違反健康保險據實說明義務之終止權－簡評臺灣臺北地方法院102年度保險小上字第5號民事判決

健康保險要保人或被保險人違反據實說明義務，保險人得否解除保險契約，取決於未據實說明事項與保險事故間有無因果關係。若認定未據實說明事項與保險事故間無因果關係，依我國部分司法實務見解，保險人得「向將來解除」（終止）保險契約，保險人仍應就已發生保險事故給付保險金。然有多數司法實務見解認為保險人不得解除保險契約，此使保險人陷於無法終止契約之困境。而本文所評釋之臺灣臺北地方法院102年度保險小上字第5號民事判決，卻迥異於上述司法實務見解，其承認保險人得解除保險契約，契約溯及既往失效，且保險人就已發生保險事故不負給付保險金之責。本文以為此一爭議，若比照日本保險法相關規定，顯見當初立法者增訂保險法第64條第2項但書規定時，並未思慮周全。在尚未修正保險法相關規定前，本文建議我國司法實務應透過類推適用保險法相關規定，承認保險人於此情形下，得單方終止保險契約，方為解決事理之道。

關鍵字

因果關係不存在抗辯；危險估計說；限制危險估計說；解除；向將來解除；終止

並列摘要

When the proposer or insured deliberately not to disclose material information before health insurance contract concluded, the insurer might void insurance contract, unless non-disclosure item has caused insurance event. If court recognized that insured event wasn't caused by non-disclosure item, according to Taiwan courts' minority opinion, insurer may cancel (terminate) contract, and insurer still had liability to pay insurance money prior to cancellation (termination). However, Majority courts ruled that insurer couldn't void insurance contract, and it caused dilemma that insurer couldn't end the contract relationship with proposer. Taipei District Court Bao-Xian-Xiao-Shang-Zi No. 5 (2013) commented by this article showed that insurer could retrospectively void insurance contract, and refuse to pay insurance money. The decision was contrast with above majority opinion. Compared with the same regulation in Japan, we could see Taiwan legislator not taking full account when enacting Taiwan Insurance Act Article 64 Section 2 proviso. Before amending Taiwan Insurance Act Article 64 Section 2 proviso, this article suggests that our judiciary might use ejusdem generis rule to hold that insurer could unilaterally terminate insurance contract, and solving present problem about Taiwan Insurance Act Article 64 Section 2 proviso.