Lenore Chen
The Taiwan High Court rendered the 103-Bao-Xian-Shang-1 Civil Decision of March 8, 2016 (hereinafter, the “Decision”), holding that based on the principle of fairness, the burden of proof on the beneficiary of an accident injury insurance contract should be reduced; and that as long as the insured does not die of aging, illness and bacterial infection, the cause of death should basically be accident.
According to the facts underlying this Decision, the Appellee asserted that his son had obtained the insurance policy at issue from the Appellant as the insured with the Appellee as the beneficiary for the death insurance benefits under the insurance policy at issue. The son subsequently died in an accident which triggered myocardial infarction. The Appellant refused to indemnify on the ground that this was not an “external sudden accident” stipulated in the insurance policy at issue since the Appellee’s son died of cardiogenic shock caused by acute myocardial infarction. Therefore, a complaint was filed to request insurance indemnity.
According to the Decision, all insurance contracts are standard contracts. When the insured accident took place, if the beneficiary was not present, it was certainly difficult to locate any eyewitness. Since the insurance system functions to diversify risks, when the conditions are not certain, the provision concerning “obvious unfairness based on the circumstances” under the proviso of Article 277 of the Code of Civil Procedure shall be considered to reduce the burden of proof of the beneficiary. If the insurer contends that this is not an accident, the insurer shall assume the burden of proof to substantiate the fact so contended (aging, illness and bacterial infection) to meet the principle of burden of proof allocation. To wit, the burden of proof of the beneficiary should be reduced under the principle of fairness. If the insured did not die of aging, illness and bacterial infection, basically accident should be considered the cause of death.
It was further held in this Decision that the Appellee’s son slipped and bumped his head in a bathroom and lost his consciousness with reduced body temperature before he subsequently died. The burden of proof to substantiate that he died of an accident was assumed. Failing to substantiate that cause of death was aging, illness or bacterial infection, the Appellant should certainly pay the insurance benefits. Thus, the Appellant’s appeal was rejected.