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■,retrsuperture occhiali da sole; ■ by Case
With the development of China's basic medical insurance business, everyone will be entitled to a basic medical insurance inevitable. Universal basic medical insurance, making more and more personal injury victims and perpetrators can not be provided under the medical expenses of the case, the problem can be solved by medical expenses insurance fund. However, thus it has brought a legal issue: the health insurance fund has reimbursed medical expenses, the victim can no longer require compensation In judicial practice in China, follow a long-term trial practice: victims have been reimbursed part of public health, can not ask for compensation. This practice has a direct impact on the health insurance fund has reimbursed medical expenses of the application of law, so that victims often can no longer be compensated for medical expenses by the health insurance fund has been reimbursed. While a citizen of Suzhou City, Jiangsu Province, argue this makes the health insurance fund has reimbursed the huge medical expenses, obtained by liability ratio of full compensation again.
Originality precedent Jinchang Suzhou City, Jiangsu Province People's Court made this decision, a breakthrough trial convention on the future of the judicial practice has played an exemplary role, with positive legal and social significance.
Medical expenses have been reimbursed the health insurance fund is able to claim compensation
Jiangzhong Fan / text
A friend to help accident victims rescue expenses Medicare reimbursement
Yan Tao, aged 38,new balance enfant, was an ordinary worker in Suzhou City, Jiangsu Province, a car repair service company, His interests, as proficient radio technology, natural to become a member of Suzhou City Amateur Radio Association. Radio Association, although from different industries,hogan sito ufficiale, but the common interest put them together, it is easy to form each other good friends. Yan Tao warm, good karma,hermes bracciali, everyone called him brother.
January 13, 2007 afternoon, Yan Tao ready to install a radio antenna device at home on the second floor roof, invited the 冯亚斌, JIANG Jianjun, Cui loose trio came home to help. Once construction starts, Yan Tao repeatedly asked everyone to pay attention to safety, 冯亚斌 et al laugh should be: "This is not the first installation of the antenna,peuterey sito ufficiale, brother, you will do well."
However, the unfortunate thing happened. Fengya Bin young, agile, volunteered to climb the north Yan Tao family house on the second floor roof, just as he chose to position the antenna,céline occhiali da sole, suddenly slipped and fell on the roof of the body, and rolled down the ramp down from the second floor roof , the "bang", head of the ground, fell heavily to the concrete floor, on the spot and nose bleeding, unconscious mind.
Seeing this, Yan Tao, who immediately dialed "120" emergency calls, will Fengya Bin rushed to Suzhou Municipal Hospital. The hospital to rescue, Fengya Bin still have no consciousness, only temporarily saved their lives. Even so, whether it is Pingya Bin relatives, or Yan Tao, have said never give up Fengya Bin, will dump all its own, the best of its ability revived Fengya Bin.
冯亚斌 in Suzhou City Hospital after the hospital for two months, on 14 March 2007 Go to the Second Affiliated Hospital of Soochow University,saldi woolrich roma, Suzhou Municipal Hospital treatment, and on April 4 to enter the Soviet Second Affiliated Hospital of New District Hospital hyperbaric chamber treatment. April 23 the same year,chapeau nhl, the Soviet Pingya Bin Second Affiliated Hospital of New District Hospital and then back to Soviet Second Affiliated Hospital for treatment. October 10 the same year, 冯亚斌 relatives in comprehensive consideration 冯亚斌 condition, after healing of the economic situation and the possibility of the family, the hospital requests for 冯亚斌 go through the automatic discharge procedures.
Pingya Bin 207 days in hospital, spent 62 million yuan for medical expenses, medical expenses up to a daily average of three thousand dollars. Such high medical bills, became Fengya Bin and Yan Tao two can not shirk. Fortunately Pingya Bin attended the basic social medical insurance,lunette de vue, 44 million yuan in medical expenses by Pingya Bin medical insurance accounts,moncler outlet online shop, the social health insurance fund the settlement. For as required by the Fengya Bin individuals to pay for medical expenses of 18 million yuan, Yan Tao to find ways to actively raise, not only to make every home, only deposits, also Radio Association in fundraising activities for the Pingya Bin 13 million yuan to raise funds , except for the payment of medical expenses Pingya Bin, nursing fee, the balance of all to the Pingya Bin families.
Despite consumes a lot of manpower and financial resources exhausting, but unfortunately been unable to retain Fengya Bin. October 16, 2007, 冯亚斌 discharged home after six days, leaving the young daughter, a young wife and elderly parents, forever.
