2025.10.30

2024(Ju)120

Minshu Vol. 79, No. 7

(Civil Case) Judgment concerning the ownership of a claim for personal injury insurance proceeds which become claimable upon the death of "the insured" as defined in a personal injury clause in an automobile insurance contract due to an accident covered by that clause in the case where that clause provides that the insurance claimant is "the insured" who has sustained damage due to a covered accident "or in the event of the death of the insured, their legal heir"

Case seeking insurance proceeds

Judgment of the First Petty Bench, dismissed

Tokyo High Court, Judgment of October 3, 2023

1. Where a personal injury clause in an automobile insurance contract provides that the insurance claimant is "the insured" who has sustained damage due to an accident covered by that clause "or in the event of the death of the insured, their legal heir," a claim for personal injury insurance proceeds for which the insurance claimant is determined under that clause and which become claimable upon the death of "the insured" as defined above due to a covered accident, belongs to the estate of the insured. 2. Where a personal injury clause in an automobile insurance contract [i] provides that the insurance claimant is "the insured" and "the parents, spouse, or children of the insured" who have sustained any damage due to an accident covered by that clause, and [ii] specifies a fixed amount for each type of "the insured" as defined above in accordance with their attribute as the amount of non-economic damage "suffered by the insured themself or their surviving family members such as the parents, spouse, and children" due to the death of the insured as defined above, which is part of the damage to be covered by the payment of personal injury insurance proceeds, but [iii] does not include a provision to the effect that an adjustment is to be made between the amount of insurance proceeds payable to "the insured" as defined above and the amount of insurance proceeds payable to "the parents, spouse, or children of the insured"; the amount of personal injury insurance proceeds for the purpose of compensating for damage sustained by "the insured" as defined above due to a covered accident should be calculated on the premise that the amount of non-economic damage sustained by the insured that is to be covered by the payment of personal injury insurance proceeds is the entirety of that fixed amount, and the existence of any of the insured's parents, spouse, or children who has sustained non-economic damage due to the death of the insured does not affect said amount of personal injury insurance proceeds.

(Concerning 1 and 2) Insurance Act, Chapter II, Non-Life Insurance; Article 91 of the Civil Code

The final appeal is dismissed. The costs of the final appeal shall be borne by the appellant of final appeal.

