Woman dies in a car accident on her way to work; her family’s insurance claim was denied. The court rules the insurance company must pay 500,000 yuan.

A woman named Zhu was a maintenance worker on a project. She was killed in a traffic accident while on her way to work, and her relatives applied for 500,000 yuan in accidental death insurance benefits, which were denied.

Red Star News reporter learned from the China Judgments Online that the Intermediate People’s Court of Yangzhou City, Jiangsu Province, published the second-instance judgment. After review, the court dismissed the insurance company’s appeal, upheld the first-instance ruling, and ordered the insurance company to pay 500,000 yuan in insurance benefits to the deceased’s family.

Photo courtesy of Visual China

Worker dies in a traffic accident on the way to work

Relatives’ claim for compensation was rejected

On April 22, 2024, Jiangsu Company Ltd. purchased group accident insurance (B) for construction workers from an insurance company. The applicable policy terms are the China Company Ltd. Construction Workers Group Accident Insurance (B) clause. The insurance coverage includes 500,000 yuan per person for accidental injury and 50,000 yuan per person for accidental medical expenses. The policyholder’s declaration states that the construction project is the Green Maintenance Project C package in the urban area of Baoying County, with a project cost of 334,500 yuan. The insurance period is from April 23, 2024, to August 9, 2025…

Zhu was a worker at the Baoying County urban greening maintenance project C site. Around 6:45 a.m. on November 29, 2024, at the intersection of Huai Jiang Avenue and Beihe Road in Baoying County, Zhu was riding an electric tricycle to work when she was involved in a traffic accident and died. On January 3, 2025, the Baoying County Public Security Bureau Traffic Police Brigade issued an accident determination, concluding that Zhu bore equal responsibility for the accident.

After the incident, Zhu’s relatives—Fang Moujia, Fang Mouyi, and Fang Moubing—who were beneficiaries, applied for insurance compensation but were denied. In September 2025, the insurance company issued a “Claim Decision Notice,” stating that Zhu’s death in a traffic accident on her way to work did not occur at the construction site specified in the policy, nor was it a commuting accident for official purposes; therefore, her death from an accidental traffic incident was not covered by the insurance. On September 12, 2025, the three relatives filed a lawsuit against the insurance company at the Baoying County People’s Court, requesting the court to order the insurer to pay 500,000 yuan in insurance benefits.

First instance court ordered the insurance company to pay 500,000 yuan

Appeal by the company was dismissed

The first-instance court held that the insurance terms were standard clauses provided by the insurance company. The interpretation of these clauses should be based on the purpose of the contract and the principles of interpreting insurance law in favor of the insured and beneficiaries. The policyholder purchased this accidental insurance partly to mitigate the risk of compensation for work-related disability. Article 14 of the Work Injury Insurance Regulations considers traffic accidents occurring during commuting, where the employee is not primarily responsible, as work-related injuries. This effectively broadens the concept of “working hours” to include “commuting time,” which has been widely accepted by society. Therefore, from an interpretation favorable to the insured and beneficiaries, this standard should be applied in this case.

Secondly, the clause stating “with the insurer’s consent, if the insured suffers an accident while commuting to or from the construction site specified in this contract, the insurer shall bear the insurance liability” implies that the insurer’s issuance of the policy indicates that commuting for work is within the scope of coverage. Otherwise, the insurer could simply omit this clause. Requiring the insurer’s consent for each commute is impractical and unreasonable.

Furthermore, the insurance company’s “Claim Rejection Notice” acknowledged that commuting for work falls within the scope of coverage, only arguing that “commuting” does not include “official business travel.” The insurer also claimed that, according to Clause 10(3) of the exclusion clause, the insurer is not liable during activities unrelated to construction work or outside the construction site and living area specified in the contract. Therefore, the accident in question is outside the scope of insurance coverage. According to insurance law, clauses that exempt the insurer from liability must be clearly highlighted in the insurance application, policy, or other insurance documents to alert the insured. If not, such clauses are invalid. During litigation, the insurer failed to provide evidence that it had fulfilled its obligation to inform and clarify this exclusion clause to the insured, and thus bears the legal consequence of failing to prove this. The court did not accept the insurer’s argument regarding this clause.

In summary, the first-instance court ruled that the insurance company should pay 500,000 yuan to Fang Moujia, Fang Mouyi, and Fang Moubing. After the first-instance judgment, the insurance company appealed. The second-instance court found that the facts were clearly established and the law correctly applied, so it upheld the original decision. The appeal was dismissed, and the original judgment was maintained.

Red Star News reporter Jiang Long

Editor Bao Chengli