Mr. Huang had already paid Mr. Wang 41,300 yuan, with 30,000 yuan to be deducted from the current claim and the remaining 11,300 yuan treated as a prepayment for future treatment. The insurance company had paid 10,000 yuan in medical expenses. The truck was insured under a compulsory motor vehicle liability insurance policy with the defendant insurance company, and the accident occurred during the policy period.

Court Findings and Judgment
The court ruled that the insurance company must compensate Mr. Wang for his losses within the compulsory insurance liability limit. The court rejected the insurer’s argument for sublimit compensation and medical cost review based on national basic medical insurance standards. The court stated that such limitations contradict the principle of fairness and the legislative purpose of the Motor Vehicle Traffic Accident Compulsory Liability Insurance Regulations, which is to ensure victims receive compensation according to law.

The court ordered the insurance company to pay Mr. Wang 85,411.02 yuan for his losses, minus the 10,000 yuan already paid by the insurer and the 30,000 yuan paid by Mr. Huang, leaving a balance of 45,411.02 yuan to be paid within ten days of the judgment taking effect. The court dismissed Mr. Wang’s other claims. Court costs of 381 yuan were divided, with Mr. Wang responsible for 181 yuan and Mr. Huang responsible for 200 yuan.

Key Legal Principles
This case establishes that compulsory motor vehicle liability insurance coverage cannot be limited by sublimits or basic medical insurance standards when compensating accident victims. The court emphasized that the purpose of compulsory insurance is to protect victims and ensure they receive compensation, not to limit insurer liability through policy provisions that conflict with statutory intent.

Practical Insights
This judgment demonstrates that courts in China prioritize victim compensation over insurance policy limitations in compulsory insurance cases. Policyholders and accident victims should be aware that insurance companies cannot avoid full liability within the policy limit by invoking sublimits or medical insurance standards. Victims should document all medical expenses and seek compensation for the full amount of reasonable medical costs.

Legal References
Tort Law of the People’s Republic of China, Articles 16 and 48
Road Traffic Safety Law of the People’s Republic of China, Article 76, Paragraph 1, Item 1
Supreme People’s Court Interpretation on Compensation for Personal Injury Cases, Article 17, Paragraph 1

Disclaimer
This article is for informational purposes only and does not constitute legal advice. Consult a qualified attorney for specific legal matters.