The principle of proximate cause in insurance claims, the principle of proximate cause in insurance

The principle of proximate cause refers to the most direct and effective cause of the loss of the subject matter of insurance, which is the principle that must be followed in the process of insurance claims. In other words, there must be a direct causal relationship between the occurrence of the insured accident and the formation of the fact of loss, in order to constitute the conditions for insurance compensation.

The flexible application of the principle of proximate cause in insurance is a means for consumers to protect their rights.

The claim is based on the proximate cause.

In real life, there are various causes of loss, and the application of the proximate cause principle varies for different causes of loss. But there are two main common ones:

Single cause of loss In the case of loss caused by a single cause, it is relatively simple to operate in the actual claim settlement process. In practice, the claims adjuster only needs to determine whether the reason is an insurance liability, and the policyholder, the insured and the beneficiary often rarely have objections. For example, Zhang accidentally broke his leg while walking on a mountain road, if Zhang bought accident insurance, then the insurance company should give Zhang the corresponding insurance money, but if Zhang is insured with critical illness insurance, then the insurance company does not need to make a claim, which is obviously beyond the coverage of critical illness.

Losses due to multiple reasons Claims disputes often arise from insurance losses caused by multiple reasons. Two of these situations are the most likely to diverge. The first is the insured loss caused by multiple causes, and each of them is a proximate cause of the accident, but only some proximate causes are covered by the insurance, and the other part is out of scope.

For insurance companies, what needs to be claimed is the insurance loss within the scope of liability, and consumers can also fight for compensation for this part of the reason. On the other hand, there is a causal relationship between multiple causes of loss, which is likely to cause contradictions between consumers and insurers when determining proximate causes.

The principle of proximate cause of insurance means that the insurer only bears the insurance liability when the most direct and effective cause of loss is the insured accident within the scope of the insurance, and does not bear the liability for compensation for the loss caused by reasons outside the scope of insurance. The basic principle of judging the direct causal relationship between the risk accident and the loss of the subject matter of the insurance, so as to determine the liability of the insurance, is the principle followed by the insurance parties when handling the insurance case, or the principle of the court. In litigation cases related to insurance compensation, investigate the cause of the accident and determine the attribution of responsibility for the accident.

Extended materials: 1. The meaning and judgment criteria of common-sense principles, in a philosophical sense, common sense can be defined as "the knowledge or beliefs that normal people usually possess and can be expressed through judgments or propositions". Common sense has the following three characteristics:

Universality, immediacy, and clarity. Specific to the law because the law has a fundamental requirement that it should be universally applicable to everyone. According to this requirement, the content of the law must be common sense.

In daily life and social interactions, people have formed a relatively consistent criterion for judging causality based on their common level of life. This criterion, although not very clear-cut, does exist.

2. In this sense, the principle of common sense means that when using the principle of proximate cause to determine whether there is a direct causal relationship between the occurrence of a dangerous accident and the loss of the subject matter of insurance, it must be based on the ability to identify and usually possess a rational person. In this concept, a rational person is a person who has a normal level of intelligence and thinking abilities, able to make judgments based on his or her age level and general social standards. Of course, this article defines a rational person as an adult.

Due to the immaturity of minors' physical and mental development, their ability to make judgments is still very lacking, and they cannot be used as a standard for the public to measure.

3. The proximate cause in the insurance relationship does not refer to the cause that is closest to the loss in time or space, but the most direct and effective main cause or controlling cause of the loss. The principle of proximate cause means that there must be a direct consequence relationship between the occurrence of a dangerous accident and the formation of the loss result, and the insurer shall bear the liability for loss compensation. 4. The principle of proximate cause is one of the basic principles of the Insurance Law, that is, the insurer shall bear the insurance liability only if the proximate cause of the insured accident belongs to the scope of insurance liability.

In other words, the insurer's liability should be limited to the proximate cause of the loss caused by the insured risk. Although China's current insurance law does not directly stipulate the principle of proximate cause, in judicial practice, the principle of proximate cause has become an important criterion for judging whether the insurer should bear the insurance liability. For losses caused by a single cause, the single cause is proximal; For losses caused by multiple causes, the cause that continues to play a decisive or effective role is proximate.

If the proximate cause is within the scope of insurance liability, the insurer shall bear the insurance liability.

The principle of proximate cause of insurance claims refers to the principle followed by the insurance parties when dealing with insurance cases or court hearings of litigation cases related to insurance compensation, investigating the cause of the occurrence of the event and determining the attribution of liability for the event. According to the principle of proximate cause, when the risk accident insured by the insurer is the proximate cause of the loss of the insured object, the insurer shall be liable for compensation. At present, the principle of proximate cause has become an important criterion for judging whether an insurance company should bear the insurance liability.

For losses caused by a single cause, the single cause is the proximate cause. For losses caused by multiple causes, the causes that continue to play a decisive or effective role are proximate causes. If the proximate cause falls within the scope of insurance liability, the insurer shall be liable for insurance.

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The principle of proximate cause means that the insurer shall bear the insurance liability only when the most direct and effective cause of the loss is the insured accident within the scope of the insurance, and shall not be liable for compensation for the loss caused by the cause outside the scope of the insurance. Rather than referring to the reason that is closest in time or space.

There are multiple causes of damage, among which the cause that plays a direct and decisive role in the occurrence of the insured event is the proximate cause. Case: The captain of the ship could not sail due to illness before the ship sailed, and the first mate was approved by the port supervisor to temporarily ** the captain, and the fire accident was caused by the arson of the third mate during the voyage, and the conflict between the third mate and the first mate was not the proximate cause, and the intentional arson of the third mate was the proximate cause of the loss of the fire accident.

If multiple causes of damage work together to cause an insured event, the multiple causes are proximate. A typical case is that SARS causes death, and neither a simple chronic disease nor SARS will have the consequence of the death of the insured, but the combined effect of the two will inevitably lead to death, so both SARS and chronic diseases can be regarded as proximate causes of death.