交通事故中的非医保用药，保险公司赔不赔？

Core Viewpoint - The case highlights the legal complexities surrounding insurance claims related to non-medical insurance drug costs in traffic accident scenarios involving delivery personnel [1][2]. Group 1: Incident Overview - A delivery rider was involved in a traffic accident that resulted in injuries to another party, leading to a court case regarding insurance claims for non-medical drug costs [1]. - The rider was found fully responsible for the accident, and the company had purchased employer liability insurance with third-party liability coverage for the rider [1]. Group 2: Insurance Company Position - The insurance company acknowledged the rider was performing work duties at the time of the accident but argued that non-medical drug costs should be deducted from the compensation [2]. - The company contended that it had not specified the non-medical drug costs in the medical bills and did not provide evidence for alternative medications covered by insurance [2]. Group 3: Court Ruling - The court ruled that the insurance contract was binding and that the company had the right to seek compensation from the insurer after fulfilling its payment obligations [2]. - The court found the insurer's argument regarding the deduction of non-medical costs unconvincing due to a lack of evidence specifying those costs [2]. Group 4: Legal Interpretation - The "non-medical drug costs" clause is a common limitation in insurance contracts, which excludes coverage for expenses outside the medical insurance directory [3]. - According to the Insurance Law of the People's Republic of China, insurers must clearly inform policyholders about such exclusion clauses for them to be legally effective [3][4]. Group 5: Judicial Guidelines - Judicial interpretations provide that insurers must prove that medical expenses exceed the standard costs of similar treatments covered by insurance [4]. - Insurers are required to demonstrate the existence of alternative treatments within the insurance directory and provide evidence of cost differences to avoid liability for excess expenses [4].