失能保險及其爭議問題之研究－以美國的發展為論述核心－

A Study on the Disability Insurance and Issues-Focusing on the Development in the United States

李志峰(Derek Lee)

《輔仁法學》 47期 (2014/06) Pp. e1-63

摘要

人在退休前，變成失能的機率是較死亡的高上數倍，但是對於失能風險並未完全瞭解，導致採取相關之保障措施之行為亦不如其他人身風險。失能保險在發展的過程中，因為較其他人身保險更具技術性、損失率受到社會經濟情況的影響及較高的逆選擇與道德危險等主觀性，使得其市占率一直不如其他人身保險，此亦使得失能風險受到較少的關注。雖然，在大部分的社會福利國家，於社會保險中多有提供失能之相關保障，然而，隨著政府財政狀況的惡化等因素，社會保險所提供的失能保障並無法切合失能者之實際需求，此時商業保險之機制即顯重要。依研究資料顯示，台灣勞動人口致生殘廢之比例日漸提高，社會保險之給付亦在往下調整，故有賴商業失能保險之發展以填補不足之部分。本文介紹、分析失能保險在美國的發展及其相關之爭議問題，對我國目前失能保險之發展提出相關建議，希冀作為有關單位日後建構失能保險體系之參考，以使得我國失能保障制度能更趨健全。

關鍵字

失能保險 ； 永久完全失能 ； 職業失能 ； 法定失能 ； 醫療照顧與治療 ； 居家或室內限制 ； 主觀性

並列摘要

Although the probability of suffering a disability is significantly greater than dying before retirement, the risk of becoming disabled is often poorly understood by the public. This leads to that the public do not well transfer the risk of disability and adopt the appropriate protections. Disability insurance is more technic than other life insurance, loss ratio of the former is affected by the social and economic situation, the higher subjectivity including adverse selection and moral hazard in the process of development, and market share is not wide-spreading as other life insurance, the above reasons lead to that the public pay less attention to the risk of disability. Although the social insurance provides coverage to disability in most social welfare states, the benefits of social insurance do not fit in with the need of the disabled as government finance is getting worse and so on, the commercial insurance plays an important role to supplement the differences. The percentage of disabled labor force is increasing annually in Taiwan, meanwhile the benefits of social insurance is going down, which means the difference should be supplemented by the disability insurance from commercial market. The author introduces and analyzes the development and related issues about disability insurance in the United States and indicates some suggestions to its development in Taiwan. The author hopes that in the future when the authorities establish the system and deal with the similar issues, the contents of this paper could be adopted as one of the reference resources so as to improve the disability insurance system.

並列關鍵字

Disability Insurance ； Permanent and Total Disability ； Occupational Disability ； Legal Disability ； Medical Care and Attention ； House or Indoors Confinement ； Subjectivity

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