Source: Insurance Educators
Recently, the Huangpu District People's Court of Shanghai (hereinafter referred to as "the Court") adjudicated an insurance contract dispute arising from the determination of statutory holidays.
On 2024-9-15, Tian died in an accident while riding an electric bike. He had purchased a personal accident insurance policy from an insurance company years ago: it pays 10 thousand yuan for accidental death, and 4 times the basic coverage amount (100 thousand yuan) if the death occurs during a "legal holiday."
The family claimed compensation of 100 ten-thousand yuan, arguing that under the State Council's holiday schedule, this day falls within the three-day Mid-Autumn Festival break. However, the insurance company countered that only two days are statutory holidays for Mid-Autumn Festival; since 9/15 is a make-up workday, it doesn't count, and they were only willing to pay 10 ten-thousand yuan. The case went to Shanghai Huangpu Court, which ultimately ruled that the insurance company must pay an additional 90 ten-thousand yuan.
Stuck on how to calculate "legal holidays"?
The controversy surrounding this event stems primarily from the fact that both sides possess official documents with red headers.
The basis in the family's possession is "Notice of the General Office of the State Council on the Arrangement of Part of the Holidays for 2024": The Mid-Autumn Festival holiday is from 9 to 15, with a total of 3 days. For ordinary people, this is simply the "Mid-Autumn Festival break."
The insurance company's basis is the "Regulations on National Holidays and Memorial Days": Mid-Autumn Festival is a public holiday for all citizens with only 1 day off, which falls on the lunar date of Mid-Autumn. The day off on 9/15 is merely a transferred rest day, not a statutory public holiday in the legal sense.
Put simply, ordinary policyholders refer to the "holiday notice," while insurers cite the "holiday implementation rules." Both sides can produce official documents from the State Council; neither can easily dismiss the other.
If policy terms are unclear, the insurer is liable.
The court did not dwell on the academic debate over whether "make-up holidays" count as statutory holidays; instead, it focused on the insurance contract itself.
First, the "statutory holidays" clause in the contract is a standard term provided by the insurer. Most policyholders won't check the "Regulations on National Holidays," so when they see "double compensation for statutory holidays," they'll likely interpret it as "days officially designated as holidays." If interpretations differ, Article 30 of the Insurance Law clearly states: when a standard term has multiple reasonable interpretations, the one most favorable to the insured or beneficiary shall prevail.
Second, the insurer failed to clarify the "no compensatory rest days" clause upfront. In cases involving tenfold compensation, whether statutory holidays include make-up days is a critical issue. The court ruled that since the insurer neither provided the relevant policy terms to the policyholder nor explained in plain language that only 1 of the Mid-Autumn Festival's 3 holiday days qualify for double coverage, it cannot deny a claim after an accident occurs by relying on a narrow interpretation.
Accordingly, the Huangpu District People's Court ruled that the insurance company must pay Mr. Chen the remaining claim amount of 90 million yuan. This judgment is now effective.
The ruling logic is clear: as the rule-maker, if the insurer fails to clarify terms beforehand, courts are highly likely to side with the policyholder in any dispute.
This incident serves as a reminder for everyone: when purchasing accident insurance with "double coverage on holidays," don't rely solely on promotional posters. Review the contract definitions carefully to understand how statutory holidays are defined, whether make-up days count, and how consecutive holiday periods like Spring Festival and National Day are treated.
Insurance companies should realize: blurring key concepts saves nothing and ultimately costs them.
