China: 保险争议系列之保险公估报告的法律效力

Last Updated: 9 May 2019
Article by Jia Hui
Most Read Contributor in China, June 2019

保险公估是指评估机构及其评估专业人员接受委托,对保险标的或者保险事故进行评估、勘验、鉴定、估损理算以及相关的风险评估。保险公估人,作为重要的保险中介机构之一,是指专门从事保险公估业务的评估机构,包括保险公估机构及其分支机构。截至2018年7月,我国共有保险公估公司336家。[1]当前我国进一步对外开放保险公估业,并于2018年6月19日发布了《中国银保监会关于允许境外投资者来华经营保险公估业务的通知》,允许经营保险公估业务3年以上的境外公估机构和开业3年以上的在华外资保险公司在华投资设立的保险公估人可以经营保险公估业务,适用《保险公估人监管规定》进行业务备案。另一方面,银保监会于2018年开展保险中介机构现场检查工作,针对保险公估机构业务备案合规性进行检查,检查重点包括检查保险公估机构备案时提交的公估从业人员信息、股东信息不真实,股东或合伙人出资资金是否不符合自有、真实、合法的要求等。

《保险公估人监管规定》和《保险公估基本准则》都对保险公估机构合法合规从事保险公估业务提出了要求。保险公估人及其从业人员应在勘验、评定、估算的基础上形成公估结论,及时编制公估报告。所出具的保险公估报告应当符合法律、行政法规等相关规定,保险公估人及其从业人员对其出具的公估报告依法承担责任。保险公估报告在保险理赔过程中发挥重要作用,尤其是其有效性将对保险理赔结果直接产生重要影响。结合司法案例和我们所参与的保险理赔争议案例,参考《最高人民法院关于民事诉讼证据的若干规定》的相关规定,我们研究了以下几种可能导致保险公估报告无效的情形。

一、保险公估机构或公估人员不具备相关评估资质

根据《保险公估人监管规定》,保险公估人在中华人民共和国境内经营保险公估业务,应当符合《资产评估法》要求及中国银保监会规定的条件,并向中国银保监会及其派出机构进行业务备案。保险公估从业人员是指在保险公估人中,为委托人办理保险标的承保前和承保后的检验、估价及风险评估,保险标的出险后的查勘、检验、估损理算及出险保险标的残值处理,风险管理咨询等业务的人员,包括公估师和其他具有公估专业知识及实践经验的评估从业人员。公估师是指通过公估师资格考试的保险公估从业人员。保险评估机构或评估人员如果不具备相关评估资质,参照《最高人民法院关于民事诉讼证据的若干规定》第二十七条第一款之规定,会导致保险公估报告无效。

(一)案例:保险公估从业人员无从业资格证书

在中银保险有限公司无锡中心支公司(简称"中银保险公司")与江阴唯尔派新材料科技有限公司(简称"唯尔派公司")、江阴市大地造田有限公司保险人代位求偿权纠纷案件中,2012年3月6日,因唯尔派公司发生火灾,殃及相邻的江阴市联盛卫生材料有限公司,导致江阴市联盛卫生材料有限公司大量仓储物品受损。事故发生后,中银保险公司委托泛华保险公估有限公司对江阴市联盛卫生材料有限公司因火灾影响造成的损失进行公估,泛华保险公估有限公司的工作人员时某某于2012年3月9日起先后多次赴现场勘察。经查明,时某某于2007年12月9日通过中国保险监督管理委员会组织的保险公估从业人员资格考试,获得保险公估从业人员资格证书,该资格证书有效期至2010年12月,该资格证书过期后时某某未申请换发新的资格证书。江苏省高级人民法院审理后认为,该公估报告因主办公估师及查勘人员时某某在进行查勘、检验、估损理算等业务时未持有合法有效的公估人员从业资格证书等存在部分瑕疵问题而遭受质疑,对此唯尔派公司等不予认可公估报告。参照《最高人民法院关于民事诉讼证据的若干规定》中"鉴定机构或者鉴定人员不具备相关的鉴定资格的"有关规定,一、二审判决认定该公估报告不符合独立、客观、公平、公正的原则,不予采信该公估报告,亦无不当。

