*This article is an original content of "Outdoor Adventure".
In the past few days, there has been a swiping incident - "26-year-old Fudan graduate student died climbing in the Mount Everest area, and the insurance company refused to rescue him before his death". Just looking at this title, it is very emotional and rhythmic. But if you think about it carefully, does this incident have anything to do with "Fudan" and "graduate students"?
After the incident, it attracted a lot of media reports and public attention, but the incident information seemed to be massive, but in fact the increase was limited. The first-hand information reported by the media mainly comes from the father of the deceased, and there are few insurance agencies involved. When dealing with disputes, judges and arbitrators never worry about the fierce confrontation between the two parties, but rather worry about the absence of one party and not speaking out. Listening to each other is clear, confrontation with each other can show the truth, only hearing one voice, may misjudge. We might as well let the bullets fly a little longer.
In this article, we deduce the controversial points of the incident, speculate on the allocation of responsibility, try to lead everyone to understand the incident from more angles, and more importantly, talk about how outdoor enthusiasts choose the right outdoor insurance.
The synopsis of the incident is as follows: Outdoor enthusiast Lu Wen (pseudonym) went to Nepal EBC for trekking on February 3, 2024, and purchased "Meiya Le Travel Asia Travel Insurance" on Alipay before the trip. However, the "coverage area" of this policy says "Asia (except Nepal)". After that, on February 13, Lu Wen died of high anti-reaction, and the insurance company refused to rescue and compensate on the grounds that the covered area did not include Nepal.
The most important point of contention in the case was whether Lu Wen's insurance application through Alipay's "Ant Insurance" (an insurance agency platform under Ant Group, which sells products from AIG Insurance Company) was not covered by Nepal on the insurance page. Red Star News relayed the words of the deceased's father, "There is indeed no reminder on the page that Nepal is not covered by insurance", and then Red Star News also checked from the webpage and found that there was indeed no reminder.
After the incident was publicly reported, the relevant insurance products have been removed from the platforms involved. At the time of writing, I also logged on to Alipay's insurance channel - "Ant Insurance", and when I searched for "Meiya Le Travel Asia Travel Insurance", I did not find the corresponding product.
▲ This insurance can no longer be found in Alipay's insurance channel "Ant Insurance".
So, I logged in to the APP and WeChat mini-program of insurance intermediaries such as Ctrip and Mingya to check, and found this "Meiya Le Travel Asia Travel Insurance". I found that they all clearly show that the insurance area does not include Nepal on the insurance page. In addition, log on to the official website of AIG Insurance Company to check, and there is also a large letter indicating that it does not include Nepal "AIG Travel Travel Insurance in Asia".
▲Ctrip APP, Minya WeChat Xiaocheng and the official website of Meiya Insurance Company all indicate that Nepal is not included
So, is it true that the page of Ant Insurance is not indicated? Why is the content of different sales channels inconsistent? For insurance products that have been removed from the shelves, who is obliged to restore the condition at the time of application? If it is not indicated at the time of application, but it is stated in the policy, is the insurance company's refusal to pay compensation reasonable?
In short, if the insurance page or the insurance application process indicates and clearly states the limits of the coverage area, then the insurance company has no obligation to rescue, otherwise it will not be effective, and the insurance company should rescue or bear the corresponding responsibility. The insurance company is not a public welfare organization, and its rescue liability shall be carried out in accordance with the terms of the valid insurance contract.
According to the provisions of the Insurance Law, the agreement that "Nepal is not included in the insurance area" is a clause that exempts the insurance company from liability or has a significant impact on the rights and interests of the policyholder, and the insurance company and the intermediary sales agency shall remind and clearly explain it. The judicial interpretation of the Supreme People's Court also stipulates that for insurance policies concluded through the Internet, the insurance company may prompt and clearly explain the clauses exempting the insurer from liability in the form of web pages, audio, video, etc.
For insurance products that have been removed from the shelves, who is obliged to restore the situation at the time of application? The author believes that it should be the insurance company's side. The judicial interpretation stipulates that an insurance company shall "bear the burden of proof that it has fulfilled its obligation to make a clear statement". The former China Banking and Insurance Regulatory Commission (CBIRC) has more specific provisions on insurance institutions in the Notice on Regulating the Retrospective Management of Internet Insurance Sales.
