保险责任认定
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保险期间内发病、期外确诊 重疾险能不能赔?
Jin Rong Shi Bao· 2026-01-07 02:53
庭审中,某财险公司主张确诊和鉴定时间均超出保险期限,且保险条款对重疾有明确释义,不应承 担责任。 港北区人民法院经审理支持了王芳的诉求。判决主要基于以下两点法律逻辑: 一是关于"保险事故发生时间"的认定。法官认为,从案件事实来看,王芳确诊时间虽在保险期限届 满之后,但其病情在保险期间内已处于发展状态并出现左侧肢体无力、言语不清等明显症状,应认定为 保险期间内发病,属于保险责任范围。根据《保险法》第三十条规定,采用保险人提供的格式条款订立 的保险合同,保险人与投保人、被保险人或者受益人对合同条款有争议的,应当按照通常理解予以解 释。对合同条款有两种以上解释的,人民法院或者仲裁机构应当作出有利于被保险人和受益人的解释。 本案保险合同中约定"被保险人在疾病观察期后因意外伤害以外的原因,被确诊初次发生合同约定的重 大疾病,按保险金额给付重大疾病保险金",并未约定确诊时间必须在保险期限内才承担赔偿责任,保 险公司与被保险人对该条款有争议,应作出有利于被保险人的解释,保险公司以此拒赔无事实与法律依 据。 人们购买重疾险本是为了规避风险,但在实际理赔中,保险事故的"时间点"界定常常容易引发纠 纷,值得引起保险消费者的关注。 ...
责任主体转向制造商!美国银行预警自动驾驶将改写保险规则
智通财经网· 2025-08-22 02:26
Core Insights - The rise of autonomous vehicles is fundamentally reshaping the auto insurance industry, shifting liability from drivers to manufacturers and software providers, potentially alleviating long-standing losses in liability insurance [1] - Despite concerns that technological advancements may compress insurance profits, data analysis suggests that while autonomous driving can reduce accident frequency, the severity of accidents has increased, offsetting cost savings [1] - Goldman Sachs predicts that the U.S. auto insurance market, currently valued at $400 billion, will undergo significant restructuring due to autonomous driving, with costs per mile potentially dropping from $0.5 to $0.23 by 2040, a reduction of over 50% [1] Market Size and Opportunities - Goldman Sachs forecasts a virtual driver market in the autonomous trucking sector to reach approximately $5 billion by 2030, with the overall autonomous vehicle market expected to exceed $7 billion [2] - The current debate centers on liability determination, as existing laws assign responsibility to drivers, but in autonomous scenarios, it will shift to product liability and cybersecurity insurance [2] Company and Regulatory Landscape - Companies such as Tesla, Waymo (Google), and Aurora are viewed positively for their long-term value, while insurance leaders like Progressive are seen as beneficiaries, with market reactions to technological risks being perceived as overly cautious [2] - Regulatory environments in states like Texas are becoming more accommodating for testing autonomous vehicles, requiring them to be equipped with cameras, comply with traffic laws, and carry insurance, although national liability standards still require federal legislation or judicial rulings for clarity [2] - Progressive and other insurers are leveraging their long-term investments in connected vehicle insurance to strengthen their market positions, enhancing customer acquisition and precise pricing strategies to expand market share during the industry transition [2]