《保险研究》20240408-《保险合同中猝死及其免责条款的若干思考》（任自力）

［摘   要］保险合同中猝死及其免责条款的效力争议是近年来司法审判中的热点和难点之一。国内多数保险合同中关于猝死的定义均亟需修正。猝死包括心源性猝死与非心源性猝死两类，即使是心源性猝死也不必然属于疾病。保险合同中猝死免责条款有效的前提是对猝死有准确定义且保险人已尽到对该条款的提示和明确说明义务。法院在审理猝死类保险纠纷时存在裁判标准不统一、裁判结果迥异的问题。问题的解决有赖于对意外伤害保险中意外理论的厘清、对猝死免责条款有效性的准确认定、对猝死原因确定依据的准确分析，以及对猝死原因确定过程中保险人义务与举证责任分配规则的明晰。

［关键词］猝死；心源性猝死；猝死免责条款；意外；举证责任

［基金项目］本文系中央高校基础科研业务费项目“国家治理现代化与养老保险法制完善研究”(KG16184301)的阶段性研究成果。

［作者简介］任自力，北京航空航天大学法学院教授，研究方向：保险法、商法。

Thoughts on Sudden Death and Its Exemption Provisions in Insurance Contracts

REN Zi-li

Abstract：The effectiveness of the sudden death clause and its exemption provisions in insurance contracts has been a focal point and challenge in recent judicial trials.The definition of sudden death in the majority of domestic insurance contracts requires revision urgently.Sudden death can be categorized into two types:cardiac and non-cardiac,and even cardiac sudden death does not necessarily fall under the category of illness.The prerequisite for the validity of the exclusion clause for sudden death in insurance contracts is an accurate definition of sudden death,and the insurer must fulfill the obligation to provide clear and explicit explanations of the clause.There are inconsistent standards and divergent outcomes when adjudicating insurance disputes related to sudden death in the courts.Resolving this issue requires clarification of the accident theory in accidental injury insurance,precise determination of the validity of sudden death exclusion clauses,accurate analysis of the criteria for determining the cause of sudden death,and a clear delineation of the rules governing the insurer′s obligations and burden of proof in the process of determining the cause of sudden death.

Key words：sudden death;cardiac sudden death;sudden death exclusion clause;accident;burden of proof