The regulatory authorities require that for the sales page of Internet insurance (including the online page that prompts the policyholder to enter the insurance application process, displays and explains the insurance terms, fulfills the reminder and clarifies the obligation to explain, verifies the identity of the policyholder, and the policyholder fills in the insurance information, independently confirms and reads the relevant information, submits the insurance application, pays the premium, etc.), the insurance institution shall record and save the operation track of the policyholder and the insured on the sales page, and the operation track shall include the time point when the policyholder enters and leaves the sales page. The policyholder and the insured fill in or click on the relevant content and time on the sales page.
Moreover, the storage period shall not be less than five years. Therefore, for the insurance products that have been removed from the shelves of Ant Insurance, the insurance institution should restore the key content of the page at the time of Lu Wen's insurance, otherwise there will be adverse legal consequences for it.
I downloaded and read the terms and conditions of the "AIG Travel Travel Insurance" and found that this insurance product is a "package package" of nearly 20 insurance terms, all of which are 60 pages long, covering dozens of travel-related insurance liabilities ranging from accidental injury and medical emergency to baggage delay, loss of documents, kidnapping and illegal detention.
▲The insurance terms of "Meiya Le Travel Asia Travel Insurance" on the official website (click to open to view)
These terms include USG Overseas Travel Accident Insurance, Travel Plus Double Benefit Accident Insurance, Travel Acute Illness Death Insurance, Travel Medical Compensation Medical Insurance, Travel Trip Transit and Repatriation Insurance, Travel Recovery Insurance, Travel Traveler's Personal Contents Insurance, Travel Daily Hospitalization Allowance Income Protection Insurance, Travel Document Loss Insurance, Travel Baggage Delay Insurance, and more.
It's not easy to read the full terms carefully. After reading it, I have a feeling that this insurance bought by Levin is not suitable for his trip, right?
First of all, altitude sickness is not guaranteed
In Article 27 "Interpretation" of the main insurance contract "US-Asia Overseas Travel Accident Insurance", "accident" is defined:
"It refers to the physical injury, disability or death caused by an external, sudden, unintentional, non-diseased, or unforeseeable objective event as a direct and isolated cause. For the avoidance of doubt, sudden death due to any circumstance and death due to altitude sickness are not covered by this contract." The key second sentence is also highlighted in bold font.
In the previous news report, it was clearly mentioned that "on the way back, Levin had an accident such as high reaction." ...... slumped on the side of the road". Therefore, if Lu Wenguo died due to altitude sickness, it is not covered.
Second, high-risk activities are not covered
In the liability exemption clause of the main insurance contract, the insurance company lists in bold font that "the insured participates in any high-risk activities" is not insured, and clarifies the specific content of high-risk activities in the form of a list. In the annex "List of High-Risk Activities", the following items are not insured:
"The following mountaineering, adventure climbing and plateau activities: (1) mountaineering (see note 4) ;( 2) outdoor climbing or abseiling, and (3) any activity above 5,500 meters above sea level".
This EBC trip to Nepal is a super trekking route to the base camp of Mount Everest. EBC is the English abbreviation of Everest Base Camp, that is, "Everest Base Camp". The journey can take more than 10 days, and most of the treks are at high altitudes of more than 4,000-5,000 meters, including more than 5,500 meters at Kala Pather (5,550 meters).
According to another related report by Red Star News on February 20, 2024, Ruben was returning from Renjo La Pass at 5,360 meters above sea level, one of the three major mountain passes in the Everest region. On the 13th, the man was found unconscious by passers-by and later died during the rescue. ...... According to public information, due to the trekking route of Nepal's Everest base camp, the altitude will soon rise to more than 4,000 meters, and basically there will be about 8 days at an altitude of 4,400 meters to 5,200 meters, and the highest point will reach 5,600 meters.
Therefore, there may be activity above 5,500 meters above sea level in the itinerary of Leuven, which is beyond the scope of coverage.
"AIG Travel Asia Travel Insurance" is a comprehensive insurance product covering a wide range of contents for ordinary overseas travel, but it is not an insurance for extreme sports such as high-altitude mountaineering and outdoor sports. In short, this product is not suitable for high-altitude trekking in Nepal.
It is indeed convenient to buy insurance through the Internet, AAP or mini program, but once the product is removed from the shelves or revised, the purchaser may not be able to restore the purchase process. Although the insurance company has the responsibility to retain the process information, it is necessary to keep the necessary evidence and be prepared.
