Ride-hailing driver dies suddenly while charging, compensation initially denied; court awards 600,000 yuan: Analysis of the boundary between work injury and accident insurance claims
"Event review: Why did the insurance company refuse to pay for the last order before the charging pile?"
"Recently, news of the sudden death of a ride-hailing driver at a charging station has caused widespread concern. After completing the last order of the day, the driver Li (a pseudonym) stopped the car in front of the charging pile to charge it, and then suddenly died of sudden cardiac death while resting in the car, and died of ineffective rescue. When family members applied to the insurance company for accident insurance claims, the insurance company refused to pay on the grounds that "sudden death is not an accidental injury" and "it was not in the process of operation at the time of the accident". The family was reluctant to sue, and the court finally ruled that the insurance company should pay 600,000 yuan for the insurance."
"This case seems to be an individual tragedy, but it reflects the common dilemma of flexible employment groups in insurance protection and legal recognition. Is there a labor relationship between the ride-hailing driver and the platform? Can sudden death be considered an accidental injury? Has the insurance company settled the u201cnon-operating hoursu201d denial? These questions are not only about the fate of a family, but also test the ability of existing laws to respond to new forms of employment. As a lawyer who has handled personal insurance and labor disputes for a long time, I think it is necessary to dismantle the judgment logic behind this judgment from the perspective of legal practice to provide rights protection reference for the tens of millions of online taxi drivers and flexible employees across the country."
"Controversy point 1: Is sudden death considered an "accidental injury"? Judicial determination of accident insurance clauses"
"The primary reason for insurance companies to refuse claims is that "sudden death is not an accidental injury". In accident insurance contracts, u201caccidental injuryu201d is generally defined as u201can external, sudden, unintentional, non-disease objective event.u201d Sudden death often results from potential diseases, such as cardiovascular and cerebrovascular abnormalities. Therefore, insurance companies often invoke the exemption clause to advocate that sudden death belongs to the category of disease and does not assume the responsibility of compensation."
"However, it is not generalized in judicial practice. When considering such cases, the court will focus on whether the insurance clause clearly interprets "sudden death" and whether the insurer has fulfilled its obligation to prompt and clearly state it. According to Article 17 of the Insurance Law, the insurer shall make sufficient reminders to exempt the insurer from liability in the insurance contract, and clearly explain the contents of the clause in writing or orally to the policyholder; if it is not prompted or clearly stated, the clause shall not have effect."
"In this case, the sudden death of the driver Li occurred during the work-related waiting period, and there is no evidence that the insurance company fully explained the "sudden death exemption" clause at the time of insurance. The court tends to believe that although sudden death is manifested as a sudden illness, if its inducement is related to factors such as work fatigue and mental stress, and the insurance company fails to prove that the exemption clause is effectively delivered, it should be considered an accident within the scope of insurance liability. In addition, Article 9 of the Interpretation of the Supreme People's Court on Several Issues Concerning the Application of the Insurance Law of the People's Republic of China (II) also emphasizes that if the exemption clause in the format clause is not prominently marked, the applicant may claim that it is not effective. Therefore, the family finally won the lawsuit and obtained 600,000 yuan of compensation, reflecting the court's inclination to protect vulnerable policyholders."
"Controversy point 2: Is it an "operational process" when charging? Application of the proximate cause principle"
"Another reason for the insurance company's refusal is that "the driver was not operating on the order at the time of the incident, and it is not part of the operating period of accident insurance coverage". These terms, which are commonly found in ride-hailing-only insurance or personal accident insurance for drivers, limit coverage to u201cwhile driving a vehicleu201d or u201cwhen performing a platform order task.u201d"
"However, in law, to judge whether it is insurance liability, it is necessary to apply the "proximate cause principle" - that is, the direct, effective and decisive reason for the loss. If the driver makes the necessary charging and rest to continue to accept orders after completing the order, which is consistent and relevant to the operation, the sudden death may be regarded as a reasonable extension of the operation behavior. Similar cases have also been supported by judgments in other local courts. For example, a municipal court has found that the sudden death of the courier during a meal between dispatches is due to work reasons and should be considered as work-related injury or insurance liability."
"Back in this case, Li is in a standby state when charging, his vehicle is an operational tool, charging is a necessary condition for maintaining operation. The court held that separating the charging time completely from the operation is not in line with the actual work mode of the ride-hailing driver and is not conducive to protecting the rights and interests of workers. As a result, the insurer's u201cnon-operational disclaimeru201d defence was not upheld. This judgment idea has reference significance for similar cases across the country, reminding insurance companies that when formulating clauses, they should reasonably define the "operating period" and avoid excessively limiting the scope of protection, otherwise the court may find the format clauses invalid."
