論保險契約解釋－以防疫保單理賠爭議為中心

A Study on the Interpretation of Insurance Contract: Focusing on the Insurance Claim of Pandemic Policies

賴煥升(Huan-Sheng Lai)

《中正大學法學集刊》 80期 (2023/07) Pp. 57-110

https://doi.org/10.53106/172876182023070080002

摘要

所謂防疫保單，係指因感染法定傳染病、或因法定傳染病遭受隔離或檢疫措施，得依約請領保險金給付之保險契約。於2022年，保險業界因防疫保單之理賠申請產生財務重大衝擊，並衍生眾多保險理賠之法律爭議，諸如快篩陽性是否視同確診，得請領確診理賠給付；居家照護是否視同住院，得請領住院醫療理賠給付；隔離、居家隔離或集中檢疫等定義，是否符合防疫保單理賠給付要件等。基此，本文遂以保險契約解釋原則與方法，就防疫保單保險理賠之法律爭議為探討，並參酌美國、日本及臺灣保險法制對於保險契約解釋原則與方法之司法實務見解適用情形，對於現行防疫保單理賠爭議為分析，期可供為日後保險業界暨司法實務之運用。

關鍵字

防疫保單 ； 保險理賠 ； 保單條款解釋 ； 通常意義 ； 疑義不利保險人解釋原則 ； 合理期待原則

並列摘要

The insurance industry has experienced a tremendous impact from the pandemic policies in 2022. The COVID-related infectious disease insurance policies, or the so-called pandemic policies, have caused insurers facing financial loss for unforeseeable claim application. Additionally, plenty of insurance claim disputes have increased due to the interpretation of pandemic insurance contract clauses in insured peril, such as whether a positive result on the rapid test can be deemed as a confirmation of COVID-19 infection or not; whether the home health care can be qualified as an in-hospital treatment. Other disputes also include the definition of home-based quarantine, group quarantine, house-isolation, and isolation care. Therefore, this research paper focus on legal issues between interpretation of insurance contract and the insurance claim of pandemic policies in insured peril. Furthermore, this research paper analyzes the relevant judicial opinions of U.S., Japan and Taiwan. The author hopes this research paper would support the relevant legal disputes on insurance claim practice and the judicial practice.

並列關鍵字

Pandemic Policies ； Insurance Claim ； Interpretation of Insurance Contract ； Plain Meaning Rule ； Ambiguity Rule ； Reasonable Expectations Doctrine

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