論保險法之因果關係 —以承保範圍與事故發生之因果為中心

在保險訴訟案例中，事故發生與承保危險是否具備因果關係，或是該事故是否由除外危險所造成，常為保險訴訟中重要之爭議，惟我國現行保險法並未明文規範保險因果關係之判斷標準，現行保險契約條款亦未詳細規範，保險因果關係之判斷標準需透過學說與實務發展建構。我國學說和實務有主張適用民法上之相當因果關係作為判斷標準，惟基於侵權法因果關係與保險因果關係目的與架構上之不同，直接適用相當因果關係作為判斷標準在特定個案將產生問題。故本文認為，應適用近因原則作為判斷標準，並經過是否為獨立原因、是否條件因果、對事故發生原因力之貢獻、是否為開始因果歷程之原因力等參考因素，認定造成事故發生之近因係為哪個原因力，再加以判斷其係為承保危險、非保危險、除外危險，而決定保險人是否應為保險給付。

關鍵字

因果關係；保險契約；承保範圍；危險事故；除外事項；相當因果關係；近因原則；契約解釋；舉證責任

並列摘要

In insurance lawsuits, the loss of accidents caused by whether the insured peril or exclusions is often an important issue. However, current Insurance Act in Taiwan does not explicitly regulate the test of insurance causation, and the phrases in insurance contracts are also deceptive simple. As a result, the standard of insurance causation needs to be constructed through the development of theory and precedent. Some scholars and courts often apply concepts form causation in tort law, especially “adequate causation”. However, the purpose and structure of tort causation and insurance causation are partly different. If courts apply adequate causation as the standard directly, it would lead to inconsistent decisions and cause unreasonable result in some cases. This article believes that “proximate cause rule” should be applied as the test of causation in insurance contract law. The approach identify the proximate cause of loss by considering some core factors, including whether the cause of loss is an independent cause, conditional causation, contribution to the chain of efficiency, and whether it is successive cause. The insurer’s liability of indemnity depends on whether proximate cause is result from insured peril or exclusions.

並列關鍵字

Causation ； Insurance contract ； Insured event ； Peril ； Exclusions ； Adequate causation ； Proximate cause ； Interpretation of contract ； Burden of proof