"Controversy 3: Can a ride-hailing driver identify an injury? Boundaries of Platform Responsibility"
"In addition to accident insurance claims, the identification of work-related injuries of ride-hailing drivers is another legal challenge. If the driver has a labor relationship with the platform, the sudden death may be recognized as a work-related injury, and the family can receive work-related injury insurance benefits (including funeral subsidies, dependent relatives' pensions, and one-time work-related death subsidies, which will be about 1.03 million yuan in 2025). However, in reality, most online car hailing drivers sign cooperation agreements or labor contracts with the platform, rather than labor contracts, which makes it difficult to determine labor relations."
"According to the Notice on Relevant Matters Concerning the Establishment of Labor Relations (Ministry of Labor and Social Affairs [2005] No. 12), the establishment of labor relations needs to have three elements at the same time: the employer and the worker are qualified; accept the management of the employer and engage in paid labor; and the labor provided by the worker is an integral part of the business of the employer. Although online ride-hailing drivers are subject to rules such as platform dispatch, assessment, rewards and penalties, but the working hours and location are relatively free, whether they constitute "subordination" is controversial."
"In recent years, the Supreme People's Court and the Ministry of Human Resources and Social Security have issued several documents, requiring platform enterprises to reasonably assume the responsibility for employment. For example, the Guiding Opinions of the Ministry of Human Resources and Social Security and other eight departments on Safeguarding the Labor Security Rights and Interests of Workers in New Forms of Employment clearly stipulate that if an enterprise does not fully comply with the establishment of labor relations but manages the labor of workers, it shall guide the enterprise to conclude a written agreement with the workers to reasonably determine the rights and obligations of the enterprise and the workers. Some local courts have tried to determine that there is a labor relationship between the platform and the driver in the case, but there is no uniform standard across the country."
"Therefore, in this case, the family did not go through the work injury procedure, but directly sued the insurance company, which may be based on the difficulty and timeliness of evidence collection. However, this does not mean that ride-hailing drivers give up their right to work-related injuries. Lawyers suggest that drivers should keep evidence such as order acceptance records, platform communication screenshots, salary streams, etc. If sudden death occurs during working hours, family members can still try to apply for work injury determination, or claim infringement compensation from the platform in accordance with Article 1192 of the Civil Code (if the platform is at fault, if excessive dispatch leads to overwork)."
"Advocacy: How can drivers build their own defenses?"
"Although the 600,000 yuan judgment brought comfort to the family, it could not save their lives. For ride-hailing drivers and flexible workers nationwide, precautionary risk prevention is far more important than ex post litigation. The following suggestions are universal:"
"First, read the terms carefully when enrolling, focusing on definitions such as "sudden death" and "during operation". If the terms are vague or the exemption is too broad, you can ask the insurance company to explain in writing, or choose an accidental insurance product with "sudden death liability". According to Article 30 of the Insurance Law, if there are more than two interpretations of the terms of the contract, the people's court shall make an interpretation in favor of the insured."
"Second, regular physical examinations to avoid working with diseases. Sudden death is often associated with cardiovascular and cerebrovascular diseases. Drivers are sedentary, stay up late, and eat irregularly, which is a high-risk group. While the law protects rights and interests, health is fundamental."
"Third, pay attention to the safeguards provided by the platform. Some platforms already have employer liability insurance or group accident insurance for drivers, but the coverage is limited and drivers can supplement the commercial insurance on their own. At the same time, if the platform does not provide any protection, the driver may complain to the regulatory authorities, or request the platform to perform production safety responsibilities in accordance with the Interim Measures for the Administration of Online Booking Taxi Operation Services."
"Fourth, in the event of an accident, family members should promptly fix the evidence, including death certificates, medical records, order acceptance records, and vehicle charging records (in this case, the charging record is the key to proving "operation extension"), and prosecute within the statute of limitations (2 years for insurance litigation). When necessary, professional lawyers are retained, because such cases involve the intersection of insurance law, labor law, and contract law, and the skills of giving evidence and debating directly affect the outcome."
"Lawyer's Conclusion: Judicial Progress Illuminates the Path to a New Business Format"
"The judgment in this case is not only an account of a family, but also a positive response to the protection of workers' rights and interests in the new employment form. The court broke through the "non-operational" restriction in accident insurance claims, reflecting respect for the working characteristics of ride-hailing drivers and warning insurance companies not to abuse the format clause. However, the safety net for flexible workers is still fragile, and the gaps in the system of work injury recognition and the vague areas of platform responsibility need to be promoted in coordination with the legislature and the judiciary."
"Guangdong Zhiming Law Firm has long been concerned about the legal issues of new business forms and has rich practical experience in insurance claims, labor disputes, personal injury and other fields. If you or someone close to you encounters a similar situation, you are welcome to consult us, and we will clarify the legal relationship with a professional perspective and strive for the maximum legitimate rights and interests."
