A 48-year-old man, Mr. Pan, from Shanghai passed away due to choking while eating a steamed bun. His family filed for a claim with the insurance company, but it was rejected on the basis of “sudden death not being an accidental death.” Ultimately, after mediation in court, both parties reached a settlement, with the insurance company paying about half of the compensation.
Recently, the “Legal Daily” learned from the Pudong New Area Court in Shanghai that under the mediation of the judge, Mr. Pan’s family and the insurance company have reached a settlement. The insurance company agreed to pay over 28,000 Chinese yuan to the insured person’s family.
The incident occurred in November 2023 when Mr. Pan collapsed at home while eating steamed buns with his mother, leading to loss of consciousness. Startled by the sudden incident, Pan’s mother sought help from neighbors before making an emergency call for assistance.
The medical history from the hospital indicated that when the ambulance arrived, Mr. Pan’s heart had already stopped beating. The death certificate stated that the primary cause of Mr. Pan’s death was “sudden death” with an “unswallowed steamed bun in the mouth and throat.”
After Mr. Pan’s body was cremated, his family recalled purchasing an accidental injury insurance policy from a certain insurance company in 2017, valid until September 2047 with a coverage amount of 100,000 yuan.
Presenting the hospital’s emergency medical history and the resident’s death certificate, the family explained that Mr. Pan choked to death on a steamed bun, which they considered an accidental occurrence, thus applied for compensation from the insurance company, only to face rejection.
The insurance company argued that according to the terms of the insurance contract, sudden death falls under exclusions and since the family had already cremated the body, further identification of the specific reason behind Mr. Pan’s sudden death couldn’t be determined for a compensation claim.
The judge, based on the emergency medical records, combined with the statements of the insured person’s family present at the scene, deduced that the most direct cause of death was “choking on the steamed bun,” leading to death by suffocation.
Through mediation, the two parties eventually reached a settlement agreement, with the insurance company agreeing to pay approximately half of the compensation to Mr. Pan’s family.
The judge explained that sudden death does not equate to exemption from accidental injury insurance claims. Family members of the insured individual should promptly report to the insurance company, verify the most direct cause of death, while the insurance company should fulfill its duty to provide guidance and explanations on the exemption clauses. Citizens should also pay attention to the terms and provisions of the insurance products they purchase to safeguard their own interests.