保險詐欺防範法制之研究 ─以人身保險為中心

A Study on Insurance Fraud Prevention Rules-Focus on Contigency Insurance

陳炫宇(Chen, XuanYu)

指導教授 ： 羅俊瑋

國立中正大學/法學院/法律學系/碩士(2013年)

摘要

自有保險制度以來，即無法避免關於保險詐欺之討論。毋寧說保險法規之制定與修正，通常與保險詐欺之防制有極大之關聯。在現今社會變遷快速之情況下，我國保險法規是否足以防範保險詐欺發生，係為本文欲探討之中心。本文將我國保險契約各階段可能發生之保險詐欺區分為二階段討論，分別為先契約階段與後契約階段。

在先契約階段，被保險人對保險人為詐欺不實說明，其可能因保險法第64條第3項之規定而不當得利。在後契約階段，被保險人大量重複投保定額給付型醫療險，其產生保險詐欺之可能性甚高。或被保險人於事故發生時對保險人為詐欺行為，保險法並無相關規範抑止保險詐欺情事之發生。此均顯示現行保險法規似無法因應社會變遷，有重新審視並加以修正之必要。

近來主要國家紛紛對其保險法規為重大修正，以符合該國社會現狀。例如英國在2012年制定消費者(告知暨說明)保險法，取代過去英國海上保險法宰制所有保險契約類型之情況。而德國於2006年對其保險契約法為大幅度修正，日本則在2008年制定保險法典取代過去商法保險章之規定。本文將參照英日最新立法例，試圖引進相關立法制度防範保險詐欺之發生。

關鍵字

不可抗爭條款 ； 詐欺索賠規則 ； 後契約義務 ； 最大誠信原則 ； 保險詐欺 ； 道德危險 ； 複保險 ； 重大事由終止權

並列摘要

There can not be avoided the discussion of insurance fraud since insurance system began. Rather, the formulation and revision of the insurance laws and regulations usually greatly associated with insurance fraud. In the case of rapid social change, whether Taiwan Insurance Law is sufficient to guard against insurance fraud occurs or not. That is what we want to discuss. There are various insurance fraud types in Taiwan insurance contract, and according the insurance contract process, we can divided into two stages: pre-contract stge and post-contract stge.
At pre-contract stge, insured may fraudulent misrepresent, and pass through incontest period which Insurance Law § 64(3) was regulated. Insured or beneficiary could get unjust benefit. At post-contract stge, the insured may take out several hospital medical insurances. This would increase the probability of insurance fraud occurrance. For another, when insurance accident occurred, the insured may falsely misrepresent about his loss. In this situation, Taiwan Insurance Law didn't stipulate the regulation about fraudulent claim. This showed that Taiwan Insurance Law couldn't response to social change, and there's necessary to re-examine it.
Recently, the major countries started to revise its Insurance Code, and the revision was according to current social situation of its country. For example, United Kingdom enacted Consumer (Disclosure and Misrepresentation) Insurance Act at 2012, which was partially replaced Marine Insurance Act 1906.Before the act was enacted, Marine Insurance Act 1906 applicated to all type of insurance contract. And in 2006, German modified its Insurance Contract Law greatly. In 2008, Japan enacted the Insurance Code to replace the regulation in Commercial Code Insurance Chapter. This article will consult the latest legislation of U.K. and Japan, trying to introduce the the relevant legislative system to prevent the occurrence of insurance fraud.

並列關鍵字

special cancellation of contract ； double insurance ； incontestable clause ； fraudulent claim rule ； post-contract obligation ； pre-contract obligation ； Utmost Good Faith ； insurance fraud ； moral hazard

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