人身保險理賠個案研究－以C公司為例

The Case Study on Life Insurance Claim - An Example of C Company

紀智傑(Zhi Jie Ji)

指導教授 ： 張婉玲

朝陽科技大學/管理學院/保險金融管理系/碩士(2014年)

摘要

金融消費者保護法的施行與財團法人金融評議中心的成立，健全的消費爭議處理機制下使消費者意識抬頭，因此必須正視爭議。理賠是保險公司依保險契約對保戶所為承諾的最具體實踐。只有在理賠時才會顯現保險之價值，有理賠就有爭議。本文研究目的：一探討常見的理賠爭議類型。二、分析C個案公司相關理賠案件。三、分析C個案公司學保之理賠事故。四、提供C個案公司理賠建議。

本文採用個案Ｃ公司案例分析，藉由案例探討增加理賠實務之經驗，作為未來理賠決策時之參考依據，實務上相同類型之理賠爭議並無一致之結果，因此證據力的提供容易影響到理賠之結果，建議探討相同類型爭議案例不同之結果原因，並從理賠資料分析事故路段、區域、時間可能之原因，提出相關建議，以期減少損率的上升，建議可以選取進入訴訟之爭議案例，增加事故過程之真實性、完整性。

關鍵字

理賠個案 ； 理賠爭議 ； 人身保險

並列摘要

With the implementation of Financial Consumer Protection Act （FCPA） and the establishment of Financial Ombudsman Institution （FOI）, the sound mechanism for handling consumer disputes has brought about the rise of consumer awareness and the need to face the disputes squarely. The way insurance companies can most concretely practice their promises to policyholders in accordance with the insurance policies is through claims. And the value of insurance is best manifested when claims are settled. Yet where there are claims, there will also be disputes. Therefore, the purposes of this study are: first, to discuss common types of claims disputes; secondly, to analyze related claims cases happened in C Case Company; thirdly, to analyze the insured incidents of Student Accident Insurance from C Case Company; and fourthly, to provide suggestions for claims settlement for C Case Company.

From the case study with C Case Company, we discuss and increase practical experience of claims therewith, and hopefully it will serve as a reference for C Case Company’s future claims decisions. In practice, there are no consistent results for the same type of claims disputes. And the truth is, the more probative value is provided, the easier the outcome of the claims is influenced. Therefore, we suggest to investigate why claims disputes of the same type were finalized with different claims outcomes. The possible causes of the incidents can be further analyzed in terms of road sessions, regions, and time etc. We hope relevant suggestions can be provided to reduce the increase of loss rate. It is even better to select disputes cases in litigation, the incidents will be totally genuine and comprehensive.

並列關鍵字

Claims Disputes ； Life Insurance ； Claims Cases

參考文獻

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