(二)案例:评估范围超出了法定业务范围

在中国太平洋财产保险股份有限公司海南分公司(以下称"太保海南公司")与中远航运股份有限公司(以下称"中远公司")及第三人海南一汽海马汽车销售有限公司(以下称海马销售公司)水路货物运输合同货损赔偿纠纷案中,事故发生后,为查明涉案火灾原因,中远公司就火灾发生原因委托鉴定,中远公司委托上海悦之保险公估有限公司进行鉴定,该公司出具《公估报告》,证明本案火灾事故是因车辆本身自燃引起;中远公司委托广州海正保险公估有限公司进行鉴定,该公司出具《检验报告》,证明本案火灾事故是因车辆本身自燃引起。最高人民法院审理后认为,公安部《火灾事故调查规定》(2009年)第六条和第十条之规定,火灾事故调查和处理机构应当为公安消防机构,调查人员应当具备相应的岗位资格。中远公司和太保海南公司委托的机构并非公安消防机构,检验师和鉴定人均不具备火灾事故鉴定的岗位资质。二审判决对中远公司和太保海南公司提交的鉴定、检验和公估报告中作出的火灾原因认定均不予采信并无不当。

二、保险公估程序严重违法

《保险公估基本准则》要求保险公估人开展保险公估业务,应当履行下列基本程序:(一)确定公估委托关系;(二)查勘调查、收集资料、核查验证、评定估算;(三)编制、审核、出具公估报告;(四)结案及整理归集公估档案。保险公估人及其从业人员不得随意减少保险公估基本程序。保险公估人在受理公估业务前,应当明确下列公估业务的基本事项:(一)委托人、公估活动当事人的权利义务关系;(二)公估委托的目的;(三)公估对象和公估委托的服务范围;(四)公估计划,包括公估业务实施的主要过程、时间进度和人员安排等;(五)公估报告的提交方式;(六)公估费用、支付方式及支付期限;(七)委托人、其他相关当事人与保险公估人之间在工作配合和协助等方面需要明确的重要事项。保险公估人应当对专业能力、独立性和业务风险进行综合分析和评价。受理公估业务应当满足专业能力、独立性和业务风险控制要求,否则不得受理。保险公估程序出现严重违法情况,参照《最高人民法院关于民事诉讼证据的若干规定》第二十七条第二款之规定,会导致保险公估报告无效。

(一)案例:保险公估过程中现场查勘不规范

在中国人民财产保险股份有限公司始兴支公司(以下简称"人保始兴公司")与始兴县铁寨林场有限公司(以下简称"铁寨林场")财产保险合同纠纷一案中,一审、二审、再审法院均认为,人保始兴公司提供了佛山市兴禅保险公估有限公司作出的《查勘报告》,但该报告是人保始兴公司单方委托作出,铁寨林场对该勘查结论不予认可,而且佛山市兴禅保险公估有限公司在对现场勘查时,铁寨林场没有工作人员在场,人保始兴公司亦未能提供已通知铁寨林场派员到场的证据。按照《广东省政策性森林保险理赔操作规程(试行)》第十一条"现场查勘无效的,承保经办机构应当重新组织查勘。有下列情形之一,现场查勘结论无效:......(二)被保险人或其委托代理人未到达现场"的规定,佛山市兴禅保险公估有限公司的现场查勘结论无效。

(二)案例:委托保险公估手续不规范

在中国人民财产保险股份有限公司潮州市分公司(简称"潮州人保财险")与广东泽洲工艺品有限公司(简称"泽洲公司")财产损失保险合同纠纷案中,泽洲公司向潮州人保财险投保了财产综合险(2009年版)。在保险合同期间内,"天兔"台风袭击潮州市区,造成保险标的受损。保险事故发生后,潮州人保财险委托深圳市信诚联合保险公估有限公司(简称信诚公估公司)对事故进行保险公估,泽洲公司后也委托信诚公估公司对事故现场进行勘查,但在《保险公估委托单》的"委托人目的"栏中并未勾选任何选项。广东省高级人民法院审理后认为,该情形属于委托估损事项不明。同时,信诚公估公司现场查勘后,分别作出两套理算方案,理算总金额差距甚大,对此不能作出合理解释。公估报告中关于受损标的物的记载前后表述不一致,故法院未予认可信诚公估公司出具的公估报告,并根据泽洲公司申请重新委托评估。

