補告知對保險公司及保戶之影響 -以S公司為例

Study on Impacts of How the supplementary disclosure Affect Insurance Corporations and Insured Persons Industry－A Case Study of S Insurance Company

彭熙宇(Hsi-Yu Peng)

指導教授 ： 郝充仁

共同指導教授 ： 李雅婷(Ya-Ting Lee)

淡江大學/商管學院/保險學系保險經營碩士在職專班/碩士(2015年)

https://doi.org/10.6846/TKU.2015.00140

摘要

我國保險法自立法即對告知義務訂出相關規定。隨著保險環境的改變和主管機關對各項法令修改及監理、消費者保護與對價平衡原則等受到重視，用以往誠實告知為原則所設計告知義務之規範，受到極大之挑戰。業務招攬爭議造成保險糾紛數量一直居於申訴首位及新契約案件量增加時，保戶於承保後再進行補告知義務之案件量亦成正比。加上本文作者是此業務之風控人員，常因資訊不對稱及必須於受理後優先處理；若有影響風險評估情形，於受理日起一個月內完成核決並通知保戶。

本研究為探討保險法中告知義務條款對於壽險公司及保戶之影響。藉由S公司之個案加以分類，透過不同個案類型與專家訪談作深入性之探討、整理分析，進而找出核保風險來源及可能的道德風險、逆選擇等因素，以提供壽險公司風險控管參考指標。若新契約參雜一些未告知或告知不實案件，事後又未提供可保性証明無法評估或拒保，導致契約效力被壽險公司解除契約；或保單生效已超過兩年，即使有解除之原因，亦不得解除契約之拒保案件，已威脅到保險公司經營風險。如何引進高品質的契約、降低補告知之發生率，實為各壽險公司核保部門之重要課題。為降低資訊不對稱案件的發生，探討目前相關法令與現今壽險業經營所面臨的風險與挑戰，並建議具體改善方案，以期有效改善壽險企業經營與法律環境之健全發展，最後分別針對保戶、壽險公司及主管機關提出建議，以供參考。

關鍵字

保險法 ； 補告知 ； 告知義務 ； 資訊不對稱 ； 道德風險 ； 解除契約 ； 壽險公司

並列摘要

Taiwan’s Insurance Act has set forth provisions on policyholder’s duty of disclosure since it was first enacted. As the insurance environment evolves and the competent authority places great importance on consumer protection and the principle of consideration equity in the exercise of its regulatory and supervisory authority, existing regulations on the duty of disclosure which are designed based on the principle of good faith are under tremendous challenge. Insurance disputes associated with duty of disclosure have been at the top of consumer complaints. The number of cases where the policyholder provides supplemental information after obtaining coverage is directly proportional to the number of new policies issued. The author works as a risk control specialist for insurance underwriting. Whenever we receive supplemental disclosure from policyholders, we need to give such cases priority in processing, and if the supplementary disclosure could affect the results of risk assessment, we need to make the underwriting decision and notify the policyholder in one month after receiving the supplemental information.
This paper explores the effect of the duty of disclosure clause in the Insurance Act on Life Insurance Corporations and policyholders. By classifying the cases of S Company and through in-depth examination and analysis of different types of cases and expert interviews, we attempt to identify the sources of underwriting risks and possible factors such as moral hazard and adverse selection, and provide the findings to life insurers as reference for risk management. If new policies issued contain some cases where important policyholder information is being withheld or only partially disclosed, and the policyholder fails to provide evidence of insurability or declines the insurance afterwards that the insurer has to cancel the policy, or a policy has been effective for two years and the insurer is not allowed to cancel the policy even if there are causes for cancellation, such cases greatly increase the operational risk of insurers. How to bring in high-quality insurance contracts and reduce the incidence of supplemental disclosure have become important topics for the underwriting department of life insurers. To reduce the incidence of information asymmetry in underwriting, this paper explores the prevailing laws and regulations as well as risks and challenges faced by life insurers, and propose concrete suggestions for improvement in the hope to effectively improve the business operations and legal environment of life insurers. Lastly, the paper makes suggestions respectively to policyholders, life insurance companies and the competent authority for their reference.

並列關鍵字

Insurance Law ； supplementary disclosure ； Duty of Disclosure ； information asymmetry ； moral hazard ； Life Insurance Corporation

參考文獻

23.關幼鳳，保險法中有關復效條文對保險公司及保戶之影響，淡江大學保險學系保險經營碩士在職專班碩士論文，2008年。

16.葉啟洲，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，臺灣大學法學論叢，41卷1期，頁315-322，2012年3月。

6.汪信君，保險法告知義務之義務性質與不真正義務，台大法學論叢，36卷1期，頁1-27，2007年3月。

17.劉曉燕，次標準體壽險保單核保理賠分析，淡江大學保險學系保險經營碩士在職專班碩士論文，2010年。

3.江朝國，論我國保險法第六十四條據實說明義務之規定—以對價平衡之概念為論點—，保險專刊，第22期，頁82-104，1990年12月。