責任保險索賠基礎制之辨正與實務運用之研究

A Study on Identification and Application of Claims-Made Basis in Liability Insurance

姚棋馨(Chi-Hsin Yao)

指導教授 ： 高棟梁

淡江大學/商學院/保險學系保險經營碩士在職專班/碩士(2006年)

https://doi.org/10.6846/TKU.2006.00552

摘要

責任保險為近年來保險業頗具發展潛力之險種，保險公司紛紛引進各類新種責任保險，然責任保險已跳脫以往以事故發生基礎制之設計思維。越多種類之責任保險，尤其是專門職業責任保險，均採取索賠基礎制之設計。但是在引進此種制度之同時，國內實務界對於此種制度之引用及解釋似乎未見成熟，因此定義常有混淆，內容亦未臻明確，實有缺憾。
由於索賠基礎制設計上之複雜性，對要保人及保險人常造成保險間隙之困擾，因此極易發生爭議。為減少此爭議，對於索賠基礎制責任保險單應有更進一步之認識與規範，配合我國法規並參酌國外經驗加以改善，始可設計出較完善之保險單，以保障保險契約之雙方當事人。
夲研究之內容主要在：(1) 比較索賠基礎制與事故發生基礎制之優劣；(2) 對索賠基礎制及其相關制度予以詳細探討介紹；(3) 與索賠及報案基礎制加以比較，分析其差異，同時就使用上之適法性予以討論；(4) 就索賠基礎制於台灣保險實務上運用所可能發生之問題加以分析，最後並提出解決這些問題之建議。

關鍵字

責任保險 ； 事故發生基礎制 ； 索賠基礎制 ； 索賠及報案基礎制 ； 追溯日 ； 延長報案期間

並列摘要

Liability insurance is one of the most potential lines in the future. Insurance companies are creating all kinds of liability insurance. But current liability insurance is different from the old design which was only written on the occurrence basis. More and more liability insurances, especially professional liability insurances, are written on a claims-made basis. Currently, the practical use of claims-made policies is not mature in the domestic insurance market. In addition, there is some confusion over the definitions of claims-made basis which at times are still not clear enough.
Because of the complication of claims-made basis policies, it is easy to have quarrels between the insurer and the insured. In order to reduce the issues, we should have more understanding of the claims-made basis. Researching the relevant laws and referring to foreign experiences will improve the design of a claims-made policy to protect the two parties of the insurance contract.
This article mainly focuses on the followings: (1) the differences between occurrence basis and claims-made basis; (2) the whole system of Claims-made basis policies; (3) the differences between claims-made basis and claims-made and reported basis, with the relevant legal basis for claims made basis; and (4) the problems resulting from claims-made basis using in Taiwan insurance market and the suggestions for solving the problems.

並列關鍵字

Liability Insurance ； Occurrence basis ； Claims Made Basis ； Claims Made and Reported Basis ； Retroactive Date ； Extended Reporting Period.

參考文獻

14.Youngman Ian, Directors’ and Officers’ liability Insurance, Woodhead Com bridge England, 1st edition , 1995, P35.

12.石浩吉、建築師工程師專業責任保險承保範圍與投保策略之研究（2004），台灣大學土木工程學研究所碩士論文，頁30。

1.Charles R. McGuire，Kathleen A. McCullough, George B. Flanigan, exposure triggers and allocation methods; learning lessons from prior court rulings, Risk Management and Insurance Review, Vol7.No1, 2004, PP73-87.

5.Donald S. Malecki, Employee Crime and Claims-Made Forms, Rough Notes Indianaapolis, Vol.144, 2001, P122.

7.George E. Rejda, Principle of Risk Management and Insurance , 8th edit , 2003, P5.