The amount of the claim has been reported to the risk of further controversy and uncompromising
Fengya Bin's death, to his family, it is a heavy blow.冯亚斌 parents Pingguo Kang, Zhu Yan to farmers, only to receive a monthly living expenses $ 300, are under 60 years of age, 冯亚斌 it is their only child. Today, the only son of leading the way, the couple felt Tiantadexian Pingguo Kang, can not afford, both fell ill. Fengya Bin wife, Cao Lifen less than 30 years of age, is unable to accept this reality, day in tears, grief Nan Yi. He was only 6 years old daughter Feng Yuanyuan worldly way, so the next person is grieved.
Feng family thought 冯亚斌 is to help a friend 严涛安 mounted antenna was unexpected calamity befell that Yan Tao shall assume full responsibility for this compensation for all losses resulting therefrom. Thus, shortly after the funeral for End 冯亚斌, Cao Lifen on behalf of the family repeatedly found Yan Tao, Tao and demanding compensation. At this time Yan Tao mood is very heavy. Yan Tao, although not well-off family, but after the event, Yan Tao ability to do their best to give the maximum compensation. For claims against Cao Lifen continue, Yan Tao said he could not afford indeed, impossible to lose money. After several fruitless negotiations, 曹丽芬 and other decisions to safeguard their legitimate rights and interests through legal channels. November 8, 2007, Cao Lifen 冯亚斌 wife, daughter and parents 冯媛媛 Pingguo Kang, Zhu Yan and other four came together in Suzhou City Jinchang District People's Court, a lawsuit filed, the Yan Tao onto the dock.
Cao Lifen, Feng Yuanyuan, Pingguo Kang, Zhu Yan claims, January 13, 2007, Yan Tao 冯亚斌 should request help 严涛安 mounted antenna, during installation, Pingya Bin unfortunate fall from a height, causing head injuries immediately unconscious.冯亚斌 into the hospital on the same day, but the treatment failed, on October 16, 2007 died.冯亚斌 suffered personal injury in providing helper activities Tao Yan process, in accordance with the relevant legal provisions, namely Yan Tao is to help the workers should bear the liability. Accordingly, Cao Lifen, Feng Yuanyuan, Pingguo Kang, Zhu Yan and other four requesting the court Yan Tao compensation for medical expenses, death compensation, alimony, mental solatium of RMB 151.9 million yuan. Among them, 620,000 yuan for medical expenses, including medical insurance fund by the settlement of 440,000 yuan, accounting for more than half of the total claims.
To court and seek compensation for the loss of this magnitude, Yan Tao felt very unjust. He said: "It happened after 冯亚斌 medical expenses paid by me, I should not ask for compensation I also paid a four plaintiff 80,000 yuan because 冯亚斌 own gross negligence, should be appropriate to relieve me. part of the responsibility. "In addition, Yan Tao, 曹丽芬 other four plaintiffs claimed lost income, care, is the amount of dependents living expenses, transportation costs, but also raised objections, asked the court in accordance with the regulations. For compensation for death, funeral expenses, mental solatium, hospital food subsidies no objection.
Because the case involves legal hot and difficult issues, coupled with the case caused by the local media reports of public concern, Jinchang District People's Court attached great importance to the three public hearing be heard.
So, medical expenses paid by the health insurance fund has been closed, 曹丽芬 the four plaintiffs can ask for compensation Yan Tao, raised the possibility of initiating donations to offset the corresponding liability This will not only become the primary focus of the defendant parties argue,sito nike, it has become the focus of public concern. On court, 曹丽芬 other four plaintiffs and Yan Tao war of words, each side.
About Pingya Bin medical expenses issue. Yan Tao believes 冯亚斌 medical expenses, 44 million yuan in the settlement by the health insurance fund, and not the actual expenditures of individuals, not part of the actual loss 冯亚斌 have occurred, so that the portion of medical expenses should be deducted, the four plaintiffs 曹丽芬We can no longer claim compensation. To support his point, Yan Tao from the Internet to find a number of case studies and theoretical research articles, he said: China's judicial practice, for medical expenses reimbursed by the public health, are not included in the victim's actual loss amount again offender sentence compensation. In other words, the victim of medical expenses reimbursed by the public health, the perpetrator can no longer claim compensation. This has become a judicial practice. Because our country is not yet universal social health insurance, basic medical insurance fund for reimbursement of part, you can ask for compensation Although there is no case can learn, however, publicly funded health insurance fund reimbursement of medical claims similar nature, after the health insurance fund reimbursement, the victim no actual loss, should no longer receive compensation.
曹丽芬 other four plaintiffs argued that Fengya Bin personal enjoyment social basic medical insurance, medical expenses paid by the health insurance fund balances 440,000 yuan Yan Tao is not equivalent to the sum already paid, can not therefore exempt from the payment of the sum Yan Tao responsibility.
