保單復效之逆選擇的防範與因應 -以國內各壽險公司之實務作法為研究

Preventions and Countermeasures for Adverse Selection of Policy Reinstatement-- Research has been done based on the practical operation of life insurance corporations in Taiwan.

林淑真(She-Jen Lin)

指導教授 ： 林麗銖

淡江大學/商學院/保險學系保險經營碩士在職專班/碩士(2007年)

https://doi.org/10.6846/TKU.2007.00410

摘要

保險契約為一諾成契約，而非要物契約，只要保險契約雙方當事人就保險標的及保險費之多寡意思表示一致，保險契約即可成立，無待保險費之交付。然保險費為保險人承擔危險之對價，若要保人不交付，即會影響保險人對於危險之承擔能力以及危險共同團體成員之利益，因此要保人在保險契約成立後應依契約遵守原則履行交付保險費之義務。惟人壽保險契約乃有別於一般民法上債之契約，亦即人壽保險之保險費依保險法第117條第1項之規定，不得以訴訟方式請求。或謂該規定主要為避免強迫要保人儲蓄，然如前所述，保險費乃保險人承擔危險之對價，保險人之承擔危險必以保險費之交付為前提，要保人不交付保險費則保險契約之效力難以維持，故為使保險契約之效力有明確之效力，保險法對此設有特別之規定。
　　按保險法第116條規定：「人壽保險之保險費到期未交付者，除契約另訂定外，經催告到達後逾三十日仍不交付時，保險契約之效力停止。催告應送達於要保人，或負有交付保險費義務之人之最後住所或居所，保險費經催告後，應於保險人營業所交付之。第1項停止效力之保險契約，於保險費及其他費用清償後，翌日上午零時，開始恢復其效力。保險人於第一項所規定之期限屆滿後，有終止契約之權。」該項規定乃基於保護要保人或被保險人及平衡保險人之利益而設，立意堪稱良善，惟保險法施行細則第12條第1項及現行實務之壽險示範條款第6條又對此加以限制，尤其是關於保險人在契約停效期間之契約終止權之限制及要保人申請復效之限制，實多有不合理之處。此三部份之條文本在規範同一事實，惟因立法意旨的誤解，條文制定技術不當，致使保險法學者與業者對相關問題始終爭論不休，間接也導致保險公司保單復效的糾紛越來越多。
　　本論文主要研究重點：
　　以我國相關法例與實務處理分析外，尚爰外國之相關法例、判決與實務處理加以探究。
　　探討申請復效之契約性質，是否需盡其據實告知義務之必要﹖
　　擬觀察目前壽險公司復效申請之實務處理，即為避免逆選擇與道德危險之發生而採進行危險選擇，而保險人得否另訂特別約定事項拘束要保人，以防止逆選擇與道德危險之發生？
　　經保險人同意申請復效後，清償欠繳之保險費扣除停效期間的危險保險費後之餘額後，契約效力是否即告恢復？至於契約恢復效力後，保險公司能否行使解除權？是否又會增加保險公司之逆險擇與道德風險？
　　將以I壽險公司實際理賠資料檢視復效後之理賠經驗，探討影響停效保單申請復效的相關因素有哪些？並加以驗證復效保單是否會增加保險公司之逆選擇與道德風險？最後再提出個人看法，以為結論與建議。

關鍵字

保單復效 ； 逆選擇 ； 保險法116條

並列摘要

Abstract:
　　Insurance contract is a sort of acceptance contract, not a sort of substantial contract. Therefore, when two parties of an insurance contract are in agreement with the subject matter insured and the premium, the contract is established. However, the payment of premium is not prerequisite. Premium is the relative value of risks taken by an insurer. It will influence the undertaking ability of an insurer and benefits of the whole group involved in risks. Thus, the policy owner should obey the contract to accomplish the obligation of paying premium after the establishment of a contract. Life insurance contract is different from debt contract of civil law, in other words, an insurer shall not demand payment of premium by the way of litigation according to Insurance Act, Article 117-1. The main purpose of this statue is to avoid forcing the policy owner to save. As mentioned above, premium is the relative value of risks taken by an insurer, and the premium payment must be the precondition for the insurer to undertake risks. It will be difficult to maintain the efficacy of a contract if the policy owner does not pay the premium. Hence, it is regulated in Insurance Act to ensure the definite efficacy of a contract.
　　Insurance Act, Article 116, “Unless otherwise stipulated in the contract, when a life insurance premium is due and unpaid, and remains unpaid more than thirty days from receipt of notice of payment due, the validity of the insurance contract shall be suspended.
Notice of payment due shall be served to the most recent domicile or residence of the proposer or of the person under obligation to pay the premium. After notice of payment due has been served, the premium shall be paid at the business office of the insurer.
A suspended insurance contract referred to in paragraph 1 shall be reinstated at zero hours on the morning of the day after the premium and other expenses have been paid. The insurer has the right to terminate the contract upon expiration of the time limit set forth in paragraph 1.”
Protecting the policy owner or the insured and balancing the benefit of the insurer are the foundation of this statute. The purpose of this statute is satisfactory. Nevertheless, the limitation from “Enforcement Rules for the Insurance Act Article 12-1”and current practical “Model Provisions for Life Insurance Policies Article 6” are unreasonable, especially the constraint to insurer’s contract cancellation right in suspension period and the application of reinstatement. These three statutes regulate the same actuality, but because of the misconception of legislation intention and the inadequacy of skill on establishing statutes, it has led to endless argument between insurance scholars and insurance companies. Thus, there is more and more controversy on reinstatement of policy.
　　The major research emphasis in this thesis are as follows:
1. Besides analyzing relative legal statutes and current practices in Taiwan, I also inquire into foreign relative legal statutes, judgments and practices.
2. Discuss the property of policy applying reinstatement and the necessity of fulfilling the obligation to inform on truth.
3.　Examine the current practice of reinstatement application in life insurance companies. That is to say, taking the proceeding of risk selection in order to avoid the occurrence of anti-selection and moral hazard. Is it adequate for insurers to set up the particular regulation to restrict the policy owner for preventing the occurrence of anti-selection and moral hazard?
4.　When the insurer agrees the reinstatement application and the policy owner pays off the owed premium reducing risk premium of suspension period and will the efficacy of policy be recovered? May the insurer exercise the right of cancellation after the policy efficacy is recovered and will it increase occurrence of anti-selection and moral hazard for insurance company?
5.　Take the practical claim records of insurance company to examine the claim experience and discuss the relative factors which influence policy applying reinstatement. In addition, inspect whether the reinstatement policy lead to the increase of anti-selection and moral hazard. Furthermore, state my personal opinion as the conclusion and recommendation.

並列關鍵字

Policy Reinstatement ； Adverse Selection ； Insurance Act ； Article 116

參考文獻

3、蕭玲蓉，2006，『人身保險停效保單復效動機與風險之研究』，淡江大學管理科學研究所企業經營碩士在職專班論文。

5、行政院金融監督管理委員會保險局

2、江朝國，2002，保險法論文集（三），瑞興圖書。

參 考 文 獻

一、碩士論文：