Insurance emphasizes compensation for losses, and fraud and insurance fraud are not allowed for the purpose of profit

1、 Summary of the case

Yue SX * * 72 heavy mobile crane (hereinafter referred to as "the subject vehicle") belonging to a hoisting and lifting limited company of the insured has insured with the insurance company special motor vehicle loss insurance (the insured amount is RMB 5.05 million), special vehicle third party liability insurance, additional lifting, loading and unloading, excavation vehicle extension clauses and other insurances, The insurance period is from August 22, 2021 to 24:00 on August 22, 2022. The insured rented the insured vehicle to a project site. At about 16:00 on August 23, 2021, Mr. Feng, the reporter, said that at the project site, Wu, the driver, suddenly broke the boom while operating the Guangdong SX * * 72 heavy mobile crane, and the estimated maintenance cost was more than 830000 yuan.

2、 Case analysis and determination of investigation direction

In this case, although it is true that the subject truck crane arm broke and hit the ground, the cause of the accident is not clear. Whether the subject truck collided with other objects and whether the subject truck crane arm has quality problems still need further evidence. In addition, whether the site project department as the lessee has made compensation to the insured is also the key point of the case.

Therefore, the insurance company has formulated a comprehensive verification plan to investigate the cause of the accident, the quality of the subject vehicle, and whether the lessee has made compensation.

3、 Case investigation and verification process

（1） Lie that the insurance is expired and obtain compensation from the construction machinery leasing company

The investigators re surveyed and visited the accident site and went to the Project Department of the accident site for verification. The project department of the construction site provided the monitoring video at the time of the incident. According to the monitoring video, the target vehicle did not have any collision at the time of the incident. According to the investigation, the company lied to the project department of the accident site that the vehicle insurance of the target vehicle was overdue and the insurance claim could not be settled, so the project department paid a total compensation of 1.36 million yuan to the company.

（2） Conceal the real accident cause and refuse to provide operation data

It is understood that the boom of the target vehicle was broken without collision during the hoisting of the 4-ton cement column. The extension length of the boom at the time of the accident was 73 meters, the span was 52 meters, and the maximum lifting weight was 5.3 tons. The 4-ton cement column operated at the time of the accident obviously did not reach the weight limit. In order to obtain documentary evidence, the insured was required to obtain the vehicle operation data of the time mark of the accident from Sany After Sales, which failed to provide the vehicle operation data of the time mark of the accident due to the lack of data.

Because the insured refused to cooperate in providing relevant documentary materials, which made it difficult to determine the cause, nature and degree of loss of the accident, and whether the insured has obtained compensation from the lessee, the insurance company issued a Notice to the insured that the accident was not handled.

4、 Case judgment

The dispute point of the case is "whether the 1.36 million yuan of compensation obtained by the insured includes the maintenance cost of the target vehicle." The insured argues that 1.36 million yuan is the cost of lost time compensated by the project engineering department, not including the vehicle maintenance cost. The insurance company entrusted the evaluation company to evaluate the operating income of the crane involved in the case. After the evaluation, it is believed that the loss of income from work delay caused by the vehicle involved in the case during the maintenance period is about more than 400000 yuan. It can be inferred that the remaining 800000 yuan belongs to the maintenance cost compensated by the project engineering department to the insured. The final court held that the 1.36 million yuan compensation paid by the project engineering department to the insured should include maintenance costs and lost time costs. Therefore, the court rejected the insured's claim for compensation of more than 830000 yuan from the insurance company.

5、 Case enlightenment

In this case, the insured, a hoisting and hoisting limited company, had a fluke mentality and deliberately concealed the fact that the responsible party had already made compensation for repeated claims to the insurance company in order to achieve the purpose of profit, which violated the principle of insurance loss compensation. The Shenzhen Branch of China Life Property&Casualty Insurance Company kindly reminds citizens that in case of property loss, they should immediately claim against the party responsible for the accident. If there is no other party responsible for the accident and the insurance liability is met, they can claim against the insurance company for the loss. Property insurance is based on the principle of compensation for losses. If the customer fails to claim compensation from the responsible party, the insurance company can also perform the right of subrogation against the relevant responsible party after making compensation for the accident.

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