保險之主要機能在於被保險人所受損失之填補,以落實穩定其經濟生活之目的,故可謂「無損失,無保險」。惟保險既係匯聚眾多個人之力量以達到預期損失之分散,其即須建立一項保險對價估算之標準,始得公平地自個別成員處收取將來填補損失所需之資金;另一方面,亦須透過該標準控管保險給付,以為制度之永續運行。而此項標準之建立,係以特定之危險或危險事故作為準繩,故亦可謂「無危險,無保險」。由此可知,無論要保人所應交付保險對價之數額多寡,亦或保險人所應負保險給付義務之成立與否,均與保險法第1條所稱「不可預料,或不可抗力之事故所致之損害」密切相關,又觀諸保險法第4條,此所謂「不可預料,或不可抗力之事故」亦被稱為「保險事故」,則究竟何謂保險事故,將影響保險關係之內涵,不僅牽涉要保人、保險人等契約當事人之權利義務內容,更將影響被保險人或受益人等利害關係人之權利,實有予以探究、分析之必要。 是本研究即以保險事故之概念分析出發,分析保險事故與其他概念(如危險、危險事故、危險因素、因果關係及保險利益等)間之差異與關係,進而確立保險事故一詞之意涵與其於保險理論中之定位,以期能就此一法律概念有妥適之解釋與適用。又為免流於抽象,遂續以因醫療傷害所生之保險需求,而由商業保險面向所衍生之保險類型為例,具體將所確立之概念操作於此等保險類型中,藉以將上位概念落實於個別具體保險類型中,並驗證此種概念與定位構築較諸其他說法之妥適性與明確性。
The main function of the insurance is to indemnify the loss of the insured and stabilize their financial life; therefore, it could be described as “no loss, no Insurance”. However, the indemnification paid for the insured is collected from the premium and have its limitation, therefore, how the insurer collect the premium from the policyholders fairly and pay the indemnification precisely shall be the key point to prevent the insurance system from collapse. The standard for the insurer to collect the premium and pay the indemnification is built based on the perils; therefore, it could be described as “no peril, no Insurance”. In other words, no matter the amount of the premium which shall be paid by policyholder or whether the insurer shall pay the indemnification or not, both closely related to the “unforeseeable events or force majeure” provided in Article 1 of the Insurance Act, which also be described as “an Insured Peril” in Article 4 of the Insurance Act. Accordingly, the concept of “Insured Peril” shall affect the legal relation among the insured, insurer, policyholder and beneficiary, it should has the necessary to be explored and analysis. Consequently, the purport of this thesis is to analysis and reconstructs the concept of the insured peril and the relationship between it and other related concept, such as risk, peril, hazard, causation and insurable interest. In addition, to make the concept more concrete and verify its appropriateness, this thesis shall illustrate the reconstructive theory of insured peril with the insurance contract which designated the medical injury as an insured peril at the last chapter.