三、公估结论明显依据不足

《保险公估人监管规定》要求保险公估人及其从业人员在开展公估业务过程中,应当勤勉尽职。保险公估报告中涉及赔款金额的,应当指明该赔款金额所依据的相应保险条款。《保险公估基本准则》也要求保险公估人及其从业人员在办理涉及保险理赔的公估委托时,应当选择恰当的评估方法,准确适用保险和有关行业标准、规范进行评估分析,在保险公估报告中科学、合理、公正地出具书面公估定损理算意见,向委托人和涉案当事方详细说明公估定损理算的依据及标准。保险公估报告的结论明显依据不足的,参照《最高人民法院关于民事诉讼证据的若干规定》第二十七条第三款之规定,会导致保险公估报告无效。

(一)案例:保险公估报告不具有客观真实性

在沈阳玉龙木制品有限公司(以下简称"玉龙公司")与中国人民财产保险股份有限公司本溪市分公司(以下简称"本溪保险公司")财产保险合同纠纷案中,事故发生后,玉龙公司与本溪保险公司共同委托辽宁永盛保险公估有限公司对火灾损失及损失金额进行鉴定评估。辽宁省高级人民法院审理后认为辽宁永盛保险公估有限公司出具的《公估报告》认定依据和计算方式不具有客观真实性。第一,玉龙公司与本溪保险公司同时签订两个保单,41号和42号保单,两份保单均足额交纳了保险费用。其中,受损的1#成品库在41号保单中,而在《公估报告》中仅依据42号保单认定固定资产部分为不足额投保,并按不足额投保的比率认定定损数额,明显与实际情况不符。第二,该《公估报告》将流动资金账面余额直接减掉2007年玉龙公司雪灾产成品账面余额,作为定损数额的基数明显不当。因此,辽宁永盛保险公估有限公司作出的《公估报告》不能客观真实的反映玉龙公司在火灾事故中所受的实际损失,不具有证据效力。

(二)案例:保险公估报告所依据的保险条款无效

在涟水新融美纺织有限公司(简称"新融美公司")与天安财产保险股份有限公司淮安中心支公司(简称"天安财保公司")保险纠纷案件中,新融美公司为其公司的房屋、机器设备、库存原材料、库存商品、半成品在天安财报公司处投保了财产综合险,保险价值的确定方式为出险时的重置价值。投保单上其他约定内容为:1.每次事故绝对免赔额为人民币5000元或损失的10%,两者以高者为准。2.若不足额投保,出险时按比例赔付。3.存货因放置在不低于15cm的垫仓板上,对发生台风、暴风、暴雨、洪水时因未按要求放置造成的损失,本公司不负赔偿责任。在保险合同期间内,涟水地区普降大暴雨,新融美公司院内大面积积水,整个厂区被淹,致使厂区内的生产设备、原材料及成品被淹。事故发生后,新融美公司与天安财保公司共同委托泛华保险公估有限公司江苏分公司对新融美公司因暴雨导致的损失进行评估。江苏省高级人民法院审理后认为,结合案涉保险合同约定的保险责任范围来看,"其他约定"系在天安财保公司的保险责任范围内免除保险人的赔偿责任,属于法律规定的"免除保险人责任的条款",但天安财保公司提供的证据不足以证明对"其他约定"履行明确说明义务,故该条款不产生效力。泛华保险公估有限公司出具的《保险公估报告》中理算的定损金额建立在"其他约定"产生法律效力的基础上,"其他约定"对新融美公司不产生效力时,故保险公估报告的定损金额不应作为天安财保公司赔付依据。

四、单方自行委托评估,另一方有证据反驳且不认可

《最高人民法院关于民事诉讼证据的若干规定》第二十八条规定,一方当事人自行委托有关部门作出的鉴定结论,另一方当事人有证据足以反驳并申请重新鉴定的,人民法院应予准许。针对保险公估,如果保险公估工作是由保险人或被保险人一方自行委托,另一方对保险公估结果存在合理证据证明存在异议,也会导致保险公估报告不被法院认可的情形。