About Yan Tao raised through donations and 13 million yuan of the issue. Yan Tao advocate, fundraiser is sponsored by the purpose of donation is used to cover the cost of treatment 冯亚斌, rather than to a living allowance 冯亚斌 family, therefore,escarpins louboutin, part of the medical expenses paid for by donations, 曹丽芬 the four plaintiffs could not claim compensation .曹丽芬 other four plaintiffs is that the contributions are good-hearted people in the community to donate to help Fengya Bin therapy, not donated to Yan Tao, Tao and therefore not exempt from strict liability for payment of the sum.
In addition, the two sides also their responsibility to raise their own ideas. Yan Tao advocates, who that day had several mounted antenna to remind each other to pay attention to safety, but 冯亚斌 themselves because they do not accidentally fell from the roof,chapeau diamond, Fengya Bin gross negligence, it should be appropriate to reduce their portion of liability.曹丽芬 other four plaintiffs considered 冯亚斌 no gross negligence, Yan Tao does not provide the necessary security measures helmets and other places to install the antenna also has a major security risk,cappelli adidas, it can not be reduced or eliminated civil liability Yan Tao, Tao strict requirements full compensation.
The final word should pay court to break the routine
Jinchang District People's Court after that, in order to help others to provide unpaid labor workers, because helper activity suffered personal injury, workers should be help liable for damages.冯亚斌 is in free fall and cause death to 严涛安 mounted radio antenna in the process, Yan Tao,chapeau new york, as is the help of workers should be liable for damages. Meanwhile, according to relevant regulations, the victim of the same damage to occur at fault, compensation may reduce the liability of the obligor. From the local police station after the incident reflects Yan Tao record of inquiry as to help the homeowner to install antennas friends have done to some safety reminders obligations. Cao Lifen the four plaintiff claims antenna installation place there are significant security risks, but did not provide evidence, inadmissible. During the installation of antennas, Fengya Bin accidentally falls, own gross negligence, therefore, reduce the liability of the defendant Yan Tao, the defendant 严涛承 bear 70% of the liability.
冯亚斌 medical expenses in part by the health insurance fund the settlement of 44 million yuan, is based Fengya Bin lifetime to pay health insurance premiums and benefits enjoyed by the health insurance, Medicare Part relief that policy and can not therefore exempt from the obligation of reparation Yan Tao, Cao Lifen Yan Tao, the four plaintiffs claim compensation for the portion of medical expenses does not violate the law, to support, therefore, the Court finds that the medical expenses of 62 million yuan.
Yan Tao initiated donations raised 13 million yuan, from the point of view is the nature of love and compassion for the community and donors for Fengya Bin treatment, not the money donated to Yan Tao, it does not belong to the money paid by Yan Tao, can not from the amount of compensation should bear deducted.
Additionally, the court in accordance with the law, on the project and the amount of compensation 曹丽芬 the four plaintiffs, calculate and confirm, identified losses totaling 120 million yuan. Yan Tao should bear 70% of the liability, net Yan Tao has been paid, the balance of 71 million yuan Yan Tao shall be paid promptly.
October 31, 2008, Jinchang District People's Court of first instance verdict in accordance with the relevant provisions of the law, judgment Yan Tao, then the four plaintiffs compensation 曹丽芬 economic losses totaling 710,000 yuan.
After the first trial, Yan Tao refused to accept the Suzhou Intermediate People's Court of Appeal. Yan Tao made the complaint: first, in this case 44 million yuan in medical expenses paid by the health insurance fund, so the loss of that part of the non-payment of the victims themselves, there would be no loss. In addition, the principle of personal injury compensation is to fill the loss, that the victims be compensated for actual losses. In this case the victim's medical expenses of only 18 million yuan, I just from the loss of this part of the compensation, otherwise press of First Instance found, 曹丽芬 other four plaintiffs will receive an additional benefit of $ 44 million 70%; secondly, donations raised 13 million yuan, was initiated by me specifically for Pingya Bin private placement to raise the cost of treatment, and all applied to the treatment and not to the four plaintiffs Cao Lifen comfort donations, and therefore should be recognized that some of the losses the victim does not exist, it should be excused of liability on the part of 13 million yuan; and third,louboutin femme site officiel, that the Court of First Instance I should bear 70% of the liability, it should bear the responsibility I should lighten. First Instance found the facts than the other because the victim Fengya Bin after treatment, the condition has stabilized and under control, just further treatment is entirely possible recovery, but due to strong demand 曹丽芬, who was discharged in the hospital to discourage invalid premise, Pingya Bin discharged, delayed treatment, the subsequent death, resulting in greater losses has not shirk responsibility. Therefore, I further loss caused by the death of its complete absence of fault, and no causal link, its liability shall be less than 70% share, the specific amount of the discretion of the court. In addition, Yan Tao, the amount recognized for some of the projects, but also raised objections. Mainly reply 曹丽芬 the four plaintiff is upheld.