I. Outline of the case 1. This is a suit filed by A's heir, B, against the appellant of final appeal, the insurer of an automobile insurance contract for A's vehicle, to seek payment of personal injury insurance proceeds, alleging that, as a result of A's death in a single-car accident that A had caused while driving, B acquired by succession A's claim for personal injury insurance proceeds based on the personal injury clause in the general policy conditions applicable to that automobile insurance contract (referred to below as the "Personal Injury Clause") (as B passed away while the case was pending before the court of first instance, the appellees of final appeal have succeeded to B's status in this suit by succession). Against this, the appellant argues as follows: in accordance with the provisions of the Personal Injury Clause, the abovementioned claim for insurance proceeds does not belong to A's estate but was originally acquired by A's children, who have renounced the inheritance from A; and even if the appellees had acquired that claim, part of the amount specified in the Personal Injury Clause as the amount of non-economic damage should be acquired by those children of A as insurance proceeds, and therefore the amount of the personal injury insurance proceeds mentioned above cannot be calculated on the premise that the appellees acquire the entirety of that amount specified as the amount of non-economic damage. 2. The outline of the facts legally determined by the court of prior instance is as follows. (1) In 2019, the company for which A served as the representative concluded with the appellant an automobile insurance contract to which the general policy conditions including the Personal Injury Clause were applicable. (2) In summary, the Personal Injury Clause provided as follows. A. Due to the insured suffering a bodily injury caused by a sudden, accidental, and external accident (limited to an accident attributed to the operation of the insured vehicle; referred to below as a "personal injury accident"), the appellant pays personal injury insurance proceeds to the insurance claimant for the damage sustained by the insured or their parents, spouse, or children. B. The insured is a person seated in the legitimate equipment in the insured vehicle that is meant to carry a person or in the cabin with such equipment, the owner of the insured vehicle, or the driver of the insured vehicle. C. The insurance claimant is a person falling under any of the following who has sustained damage due to a personal injury accident: (a) the insured, or in the event of the death of the insured, their legal heir; (b) the parents, spouse, or children of the insured. (Below, the provision under which the insurance claimant is a person falling under (a) above is referred to as "Provision 1," and the provision under which the insurance claimant is a person falling under (b) above is referred to as "Provision 2"; and personal injury insurance proceeds for which the insurance claimant is determined under Provision 1 and which become claimable upon the death of the insured due to a personal injury accident are referred to as "death benefit proceeds.") D. The amount of personal injury insurance proceeds to be paid by the appellant for a single personal injury accident is an amount calculated by deducting any amount of benefits payable for the purpose of compensating for the covered damage that are already acquired by the insurance claimant, from the total of the amount of damage determined under E. below and the amount of expenses for prevention of damage and expenses for preservation and enforcement of rights. E. The amount of damage to be covered by the payment of personal injury insurance proceeds is the total of the amounts calculated according to the standards for the amount of damage under the personal injury clause (referred to below as the "Standards for the Amount of Damage") for each of the following categories of damage, upon the occurrence of the damage on the insured as a direct result of suffering an injury: [i] damage due to requiring medical treatment; [ii] damage due to suffering residual disabilities; and [iii] damage due to death. F. The part of the Standards for the Amount of Damage regarding damage due to death is as follows. (a) Damage due to death includes funeral cost, lost profit, non-economic damage, and other damage. (b) The funeral cost is set as 600,000 yen; however, if it is clear based on evidence that the funeral cost exceeds 600,000 yen, the actual cost as necessary and reasonable, up to 1,200,000 yen, is provided. (c) In principle, the amount of lost profit is calculated by multiplying the amount of income minus living expenses by the Leibniz coefficient corresponding to the number of remaining working years. (d) Non-economic damage is damage arising from the mental distress suffered by the insured themself or their surviving family members such as the parents, spouse, and children. The amount of non-economic damage is fixed as follows in accordance with the attribute of the insured: [i] 20 million yen if the insured is the primary income earner of their family; [ii] 15 million yen if the insured is not the primary income earner of their family and is aged 65 years or older; and [iii] 16 million yen if the insured is not the primary income earner of their family and is aged under 65 years (these amounts are collectively referred to below as the "Amount of Non-Economic Damage"). (e) Other damage is the actual cost as necessary and reasonable according to general societal terms, within the extent that has a reasonable causal relationship with the personal injury accident. (3) In January 2020, A caused a single-car accident while driving the insured vehicle under the abovementioned insurance contract, and died in this accident. A is therefore the insured under the Personal Injury Clause (referred to below simply as "the insured"). (4) Since all of A's children filed statements to renounce the inheritance from A and their statements were accepted by the family court, B, who is A's mother, inherited A's estate as the sole heir. B passed away in September 2022 while the case was pending before the court of first instance, and the appellees, who are B's children, succeeded to B's status in this suit. II. Concerning Reasons III to V for a petition for acceptance of final appeal stated by the counsel for final appeal, KOBUE Keiko 1. The counsel argues that: in light of Provision 1 which specifically stipulates that the insurance claimant is "in the event of the death of the insured, their legal heir," it is understood that a claim for death benefit proceeds originally belongs to A's children, who are the insured's legal heirs in the first place in the line of succession, and does not belong to the insured's estate; however, the court of prior instance determined that this claim belongs to the insured's estate, and thus erred in the interpretation and application of laws and regulations. 