自己的保險自己買？——論團體保險契約之保障主體與相關法律問題

Research on the Insured and Related Legal Issues of Group Insurance

林政豪(Cheng-Hao Lin)

指導教授 ： 汪信君

國立臺灣大學/法律學院/法律學研究所/碩士(2014年)

https://doi.org/10.6342/NTU.2014.00657

摘要

由於現行團體保險之契約條款以及運作方式，與我國保險契約法有許多衝突，導致實務上發生許多爭議。主要問題包括：1. 團體保險契約之要保人為誰（即現行團體保險契約之「要保單位」應如何解釋？）、2. 團體保險契約之要保人對被保險人之保險利益應如何認定？3. 由第三人訂立之團體保險契約，是否須得被保險人之書面同意？4. 是否應限制團體保險契約下受益人之資格？5. 團體保險契約之受益人之指定變更權人為誰？

而財團法人保險事業發展中心，為解決前揭問題，亦於保險契約法修正草案中，增訂團體保險一節。本文係就上揭實務爭議出發，分析相關問題，並參考我國法院實務見解、學說見解，以及美國法（包括美國保險監理官協會之團體人壽保險定義及規定模範法案及團體健康保險定義及規定模範法案、紐約州保險法、加州保險法）、法國保險法以及日本保險法之見解，討論上揭爭議應如何解決，並對前揭保險契約法草案之規定加以評析。

本文並提出以下建議：1. 就團體保險契約之要保人之認定，應以團體為要保人，惟例外於團體無權利能力時，則應以其代表人為要保人；2. 因團體保險契約道德危險發生機率極低，故要保人對被保險人無須具有保險利益；3. 於締結保險契約時，仍應尊重被保險人之意思，惟為使實務作業方便，似得修正適用保險法第105條之規定，即若被保險人未書面表示反對者，擬制其已同意；4. 應限制團體保險契約之受益人資格，以避免道德危險發生並貫徹對被保險人之保障；5. 於團體保險契約，應以被保險人為受益人之指定變更權人。最後，因本文之結論，仍與現行保險法之規範有所衝突，故期待相關單位能完成保險契約法中團體保險之立法，並希冀藉由健全之團體保險制度，提高我國企業員工之保障。

關鍵字

團體保險 ； 要保人 ； 被保險人 ； 受益人 ； 保險利益

並列摘要

There are many legal issues in Taiwan resulted from the conflicts which exist between The Insurance Act and how to operate the contract terms of current group insurance. The main controversies could be illustrated as follows：First, who is the policyholder of the group insurance? Second, how do we identify the insurable interest of the policyholder and the insured? Third, should the insured consent in writing when the insurance contract is contracted by the other person? Fourth, should the qualification of the beneficiary be restricted? Fifth, who can designate or change the beneficiary of the group insurance?

To solve those juridical problems above, The Taiwan Insurance Institute （TII）already commenced amending the section of group insurance in the draft of The Insurance Act. However, disputes remains even after the completion of this draft. Thus, in my thesis, I will attempt to settle the remained legal issues concerning conflicts between The Insurance Act and how to operate the contract terms of current group insurance in practice. To achieve this end, the comparative legal analysis of Taiwanese courts’ verdicts and our scholars’ criticisms to them; in addition to their comparisons with American laws (e.g., the Group Life Insurance Definition and Group Life Insurance Standard Provisions Model Act, Group Health Insurance Standards Model Act of NAIC, plus New York and California insurance codes), France and Japanese Insurance Codes will be adopted as my methodology. In the end, I will also try to comment on the present section of group insurance in the draft of The Insurance Act.

In sum, I am going to propose the following suggestions in my treatise. Firstly, the policyholder of the group insurance must be the group; or the representative of the group when the group is not a legal entity. Secondly, because the chance of motivating a moral hazard in the group insurance are low, the insurable interest between the policyholder and the insured is not necessary. Thirdly, though the will of the insured shall be esteemed when drafting an insurance contract, in order to facilitate this process in practice, the article 105 of The Insurance Act might be altered－the insured would still be deemed as the insured of a written insurance contract, as long as he or she does not give opposed recitation. Fourthly, the qualification of a beneficiary must be restricted to avoid the possible moral hazard and ensure the insured of the group insurance. Fifthly, the beneficiary of a group insurance must be entitled to designate or change the insured. In conclusion, in view of the fact that there are still many differences between my proposed suggestions and the current system of group insurance, I sincerely hope my research will greatly help improving The Insurance Act in Taiwan, and further benefit the welfare of Taiwanese employees in the near future.

並列關鍵字

Group Insurance ； The Policyholder ； The Insured ； The Beneficiary ； The Insurable Interest

參考文獻

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一、中文部分