| The commercial third party liability insurance insured by motor vehicle owners plays an important role in the compensation of the injured when the third party is injured in a traffic accident.However,it is also accompanied by insurance claim settlement disputes.Among them,the dispute over the clause of "no compensation for non-insured drugs" is troubling the insurance parties and the third victim.The dispute about how to deal with the out-of-insurance drug expenses incurred in the course of the third victim’s medical assistance is constant.As commercial insurance is a kind of commercial insurance,the law does not make clear provisions on the application of this kind of insurance.The academic circle has not reached consensus on the nature of the "no claim for non-medical insurance drugs" clause in the three commercial insurance risks,whether the insurance company needs to fulfill the obligation of explicit explanation and how to settle the claim for non-medical insurance drugs,and there is no uniform discretion standard in the practice circle,so the identification and treatment of non-medical insurance drugs are confused.Through the study of "the Dispute case of the Insurance contract between Guo and R Insurance Company",this paper analyzes the application of the clause of "non-medical drugs without compensation" in the commercial three-insurance contract from the three controversial issues in the case,and tries to conclude the practical identification of the clause: First of all,the understanding of the clause of "no compensation for non-insured drugs" in commercial insurance contract stipulates that only the drugs within the scope of national basic medical insurance shall be compensated,and the drugs beyond the scope of medical insurance shall not be compensated,which actually exempts the insurance company from the obligation to pay to a certain extent and limits the scope of medical expenses that the insured can obtain in commercial insurance.Therefore,this clause conforms to the characteristics of the disclaimer clause,which should be identified as the disclaimer clause.Secondly,the judgment of the legal effect of "no compensation for non-insured drugs" clause should be based on the Insurance Law’s provisions on the effect of exemption clause,that is,through the "Insurance Law" Article 17 to examine whether the insurance company has fulfilled the obligation of prompt and clear explanation,to obtain the effect result.If the provisions are valid,the insurance company has the right to refuse to settle claims for medical expenses exceeding the national basic medical insurance standard.Otherwise,the clause is invalid,and the insurance company shall bear the non-insured drug costs and pay compensation to the third party affected.However,the amount of compensation is not the whole medical expenses.It is necessary to review the expenses of non-medical insurance drugs and pay the reasonable and necessary part of the compensation.Both the insurance company and the insured shall bear a certain burden of proof for the determination of the amount of compensation. |