2. Under the Personal Injury Clause, personal injury insurance proceeds are to be paid to cover damage arising from a personal injury accident, and the main paragraph of Provision 1 prescribes that the insurance claimant is a person "who has sustained damage due to a personal injury accident." Furthermore, according to the Personal Injury Clause, for each type of damage, the amount of damage to be covered by the payment of personal injury insurance proceeds is either the amount of actual cost or the amount calculated by a specific method depending on the extent of damage, and the amount of personal injury insurance proceeds is to be determined based on the specific amount of damage arising from a personal injury accident. If any amount of money for compensating for damage has been paid, such amount is to be deducted from the amount of personal injury insurance proceeds to be paid. In light of these points, it can be understood that the Personal Injury Clause provides that personal injury insurance proceeds are to be paid to a person who has sustained damage from a personal injury accident for the purpose of compensating for their damage. Furthermore, the Personal Injury Clause literally provides that even in the event of the death of the insured due to a personal injury accident, damage arising from mental distress suffered by persons including "the insured themselves" is treated as non-economic damage, and that it specifies the method for calculating the amount of lost profit on the premise that lost profit arises with regard to the insured themself. In consideration of the above, it can be said that damage to be compensated for by death benefit proceeds is supposed to be damage arising with regard to the insured themself. In light of the wording of Provision 1, the wording of the other provisions in the Personal Injury Clause, and their structure as described above, and the understanding that a policyholder would normally have, Provision 1 should be interpreted as prescribing that a claim for personal injury insurance proceeds for the purpose of compensating for damage sustained by the insured arises for the insured themself, even in the case where the insured dies due to a personal injury accident. The proviso to Provision 1 should be understood as giving caution to the effect that a claim for death benefit proceeds will normally be acquired by the insured's legal heir by succession, on the premise that this claim belongs to the insured's estate. Consequently, it is reasonable to consider that a claim for death benefit proceeds belongs to the insured's estate. Therefore, the determination by the court of prior instance regarding the point argued by the counsel can be upheld. III. Concerning Reason II for a petition for acceptance of final appeal stated by the counsel for final appeal, KOBUE Keiko (except for the reasons excluded) 1. The counsel argues that in the case where any of the insured's parents, spouse, or children (referred to below collectively as "close relatives") has sustained non-economic damage due to the death of the insured, the amount of death benefit proceeds cannot be calculated on the premise that the amount of non-economic damage sustained by the insured that is to be covered by the payment of personal injury insurance benefits is the entirety of the Amount of Non-Economic Damage, but the court of prior instance determined that such calculation is possible, thus erred in the interpretation and application of laws and regulations. 2. Provision 2 names close relatives of the insured who has sustained damage due to a personal injury accident as the insurance claimant, and the Standards for the Amount of Damage provide for non-economic damage sustained by the insured's close relative in the event of the death of the insured. Accordingly, it is interpreted that pursuant to Provision 2, the insured's close relative who has suffered non-economic damage of their own due to the death of the insured is to acquire a claim for personal injury insurance proceeds for the purpose of compensating for such damage. The amount of damage to be covered by the payment of personal injury insurance proceeds is specified as the total of the amounts calculated according to the Standards for the Amount of Damage. As the amount of non-economic damage "suffered by the insured themself or their surviving family members such as the parents, spouse, and children" due to the death of the insured, the Standards for the Amount of Damage specify the Amount of Non-Economic Damage, which is a fixed amount for each type in accordance with the attribute of the insured. Accordingly, it is reasonable to consider that the Amount of Non-Economic Damage is specified as the total amount of personal injury insurance proceeds to be paid as compensation for the non-economic damage suffered by the insured themself and their close relatives. Based on this, the amount of death benefit proceeds is examined. Pursuant to the Personal Injury Clause, if none of the insured's close relatives exists, the amount of death benefit proceeds should be calculated on the premise that the amount of non-economic damage sustained by the insured who died due to a personal injury accident is the entirety of the Amount of Non-Economic Damage. It cannot be said that the existence of any close relative who may be an insurance claimant under Provision 2 would reduce the mental distress suffered by the insured, and in this respect, the Personal Injury Clause does not include a provision to the effect that if such close relative exists, an adjustment is to be made between the amount of insurance proceeds payable to the close relative and the amount of death benefit proceeds. In addition, if the amount of death benefit proceeds is to be reduced when the insured's close relative has no intention to claim insurance proceeds for non-economic damage of their own, the amount to be eventually paid would be less than the entirety of the Amount of Non-Economic Damage, which is no doubt inconsistent with the fact that the Standards for the Amount of Damage specify a fixed amount for each type in accordance with the attribute of the insured as the Amount of Non-Economic Damage. In light of these points and the understanding that an insurance policyholder would normally have, the Personal Injury Clause should be interpreted as prescribing that in the event of the death of the insured due to a personal injury accident, even if any of the insured's close relatives exist, the amount of death benefit proceeds is to be calculated on the premise that the amount of non-economic damage sustained by the insured that is to be covered by the payment of personal injury insurance benefits is the entirety of the Amount of Non-Economic Damage. Even based on this interpretation, it is possible to understand that the Personal Injury Clause provides that with regard to a claim for death benefit proceeds and a claim for insurance proceeds payable to the insured's close relative under Provision 2, the appellant may perform its obligation to each insurance claimant for the sake of all insurance claimants, within the extent of the amount of the latter claim, and hence, the appellant would never bear the burden of duplicate payments. According to the above, it is reasonable to consider that the amount of death benefit proceeds should be calculated on the premise that the amount of non-economic damage sustained by the insured that is to be covered by the payment of personal injury insurance proceeds is the entirety of the Amount of Non-Economic Damage, and that the existence of any of the insured's close relatives who has sustained non-economic damage due to the death of the insured does not affect the amount of death benefit proceeds. Therefore, the determination by the court of prior instance regarding the point argued by the counsel can be upheld in terms of its conclusion, IV. Conclusion For the reasons stated above, none of the counsel's arguments can be accepted. The other reasons for acceptance of final appeal were excluded by an order to accept a final appeal. For the reasons stated above, the Court unanimously decides as set forth in the main text of the judgment.

Justice SAKAI Toru Justice YASUNAMI Ryosuke Justice OKA Masaaki Justice MIYAGAWA Mitsuko Justice NAKAMURA Makoto