The easiest way to do this is to take screenshots and screen recordings, and send them to friends and family with your policy details for future records in case of travel accidents or lost phones. In the event of a dispute, the screenshot can be used as preliminary evidence to communicate with the insurance company or present to the court.
However, due to the fact that screenshots and screen recordings are easily "deeply photoshopped" and constitute forged invalid evidence, their legal effect is easy to be questioned. Even so, its application value is still very high, because if the insurance company challenges it, it will have to produce evidence to the contrary and bear the burden of proof. In short, taking a screenshot is a good way to get your opponent out of the cards.
Insurance clauses, fund account opening agreements, loan agreements and other financial contracts are all well-known "heavenly books", with many professional terms and brain-burning reading. Even so, when buying outdoor insurance, it's important to read the terms and conditions to understand what you're buying. The promotions and summaries on the application page do not cover all important information.
There are many insurance terms, but for mountaineering and outdoor insurance, there are at least three items to pay close attention to:
First, the "insurance liability" clause
It will set out the specific scope and content of the insurance, such as accidental injury, death insurance, medical assistance liability, etc.;
Second, the "exclusion of liability" clause
This clause amounts to a reduction in "insurance liability" and should be seen in combination. Using a mathematical formula like this:
The "exclusion of liability" clause in mountaineering and outdoor insurance is particularly important because they are often designed for specific travel scenarios and the specific exclusions vary widely.
For example, general travel insurance does not cover high-risk outdoor activities such as adventure, high-altitude climbing, rock climbing, diving, skiing, paragliding, etc. International travel insurance will also have restrictions on the countries to be visited, especially in countries where there are wars, bad environments, and insurance fraud, which are often exempt from liability and are not covered. Therefore, it is important to read carefully at the time of purchase to ensure that the insurance covers the travel arrangements.
▲Take the list of high-risk activities listed in "Meiya Leisure Asia Travel Insurance" as an example
Third, the "interpretation" clause
This clause is often located at the end of the insurance clause and is a concentrated explanation of the various terms and nouns in the clause.
This clause is also crucial for outdoor enthusiasts of mountaineering. There are many specific types of high-risk outdoor sports that will be covered in the liability exemption clause, but due to the limitation of the expression, it is impossible to expand the specific definition and scope of each of them. Therefore, the clause will be written in a way that is followed by a centralized interpretation, and each high-risk outdoor sport will be explained in the interpretation clause (and some will also use a high-risk list to explain it one by one). This explanation also indicates the scope of liability that the insurance can cover.
For example, there is usually no uniform and unique definition of what is meant by "mountaineering" or "high-altitude climbing", but it is closely related to insurance liability, so it is often interpreted in the clause and varies widely.
Some clauses state in the interpretation that all technical climbs that require ropes are not covered, but general mountaineering, or climbs led by a compliance guide, are covered by insurance. Some insurance plans use a clear altitude to distinguish insurance liability. For example, some do not guarantee climbing more than 5,500 meters, some do not guarantee more than 5,000 meters and 3,500 meters, and I have also seen the writing of not covering 6,500 meters and 6,000 meters.
These expressions vary greatly, and often originate from laws, regulations or normative documents of different periods, different government departments, and even different countries, such as domestic mountaineering management, climbing athlete level recognition, etc.
▲Take the annotation listed in "Meiya Le Travel Insurance in Asia" as an example
The total amount of coverage in a comprehensive insurance plan can be very high, in the millions, but these amounts are spread over a few or even a dozen liabilities. The amount of each insurance liability may not be enough to meet your needs.
Taking the insurance plan purchased by Lu Wen in the incident as an example, its total coverage amount is as high as 1.7 million yuan, and these insurance amounts are distributed among 18 insurance liabilities. The highest is 400,000 yuan, and the lowest is only a few hundred yuan.
Therefore, when purchasing this type of insurance, it is necessary to carefully observe whether the liability amount of each item is sufficient. Generally speaking, the medical liability for accidental death and accidental injury is relatively high, while the insurance liability for rescue, transport and treatment, and loss of personal property is low.
What do you think about the event?
Do you insure yourself before going outdoors?
What experiences can you share?
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The views expressed in this article are those of the author and do not constitute legal advice
Nor does it constitute a direct recommendation to take out insurance
Written by Law & Rock
Edited/up
Design/Tianyu