人身保險告知義務與核保實務之研究

The Study of Informed Obligation to Life Insurance and Underwriting Practices

陳惠珠(Hui-Chu Chen)

指導教授 ： 施懿純

朝陽科技大學/管理學院/保險金融管理系/碩士(2013年)

摘要

保險的制度在保障現代人的經濟生活，當個人在發生經濟上的危險時，可藉由保險制度的危險分散、損失分攤之大數法則的原理來恢復或減輕可能遭遇到的損失。但保險市場是一個典型資訊不對稱的市場，保險公司與投保的消費者雙方都存在著無法獲得所需相關資訊的問題。這種情形很容易被市場參與者所利用，導致保險機制被破壞。
要解決資訊不對稱的問題，保險公司具體作法是透過各種管道收集有關投保者資訊，再透過第一線業務人員及第二線核保人員對投保者做出準確的風險分類，並各自賦予其適當的承保條件，使危險達到同質化，讓保險制度能達到公平合理的目的。
由統計資料可知違反告知義務而被保險公司解除契約案件，一直佔保險局所受理之申訴案件一定的比例。解除契約雖無法和保險詐欺劃上等號，但因保險契約是雙方誠信契約，假設投保時故意隱匿或告知不實，顯示其投保動機不良，與保險詐欺又有何差別？保險公司透過合理精算與大數法則本可穩健經營，但如果新契約參雜一些告知不實案件，而被保險公司解除契約，其實與投保發生短期死亡一樣，已威脅到保險公司經營風險，如何減少不良契約引進，減少解除契約的發生率，確實是各保險公司核保部門之重要課題。
本文藉由說明告知義務之意義、法律性質與各國立法例，並針對人壽保險危險選擇的過程及核保實務，配合我國實務爭議案例分析結果，來探討如何消弭此種情形，最後並分別針對現行台灣保險法、主管機關及保險公司提出建議，以供參考。

關鍵字

大數法則 ； 資訊不對稱 ； 告知義務

並列摘要

The insurance system protects modern economic life. When the individual encounters economic danger, he can recover or relieve possible losses by the function of the large numbers law of the risk dispersion and loss-sharing in the insurance system. But the insurance market is a typical information asymmetry one, both of the insurance companies and the insured consumers exist the problem, that they can’t obtain required and associated information. The condition of the asymmetry information is easily used by this market participants and it also results in the destruction of the insurance mechanism.
To resolve the problem of the information asymmetry, the specific way of the insurance company is to collect the information associated the insured by all kinds of methods. Then the first line of sales personnel and the second line of underwriting staff make accurate risk classification and give its own appropriate underwriting conditions to attain danger of homogenization. Let the insurance system achieve a fair and reasonable purpose.
By statistics that the rescinded contract cases ,owing to breach of the obligation , always keep a certain proportion in the admissibility complaint cases of the Insurance Division. Rescinding the contracts and insurance fraud can not be equated. But the insurance contract is a bilateral Faith Contract. Assuming the insured intends to conceal or informs untruly which reveals the insured’s bad motives. What’s the difference between untrue description and insurance fraud?
The Insurance companies may operate steadily through reasonable actuarial and the large numbers law. However, if the new contracts are mixed some di shonestly informed cases and are rescinded for breach of the obligation. In fact, it’s the same condition as the insured short-term death. It has already threaten the insurance company’s operational risks. It’s actually the important issue of underwriting department of the insurance companies to reduce the bad contracts and the contract cancellation incidence.
In this study, by means of the significance of the obligation to inform, the legal nature and various national legislation cases, and for the life insurance risk selection process and underwriting practices, with our certain disputes analysis results, we explore how to eliminate such a situation. At last, we offer proposals respectively for the current Taiwan Insurance Law, Competent authorities and the insurance companies for reference.

並列關鍵字

Informed obligation ； the Large Numbers Law ； Typical Information Asymmetry

參考文獻

3、葉啟洲（2012）。德國保險契約法之百年改革-要保人告知義務新制及其檢討。台大法學論叢。41（1），245-326。

7、邱美惠、許妙菁、盧靜怡（2011）。人身保險理賠爭議調處案例彙

1、邱麗文（2009）。兩岸保險法制之比較-以產物保險為核心探討。

（一）書籍

1、人身保險判決彙編（2011）。台北：中華民國人壽保險商業同業公