(一)案例:保险公估报告由单方委托作出,另一方不予认可

中国人寿财产保险股份有限公司内蒙古自治区分公司兴安中心支公司(简称"人寿财险兴安支公司")、上海警通建设(集团)有限公司重庆分公司(简称"上海警通公司重庆分公司")财产损失保险合同纠纷案中,上海警通公司重庆分公司向人寿财险兴安支公司投保道路建筑一切险,被保险人为上海警通公司重庆分公司,投保工程名称为国道334代钦塔拉至吐列毛都段公路改扩建项目。在保险合同约定的期限内,保险标的遭受暴雨,造成该标段部分路段及设施冲毁。事故发生后,人寿财险兴安支公司委托泛华保险公估有限公司对此次损失进行评估鉴定。二审法院审理后认为,泛华保险公估有限公司出具的《保险公估报告》中,有报案人李明坤签字及上海警通公司建设(集团)有限公司国道334线经理部公章,本案中签订保险合同的主体是人寿财险兴安支公司与上海警通公司重庆分公司,而在报损清单上盖章并非是上海警通公司重庆分公司,且李明坤亦没有授权委托书,依据合同相对性原则,故该《保险公估报告》视为人寿财险兴安支公司单方作出,上海警通公司重庆分公司对该报告亦不认可,故其不能作为定案依据。而内蒙古衡正通价格评估有限责任公司内衡正通(兴)字(2017)127号《评估报告书》是上海警通公司重庆分公司提出申请,一审法院委托,且该《评估报告书》一审庭审中人寿财险兴安支公司申请鉴定人出庭进行质证,现人寿财险兴安支公司虽不认可,但其未提交反驳证据证明其主张成立。从现有的证据上看,内蒙古衡正通价格评估有限责任公司内衡正通(兴)字(2017)127号《评估报告书》应作为本案定案依据。

文中备注:

[1] "多方发力保险中介30家险企成立了35家中介机构",2018-07-24,和讯网,网址:http://insurance.hexun.com/2018-07-24/193551391.html

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Mondaq hopes that our registered users will support us in maintaining our free to view business model by consenting to our use of your personal data as described below.

Mondaq has a "free to view" business model. Our services are paid for by Contributors in exchange for Mondaq providing them with access to information about who accesses their content. Once personal data is transferred to our Contributors they become a data controller of this personal data. They use it to measure the response that their articles are receiving, as a form of market research. They may also use it to provide Mondaq users with information about their products and services.

Details of each Contributor to which your personal data will be transferred is clearly stated within the Content that you access. For full details of how this Contributor will use your personal data, you should review the Contributor’s own Privacy Notice.

Please indicate your preference below:

Yes, I am happy to support Mondaq in maintaining its free to view business model by agreeing to allow Mondaq to share my personal data with Contributors whose Content I access
No, I do not want Mondaq to share my personal data with Contributors

Also please let us know whether you are happy to receive communications promoting products and services offered by Mondaq:

Yes, I am happy to received promotional communications from Mondaq
No, please do not send me promotional communications from Mondaq
Terms & Conditions

Mondaq.com (the Website) is owned and managed by Mondaq Ltd (Mondaq). Mondaq grants you a non-exclusive, revocable licence to access the Website and associated services, such as the Mondaq News Alerts (Services), subject to and in consideration of your compliance with the following terms and conditions of use (Terms). Your use of the Website and/or Services constitutes your agreement to the Terms. Mondaq may terminate your use of the Website and Services if you are in breach of these Terms or if Mondaq decides to terminate the licence granted hereunder for any reason whatsoever.

Use of www.mondaq.com

To Use Mondaq.com you must be: eighteen (18) years old or over; legally capable of entering into binding contracts; and not in any way prohibited by the applicable law to enter into these Terms in the jurisdiction which you are currently located.

You may use the Website as an unregistered user, however, you are required to register as a user if you wish to read the full text of the Content or to receive the Services.

You may not modify, publish, transmit, transfer or sell, reproduce, create derivative works from, distribute, perform, link, display, or in any way exploit any of the Content, in whole or in part, except as expressly permitted in these Terms or with the prior written consent of Mondaq. You may not use electronic or other means to extract details or information from the Content. Nor shall you extract information about users or Contributors in order to offer them any services or products.