Suzhou Intermediate People's Court after hearing that: in this case the facts are clear, explicit nature of the dispute, the Department of 冯亚斌 as help workers help 严涛安 mounted radio antenna activity, due to their own negligence fall induced brain trauma, is to help workers to Yan Tao shall be liable for the range It caused controversy.
On liability ratio. Help workers because helper activity suffered personal injury, worker's responsibility is to help similar employer liability, because help workers with gross negligence, you can reduce the liability of obligation to compensate people. Therefore, the trial court found that Fengya Bin own gross negligence, Yan Tao alleviate 30% of the liability, in the range of reasonable discretion, Yan Tao proportionate liability on the grounds of appeal in delayed treatment and other issues related to the scope of the loss ratio rather than liability.
About the extent of damage and the health insurance fund to pay part of the expansion of losses and delays in treatment, the Court considers that the existing dispute over compensation for personal injury insurance fund payments on the obligation and liability coverage of the liability relations treatment using the principles of the victims have both, health insurance fund the scope of compensation is not offset compensation obligor.冯亚斌 hospitalized due to falls to family members who discharged the past nine months, in the treatment of traumatic brain injury sustained phase, from October 10, 2007 was discharged to family members who died on October 16 very short intervals, according to the final discharge records, admission diagnosis of traumatic brain injury After surgery, hydrocephalus, skull defects, discharge diagnosis of the situation is even worse, despite the existence of rehabilitation could continue treatment, but should be considered to select Fengya Bin families also out of frustration. Yan Tao believes Fengya Bin family requested the hospital delayed treatment,basket nike, final Fengya Bin death, resulting in greater losses unfounded. The trial court treatment and is dependent on raising money identification is correct.
July 3, 2009, the Suzhou Intermediate People's Court in accordance with the law, making "rejected the appeal and upheld the original verdict," the final decision.
Judges say
Together because a friend of mine was killed brutally violent death caused a huge personal injury compensation cases, as issued a final judgment and settled. Which has aroused widespread concern, the health insurance fund has reimbursed medical expenses can no longer claim the disputed compensation, also will be at the legislative level has been determined. Decision in that case to break the traditional trial practice,cappelli jordan, play an exemplary role, with positive legal and social significance.
Prior to the implementation of social health insurance, to achieve the public health mechanisms. Under public health mechanisms, public health institutions are paid enterprises, institutions, government agencies, military and other, in addition to outside enterprises, including state-owned enterprises and collective enterprises, the other for the state. Public health,basket adidas, and its essence is the state to provide health care, the state free to give welfare of citizens. Under this system, the victims have been publicly funded medical reimbursement of medical expenses, in essence, to give a commitment free country, the victim has not losses, should no longer be compensated. For public health has been reimbursed medical expenses, the court will not be included in the amount of the victim's actual loss, the decision perpetrators then be compensated. Because of our country's public health system for a long time, over time, that the trial court's practice became a trial practice, and is the national courts to follow.
In recent years, we continue to strengthen the basic medical insurance system, medical security system and gradually realize the transformation from a publicly funded health care system to the social basic medical insurance system. Because of the health insurance fund has reimbursed medical expenses can not ask the question of compensation, the law does not clearly defined, judicial practice on public health has been part of the claims processing practices, it will directly affect the medical expenses of the health insurance fund has reimbursed the Court of The application of law, the trial could easily lead to inconsistent consequences. Legally speaking, the level of mobilization and guaranteeing social basic medical expenses, all medical treatment from the original country into a full embrace of individuals and units to share the burden, medical insurance is to protect individual citizens in accordance with the conditions and the contribution given that citizens enjoy basic medical treatment has been part of the property rights of individual citizens. Thus, by the insurer personal accounts from the basic medical insurance fund to pay the costs, medical insurance proceeds to pay health insurance premiums based on the insured person is entitled, if the insurer because the insurer received the benefit of people exoneration of liability, it constitute the insurer's actual losses have not been compensated. Therefore, the health insurance fund medical expenses reimbursed shall again claim compensation. Similarly, the circumstances of the offender if the victim previously obtained full compensation for medical expenses, may still require social health insurance fund reimbursement of medical expenses to be reimbursed. In other words, personal injury compensation disputes, medical insurance fund and the compensation obligation shall not be liable,giubbotto woolrich, the victim can have both.
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