Since the unexpected death of Feng Mouding, his father Feng has been immersed in sadness. Feng claimed that his son was bitten on the left leg by red imported fire ants. Since October 4, 2023, he has been continuously receiving intravenous infusion and medication treatment in the hospital. Unexpectedly, the injury continued to worsen, and on January 16, 2024, he developed symptoms such as septic shock. Despite rescue efforts, he died. Previously, he had purchased accident insurance, but his claim to the insurance company was rejected afterwards. Therefore, the family sued the insurance company to the court, demanding that they compensate according to the insurance contract signed by both parties. Recently, a reporter from Red Star News learned from China Judgments Online that on June 7th, the Intermediate People's Court of Lijiang City, Yunnan Province, announced the second instance civil judgment. The verdict shows that the medical records provided by the family and others can confirm the objective fact that Feng Mouding was bitten by ants, resulting in a "4 × 2.5CM" wound on his left calf and "septic shock" as one of the causes of his death. The first instance court ruled that the insurance company shall pay a total of more than 120000 yuan in accidental death insurance benefits, accidental medical insurance benefits, etc. to the family of Feng. The insurance company appealed against the decision, but the second instance court rejected the appeal and upheld the original verdict. Lawsuit: A man claims that his son was bitten by a red fire ant and died after hospitalization and unsuccessful treatment. He purchased insurance but was refused compensation. On May 14, 2023, Feng, who lives in Huaping County, Lijiang City, Yunnan Province, purchased "Ping An Property and Casualty Insurance Accidental Injury Insurance (Option D)" and "Ping An Property and Casualty Insurance Additional Accidental Injury Hospitalization Allowance Insurance" from a certain company. The policyholder and insured are both Feng, and the insurance period is from 00:00 on May 14, 2023 to 24:00 on May 13, 2024. The main provisions of "Ping An Property and Casualty Insurance (D section)" include: accidental death and disability insurance amount of 100000 yuan, liability description: during the insurance period, if the insured dies or becomes disabled due to accidental injury accidents, the insurer will pay the insurance benefits according to the agreement... The main provisions of "Ping An Property and Casualty Insurance Additional Accidental Injury Hospitalization Allowance Insurance" include: accidental hospitalization allowance insurance amount of 27000 yuan, daily allowance amount: 150 yuan/day; Allowance days: 180 days... "Ping An Property and Casualty Insurance Accidental Injury Insurance (Option D)" "Ping An Property and Casualty Insurance Additional Accidental Injury Hospitalization Allowance Insurance" Special provisions: The coverage of personal accidental death/disability, personal accidental medical care, and accidental hospitalization allowance in this insurance mainly covers the insured person, the legal parents of the insured person, the legal spouse of the insured person, the legal parents of the legal spouse of the insured person, and the legal children of the insured person who suffer from accidental injury accidents. Feng Mouding (deceased) was the son of the insured Feng Mou and was a security guard at a certain hydropower station before his death. Feng filed a lawsuit claiming that his son Feng Ding was bitten by red fire ants during work and has been continuously receiving intravenous infusion and medication treatment in the outpatient department of a hospital in Huaping since October 4, 2023. On January 12, 2024, Feng Mouding felt extremely unwell and was admitted to the hospital without a specific diagnosis of the cause; On January 14, 2024, as the condition worsened rapidly, I was transferred to a hospital in Panzhihua City on the advice of a doctor. I was diagnosed with acute kidney failure upon admission. On January 16, 2024, at 23:36, despite rescue efforts, I passed away. Upon discharge, I was mainly diagnosed with sepsis, septic shock, and skin and soft tissue infection in the left knee (where I was bitten by red ants). Feng claimed that he reported the incident to the insurance company within 48 hours. After handling the funeral of his son Feng, he provided relevant medical records, death certificates, and relationship certificates as requested by the insurance claims officer. However, the company believed that Feng's death was caused by his own illness and decided not to pay insurance benefits. In July 2024, Feng's family filed a lawsuit with the People's Court of Huaping County, requesting the court to order a company to pay more than 120000 yuan in accidental death insurance, accidental injury medical insurance, accidental hospitalization allowance, and other benefits to family members in accordance with the insurance contract agreed upon by both parties. Judgment: The fact of being bitten by ants for treatment objectively exists. The insurance company claims a total of more than 120000 yuan. The first instance court believes that the focus of the dispute in this case is whether the death of the insured Feng Mouding falls under the liability exemption situation stipulated in the insurance contract? Should insurance companies bear insurance liability? According to Article 7 of Ping An Property and Casualty Insurance (Section D) of a certain company, if the insured's death, disability, or medical expenses are caused by the following reasons, the insurer shall not be liable for paying insurance benefits: (4) pregnancy, miscarriage, childbirth, illness, drug allergy, heatstroke, or sudden death of the insured. The death record issued by the hospital only described the pathological cause of Feng's death, believing it to be sepsis and septic shock. However, the death record did not identify the cause of Feng's sepsis and septic shock. There is no doubt that Feng Mouding had such basic diseases as hypertension, diabetes, gout, and severe obesity before he died. However, hypertension, diabetes, and gout are chronic diseases. Under normal circumstances, they do not lead to Feng Mouding's immediate death. Therefore, the real cause of Feng Mouding's death is the cause of sepsis and septic shock. No one witnessed the process of Feng Mouding being bitten by ants, but on October 4, 2023, he went to a hospital in Huaping County for treatment. He complained of left calf swelling and pain caused by ant bites for one month. From October 4 to October 26, 2023, he received anti-inflammatory, anti-inflammatory, and analgesic treatment in the outpatient department. It can be concluded that the fact that Feng Mouding was bitten by ants for treatment objectively exists. Will ant bites cause sepsis and septic shock in Feng Mouding? Feng's body has been cremated, and no autopsy was conducted before cremation. Therefore, it is currently unclear whether Feng's death was caused by sepsis and septic shock due to ant bites. Both the plaintiff and defendant have not submitted direct evidence to prove the cause of Feng's death, so there are two possible causes of Feng's death: disease death and non disease death. According to the principle of burden of proof allocation, the plaintiff, as the beneficiary of the insurance, only needs to provide preliminary evidence, while the defendant has the corresponding professional knowledge to further prove the cause and nature of the insurance accident. The defendant claimed that the cause of Feng's death was due to his own illness, but from the time he learned of the accident until the cremation of the body, he did not claim to conduct an autopsy on the insured, resulting in the inability to determine the cause of Feng's death. The inability to provide evidence is due to the defendant's fault, therefore, the defendant should bear the responsibility for insurance claims. In summary, the first instance court ruled that the defendant company shall compensate the plaintiff Feng's family for accidental death insurance of 100000 yuan, accidental medical insurance of 20210.58 yuan, and accidental hospitalization allowance of 600 yuan, totaling 120810.58 yuan. After the first instance verdict, a certain company appealed against it. The Intermediate People's Court of Lijiang City held that the original judgment was clear in determining the facts and correctly applying the law, and should be upheld. Therefore, the court's second instance judgment rejected the appeal and upheld the original verdict. (New Society)