火災保險理賠主要爭議問題之研究

A Study On Main Contentions Arising From Claims of Fire Insurance

顏思齊(Szu-Chi Yen)

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(2008年)

https://doi.org/10.6846/TKU.2008.00968

摘要

保險制度之建立乃在維護個人及社會經濟之穩定，而火災保險在人類經濟發展過程中，一直扮演著互助救濟、穩定經濟成長的重要角色。隨著經濟發展及多樣化的保障需求，保險契約的內容也日趨複雜，而理賠爭議的發生也隨之增加。本文歸納、整理火災保險理賠常見之爭議案例，將火險賠案處理分為賠案調查、損失理算與結案三個階段，逐一討探過程中可能發生之爭議問題，以文獻分析法、保單分析法與案例分析法探討合理之解決方法。研究內容主要分四部分加以闡釋，第一部份為火災保單解析與理賠處理實務，第二部分為火災保險保單責任之爭議，第三部分為火災保險理賠金額之爭議，第四部分為火災保險理賠款應給付對象之爭議及代位權之探討。最後，對於火災保險核保人員、理賠人員與被保險人提出建言，避免文義不清與合理期待產生落差之爭議一再發生；同時，建議修改或刪除保險法第54條第2項之規定，俾使公平、合理之補償機制得到確保。

關鍵字

火災保險 ； 理賠爭議 ； 折舊 ； ABI ； 自負額 ； 抵押權人

並列摘要

Insurance system is designed to protect and maintain the financial stability of an individual and the society as a whole. Fire insurance has always been playing a key role in stabilizing the economic development. Coming along with the economic growth, the demand of insurance cover is increasing day by day and so is the complexity and varieties of claims disputes.
This essay attempts to review and analysis from different perspectives- academic theories, policies analysis and legal precedent-- the most common Fire Insurance Claims Disputes between the insurer and the insured. For the purpose of this essay, Fire claims-handling is divided into three phases- i) factual investigation, ii) loss assessment and iii) Conclusion.
There are four major parts of this essay, namely i) an analysis of fire insurance policies together with general claims handling practices; ii) disputes over policy liability; iii) disputes over loss/compensation assessment and iv) disputes over legitimated payee and issues related to subrogation.
This essay concluded by making certain suggestions to underwriters, claims-handlers/adjusters and Insureds so that those common disputes, such as ambiguity of policy wordings or unrealistic expectation of the insured, could be avoided. Meanwhile, this is also suggested to amend Article 54 of the Insurance Law because it would appear that the current version is no longer suitable for the insurance market of today.

並列關鍵字

Fire Insurance ； Claim Contention ； Depreciation ； ABI ； Deductible ； Mortgagee

參考文獻

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4. 最高法院九十五年度台上字第三○四號民事判決

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6. 最高法院九十五年度台上字第一六九六號民事判決

7. 最高法院九十六年度台上字第一三三號民事判決