Eastern China Traffic Accident Ruling: Insurance Company Ordered to Pay 77,548 Yuan for Victim Injury

Eastern China Traffic Accident Ruling: Insurance Company Ordered to Pay 77,548 Yuan for Victim Injury

CASE OVERVIEW

A Chinese appeals court upheld a lower court ruling requiring an insurance company to pay 77,548.12 yuan in compensation to a traffic accident victim. The insurer argued that non-medical insurance drug costs should be excluded from the payout. The court rejected this argument, holding that compulsory traffic insurance (jiaqiangxian) must cover all reasonable medical expenses without distinguishing between medical insurance and non-medical insurance drugs.

CASE BACKGROUND AND FACTS

On September 7, 2009, at approximately 6:40 AM, Mr. Fang was driving a sedan from Maozhubu Bridge along Jiyang Road toward Huanjiang Middle School in Eastern China. He collided with an electric bicycle operated by Mr. Zhang, causing Mr. Zhang to suffer personal injury and damage to the bicycle. The accident resulted in medical expenses of 14,143.92 yuan, plus towing and parking fees of 265 yuan.

Mr. Zhang sustained injuries that were assessed as a Class 10 disability by Shaoxing Minghong Judicial Appraisal Institute. He incurred appraisal fees of 1,600 yuan. The insurance company, People’s Property Insurance Company of China, a branch in Eastern China, disputed the disability level and work loss period and requested a second appraisal. Jinhua Jingcheng Judicial Appraisal Institute conducted the re-appraisal, confirming a Class 10 disability and recommending a work loss period of 120 days. This second appraisal cost 1,640 yuan.

Mr. Zhang had resided at a property in a local residential complex since 2007 and obtained the property certificate in 2010. The sedan was insured with the insurance company under a compulsory traffic insurance policy and a third-party liability policy with a limit of 300,000 yuan, effective from May 3, 2009, to May 2, 2010.

COURT PROCEEDINGS AND EVIDENCE

Mr. Zhang filed a lawsuit seeking total compensation of 94,522.52 yuan. The first instance court calculated his losses as follows: medical expenses 14,143.92 yuan, lost work income 9,036 yuan, nursing fees 1,807.20 yuan, transportation fees 300 yuan, hospitalization meal subsidies 360 yuan, appraisal fees 1,600 yuan, disability compensation 49,222 yuan, emotional distress damages 2,000 yuan, vehicle loss 579 yuan, towing fees 100 yuan, parking fees 165 yuan, and evaluation fees 100 yuan. Total losses amounted to 79,413.12 yuan.

The first instance court ordered the insurance company to pay 77,548.12 yuan and Mr. Fang to pay 1,865 yuan. The insurance company appealed, arguing that the medical expense award of 14,143.92 yuan was improper because it included 2,251.29 yuan for non-medical insurance drugs that should have been excluded.

COURT FINDINGS AND JUDGMENT

The appeals court affirmed the lower court decision. The court held that the legislative purpose of compulsory traffic insurance is to provide basic protection for traffic accident victims. Under the Road Traffic Safety Law, insurance companies have a statutory obligation to compensate victims for personal injury and property losses within the compulsory insurance limit. The court stated that victims are entitled to claim reimbursement for all reasonable medical expenses, without distinguishing between medical insurance and non-medical insurance drugs. Any clause in the insurance policy excluding non-medical insurance drugs from coverage cannot override the victim’s statutory right to claim compensation from the insurer. The court dismissed the appeal and ordered the insurance company to pay the second instance litigation fee of 50 yuan.

KEY LEGAL PRINCIPLES

The court emphasized that compulsory traffic insurance is designed to guarantee basic compensation for accident victims. Insurance policy exclusions that conflict with statutory obligations are not enforceable against third-party victims. Reasonable medical expenses incurred by victims must be fully covered within the compulsory insurance limit, regardless of whether the drugs are on the medical insurance reimbursement list.

PRACTICAL INSIGHTS

This case clarifies that insurance companies cannot avoid paying for non-medical insurance drugs in compulsory traffic insurance claims. Victims and their legal representatives should be aware that all medically necessary treatment costs are recoverable. Insurers should not rely on policy exclusions to deny such claims when dealing with third-party victims.

LEGAL REFERENCES

Road Traffic Safety Law of the People’s Republic of China, Article 76
Insurance Law of the People’s Republic of China, Article 65
Civil Procedure Law of the People’s Republic of China, Article 153, Paragraph 1, Item 1

DISCLAIMER

This article is for informational purposes only and does not constitute legal advice. Laws and regulations may vary by jurisdiction. Readers should consult a qualified legal professional for advice specific to their situation.