美國法上保險人處理賠案之義務－兼評我國保險法之相關規定

A Study on the Insurer's Duty to Process Claims in the United States-A Commentary of the Related Insurance Regulations in Taiwan

李志峰(Derek Lee)

《輔仁法學》 46期 (2013/12) Pp. 153-264

摘要

現代保險之目的，已從單純的損失填補轉化為對於被保險人財務安全與心境安寧之保障，欲達到此目的，則在危險事故發生後，保險人對於被保險人請求保險給付時，應予以妥善之處理。保險為最大誠信契約，契約雙方當事人於履行保險契約之時，不得為取得契約上之利益而做出有害他方當事人之行為。在被保險人提出理賠時，多處於財務上之弱勢地位，保險人能否妥善處理，關乎被保險人既有之事業能否儘速恢復而免於倒閉及對受害第三人之責任能否控制在一定範圍內。所以，被保險人向保險人告知賠案發生時，秉持誠信善意原則之保險人，為被保險人處理所遭遇之損失與面臨第三人之責任關係訴訟，應如同處理自己事務一般，如此，保險始能依被保險人之期待，真正發揮其保障被保險人心境安寧並具社會安定之功能。美國為全球保險最為發達的國家之一，各州法院於近百年間已將學者發展之相關理論，作為判決基礎而實際運用於司法實務中，並藉以建構保險契約當事人間義務之法律內涵；保險人亦對法院所採之見解對相關行為及契約條款作出調整，使其符合法令之內涵。本文以美國法制發展為立論重心，探討保險人處理賠案義務之性質、內涵、最新發展與改革。最後，剖析我國現況與缺失，參酌美國學說與實務見解，提出相關建建議，期能成為立法機關與相關單位之參考。

關鍵字

第一人保險 ； 第三人保險 ； 誠信善意與公平交易默示協定 ； 信賴義務 ； 處理賠案義務 ； 調查義務 ； 惡意行為 ； 惡意侵權行為請求權

並列摘要

The purpose of modern insurance is transformed from indemnification against actual out-of-pocket loss to providing the insured with financial security and peace of mind. In order to achieve the aforesaid purpose, the insurer should appropriately process the claims submitted by the insured after the loss occurred. Insurance contract is contract of good faith and neither of the contractual parties should not do anything which will injure the right of the other to receive the benefits of the agreement when they implement the contract. The insured is vulnerable in finance when the claim is submitted and the claim-handling by the insurer is related to that if the insured's business can recover from the suffering and prevent from being into bankruptcy and the liability to the injured third party can be limited to some level. Thus, when the insured gives the notice of claims to the insurer, the latter should give the former's interests consideration equal to its own in the process of handling the claim. As a result, insurer can bring the peace of mind to the insured as the latter's expectation and achieve the function of social stability.The United State is one of the blooming markets in the world and the state courts have adjudged the insurance case based on the scholar's theories in the recent hundred years and established the legal contents of the contractual parties' duties. Afterwards, the insurer revises the related provisions in the insurance contract and adjusts the conducts to conform to the regulations in accordance with the court's opinions. This paper will focus on the development in the United States, to examine the characteristics, contents, the latest development and reform relevant to the insurer's duty to process the claims. In conclusion, this paper will analyze the current legislative conditions and policy clauses in Taiwan and presents the suggestions for legislation and amendments in Taiwan's policy clause with references to the regulations and judicial precedents in the United States.

並列關鍵字

First-Party Insurance ； Third-Party Insurance ； Implied Covenant of Good Faith and Fair Dealing ； Fiduciary Duty ； Duty to Process the Claims ； Duty to Investigate ； Bad Faith ； Bad Faith Tort Cause of Action

參考文獻

王澤鑑(1992)。民法債編總論。自版。

王澤鑑(2000)。民法總則。自版。

王澤鑑(2009)。侵權行為法。自版。

江朝國譯(1993)。德國保險契約法。保險事業發展中心。

江朝國(2009)。保險法基礎理論。瑞興。