In your use of the Website and/or Services you shall: comply with all applicable laws, regulations, directives and legislations which apply to your Use of the Website and/or Services in whatever country you are physically located including without limitation any and all consumer law, export control laws and regulations; provide to us true, correct and accurate information and promptly inform us in the event that any information that you have provided to us changes or becomes inaccurate; notify Mondaq immediately of any circumstances where you have reason to believe that any Intellectual Property Rights or any other rights of any third party may have been infringed; co-operate with reasonable security or other checks or requests for information made by Mondaq from time to time; and at all times be fully liable for the breach of any of these Terms by a third party using your login details to access the Website and/or Services

however, you shall not: do anything likely to impair, interfere with or damage or cause harm or distress to any persons, or the network; do anything that will infringe any Intellectual Property Rights or other rights of Mondaq or any third party; or use the Website, Services and/or Content otherwise than in accordance with these Terms; use any trade marks or service marks of Mondaq or the Contributors, or do anything which may be seen to take unfair advantage of the reputation and goodwill of Mondaq or the Contributors, or the Website, Services and/or Content.

Mondaq reserves the right, in its sole discretion, to take any action that it deems necessary and appropriate in the event it considers that there is a breach or threatened breach of the Terms.

Mondaq’s Rights and Obligations

Unless otherwise expressly set out to the contrary, nothing in these Terms shall serve to transfer from Mondaq to you, any Intellectual Property Rights owned by and/or licensed to Mondaq and all rights, title and interest in and to such Intellectual Property Rights will remain exclusively with Mondaq and/or its licensors.

Mondaq shall use its reasonable endeavours to make the Website and Services available to you at all times, but we cannot guarantee an uninterrupted and fault free service.

Mondaq reserves the right to make changes to the services and/or the Website or part thereof, from time to time, and we may add, remove, modify and/or vary any elements of features and functionalities of the Website or the services.

Mondaq also reserves the right from time to time to monitor your Use of the Website and/or services.

Disclaimer

The Content is general information only. It is not intended to constitute legal advice or seek to be the complete and comprehensive statement of the law, nor is it intended to address your specific requirements or provide advice on which reliance should be placed. Mondaq and/or its Contributors and other suppliers make no representations about the suitability of the information contained in the Content for any purpose. All Content provided "as is" without warranty of any kind. Mondaq and/or its Contributors and other suppliers hereby exclude and disclaim all representations, warranties or guarantees with regard to the Content, including all implied warranties and conditions of merchantability, fitness for a particular purpose, title and non-infringement. To the maximum extent permitted by law, Mondaq expressly excludes all representations, warranties, obligations, and liabilities arising out of or in connection with all Content. In no event shall Mondaq and/or its respective suppliers be liable for any special, indirect or consequential damages or any damages whatsoever resulting from loss of use, data or profits, whether in an action of contract, negligence or other tortious action, arising out of or in connection with the use of the Content or performance of Mondaq’s Services.

General

Mondaq may alter or amend these Terms by amending them on the Website. By continuing to Use the Services and/or the Website after such amendment, you will be deemed to have accepted any amendment to these Terms.

These Terms shall be governed by and construed in accordance with the laws of England and Wales and you irrevocably submit to the exclusive jurisdiction of the courts of England and Wales to settle any dispute which may arise out of or in connection with these Terms. If you live outside the United Kingdom, English law shall apply only to the extent that English law shall not deprive you of any legal protection accorded in accordance with the law of the place where you are habitually resident ("Local Law"). In the event English law deprives you of any legal protection which is accorded to you under Local Law, then these terms shall be governed by Local Law and any dispute or claim arising out of or in connection with these Terms shall be subject to the non-exclusive jurisdiction of the courts where you are habitually resident.

You may print and keep a copy of these Terms, which form the entire agreement between you and Mondaq and supersede any other communications or advertising in respect of the Service and/or the Website.

No delay in exercising or non-exercise by you and/or Mondaq of any of its rights under or in connection with these Terms shall operate as a waiver or release of each of your or Mondaq’s right. Rather, any such waiver or release must be specifically granted in writing signed by the party granting it.

If any part of these Terms is held unenforceable, that part shall be enforced to the maximum extent permissible so as to give effect to the intent of the parties, and the Terms shall continue in full force and effect.

Mondaq shall not incur any liability to you on account of any loss or damage resulting from any delay or failure to perform all or any part of these Terms if such delay or failure is caused, in whole or in part, by events, occurrences, or causes beyond the control of Mondaq. Such events, occurrences or causes will include, without limitation, acts of God, strikes, lockouts, server and network failure, riots, acts of war, earthquakes, fire and explosions.

By clicking Register you state you have read and agree to our Terms and Conditions