英日保險詐欺索賠法制比較研究－兼評我國保險法相關建議修正條文

Comparative Study on Insurance Fraudulent Claim Regulation in U.K. and Japan-Focus on Fraudulent Claim Rule in Taiwan Insurance Act Amendment

陳炫宇(Xuan-Yu Chen)

《東吳法律學報》 26卷2期 (2014/10) Pp. 105-148

摘要

自有保險制度以來，保險詐欺情事從未間斷過。然而若容許保險詐欺案件頻繁發生，保險制度將會崩潰，致使無辜消費者無法透過保險制度分散風險。因此在法制上須對保險詐欺之防制有所作為，始能減少保險詐欺之發生。近來我國保險事業發展中心提出保險法修正草案，其中針對保險詐欺索賠為特別規範。由於我國司法實務與學界甚少就詐欺索賠為深入討論，本文欲藉保險事業發展中心提出保險法修正草案之機會，嘗試就英國2014年保險契約法修正草案與日本2008年保險法有關保險詐欺索賠法制為介紹，並比較分析該保險法修正草案之良窳，進而提出相關建議。

關鍵字

詐欺索賠 ； 最大誠信原則 ； 海上保險法第17條 ； 保險契約後義務 ； 比例調整原則 ； 全有全無原則 ； 重大事由終止權 ； 保險人免責權 ； 終止保險契約

並列摘要

Insurance fraud has never been stopped ever since the beginning of insurance system. Nevertheless if we allow the insurance fraud case to occur frequently, the insurance system will collapse, leading to the innocent consumer can't transfer risk to the insurer. Thus, in the legal system it should take different control to insurance fraud, which reduced the occurrence probability of insurance fraud. Recently, it is submitted to Insurance Act Amendment by Taiwan Insurance Institution, and the Amendment is focused on fraudulent claim regulation. Because there is not any deeply discussion regarding fraudulent claim rule in Taiwan judiciary and scholarship. When the Amendment is submitted by Taiwan Insurance Institution, this article may take the chance trying to introduce the fraudulent claim rule regarding U.K. Insurance Contract Bill 2014 and Japan Insurance Act 2008. According the comparative analysis fraudulent claim rule in U.K. and Japan, this article will point to advantage and disadvantage of the A mendment, and offer some legislative suggestion.

並列關鍵字

fraudulent claim ； Utmost Good Faith ； Marine Insurance Act (1906) section 17 ； insurance post-contractual obligation ； proportionality principle ； all-ornothing principle, cancellation of insurance contracts based on material grounds ； discharge of insurer's obligations ； terminate insurance contract

參考文獻

李志峰(2013)。美國法上保險人處理賠案之義務─兼評我國保險法之相關規定。輔仁法學。46，153-264。

陳炫宇(2013)。英國保險後契約義務之發展─兼論我國詐欺索賠條款。法令月刊。64(8)，107-138。

(Association of British Insurer, No Hiding Place - Insurance Fraud Exposed, 1-10 (2012)).

Law Commission, Insurance Contract Law, Issue Paper 7, The Insured's Post-Contract Duty of Good Faith (2010) available at http://lawcommission.justice.gov.uk/docs/ICL7_Insureds_Duty_of_Good_Faith.pdf (last visited on 10/08/2014)。

Law Commission, Insurance Contract Law, Discussion Paper No 152, Post Contract Duties and Other Issues (2012) available at http://lawcommission.justice.gov.uk/docs/insurers-remedies-for-fraud_responses.pdf(last visited on 10/08/2014)。