Ankwei Chen
The Taiwan High Court rendered the 104-Bao-Xian-Shang-11 Civil Decision of May 5, 2016 (hereinafter, the “Decision”), holding that for the burden of proof in an insurance claim, the insured or the beneficiary must still present sufficient support to the point that the court is persuaded to lower the standard of proof and recognize the veracity of the disputed facts in question.
According to the facts underlying this Decision, the Appellant obtained the insurance policy at issue from the Appellee as the applicant and the insured, which includes a “Nan Shan Life Insurance on Personal Accidents Rider” (hereinafter, the “Rider at Issue”). The Appellant asserted that an unknown foreign object entered his left eye, and after receiving medical treatment, a physician informed the Applicant that his left eye is disabled and issued a certificate evidencing the disability of the left eye. As the loss of vision in his left eye is caused by a foreign object or medical malpractice and and subsequent surgery, the Appellant claimed insurance from the Appellee.
According to the Decision, before the insurance claim is paid, two facts need to be proven, namely that the “insured event was not triggered by illness” and “was caused by a sudden external accident.” The insured or the beneficiary must still substantiate the above two facts to the point that the court is persuaded to lower the standard of proof and deem the two facts to have been proven; if that threshold is not met, the insurer has no duty to make the insurance payout.
According to the Decision, the AppellantÕs certificate of diagnosis indicated a loss of vision due to macular degeneration, which means it is not possible to tell whether it was caused by an external, sudden and unforeseeable accident. The Appellant thus needed to show that the loss of vision was not caused by a disease but by an external accident. However, the Appellant failed to substantiate his assertion of such fact, failed to present a consistent timeline and sequence of events, and also failed to show evidence substantiating that medical malpractice was the cause of such blindness. Since the Appellant had no ground to claim insurance, the Appellant’s appeal was rejected.