摘要
本研究以財團法人金融消費評議中心公告之統計資料進行比較分析，統計101年至105年人壽保險理賠、非理賠申訴件數為7,072件、5,974件，人壽保險理賠、非理賠評議案件為3,037件、3,084件，其中申訴成功未進入評議之比例於理賠及非理賠類分別為57.05%、48.37%。而現行之保險申訴管道包含保險公司申訴部門、財團法人金融消費評議中心、各縣市政府附設之消費者服務中心、直轄市及各縣(市)政府消保官、民間消費者保護團體、民意代表等。並分別探討理賠類及非理賠類之評議案件數前五名，分析實際案例以提供消費者及保險業者參考。 保險爭議之減少須由保險公司、消費者及政府機關三方面共同努力，保險公司做好員工教育訓練及部門溝通協調，消費者檢視自身能力並提升保險知識，政府機關協調行政、司法、立法部門共同運作，減少保險爭議，保障民眾權益，發揮保險應有的功能，建立安定祥和的社會。
並列摘要
The analysis of this study is based on the statistical data which was done by the Financial Ombudsman Institution. It indicated that the number of the complaint cases of life insurance claim were 7,072 and the complaint cases of no life insurance claim were 5,974 ; the deliberative cases of life insurance claim were 3,037 and the deliberative cases of no life insurance claim were 3,084 from 2012 to 2016. Among these cases, there are 57.05% on life insurance claim cases and 48.37% on no life insurance claim which passed the appeal procedure for deliberating. Nowadays, the available accesses for customers to grievance redressal system are as below the service line of life insurer, the Financial Ombudsman Institution, the Consumers Service Center, the Consumer Ombudsman Office, Consumer Protection Committee, legislators, etc. The study also discuss the top 5 deliberative cases of life insurance claim and no life insurance claim by analyzing the actual examples which should be helpful reference for the consumers and insurers. The effort on the reduction of life insurance dispute should be made by the insurer, the customers and the government. The insurer should enhance the employee training and the coordination of each department. The consumers should be aware of their own ability and enhance the knowledge of insurance. The government should coordinate the administrative, judicial and legislative departments to prevent the insurance disputes, protect consumers’ right, ensure the insurance functions and establish a stable society.
參考文獻
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5、 行政院消費者保護會 http://www.cpc.ey.gov.tw
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