論健保署代位求償權與保險安定基金之墊付義務

Discussion of National Health Insurance Administration's Subrogation right and the Obligation to advance by Insurance Guaranty Fund

林家祺(Chia-Chi Lin)

《真理財經法學》 16期 (2016/03) Pp. 49+51-78

摘要

車禍事故之受害人的醫療費用損失可獲自強制汽車責任保險以及全民健保的保障，係因全民健保與強制汽車責任保險發生保險競合。其醫療費用（健保負擔之部分）由健保署支付予醫療院所，健保署支付後依據全民健康保險法第82條仍可代位受害人向車禍事故之加害人所投保強制責任險之保險公司求償，但如健保署向保險公司代位求償時，該保險公司失去清償能力，則得否向安定基金請求墊付？本文認為車禍之受害人於保險公司失去清償能力時，得依保險法143條之三第一項第三款規定請求保險安定基金墊付原保險公司依強制責任保險契約所應給付予受害人之理賠，且健保署於給付醫療費用之限額內亦得依全民健保法第82條代位受害人向安定基金請求墊付較符合立法目的及債法之基本法理。

關鍵字

保險法 ； 強制汽車責任保險 ； 全民健康保險 ； 代位求償 ； 安定基金

並列摘要

Accident victim's medical expenses loss can be obtained from the compulsory automobile liability insurance and the national health insurance policies, because of concurrent Relationship between Compulsory Automobile Liability Insurance Act and National Health Insurance Act. Its medical costs (health insurance burden of part) by National Health Insurance Administration paid to medical hospital by. According to National Health Insurance Act 82nd article, National Health Insurance Administration has Subrogation right, which is an insured party agrees to have National Health Insurance Administration covers the losses incurred by the insurance enterprise. National Health Insurance Administration then inherits the right to recover those losses from the insurance enterprise responsible for the loss for a paid claim. But if the insurance enterprise lost settlement capacity, is have whether to Insurance Guaranty Fund requests the losses? Depending on Insurance Act specified in the first paragraph of article 143, accidence of victims can ask Insurance Guaranty Fund to recover those losses, when the insurance enterprise lost settlement capacity. And in accordance with Subrogation right, National Health Insurance Administration then inherits the right to recover those losses from the Insurance Guaranty Fund responsible for the loss for a paid claim under National Health Insurance Act Article 82nd.It is complied with jurisprudence and Basic Assumptions of Legislation of General Principles of Law of Obligation in Civil Code.

並列關鍵字

Insurance Act ； compulsory automobile liability insurance national health insurance ； subrogation ； insurance guaranty fund ； other insurance ； insurance enterprise ； transfer of obligations ； National Health Insurance Administration ； Ministry of Health and Welfare ； Advance