| 摘要註: |
摘要在現今工商業社會,人們吃五穀雜糧總有生病的時候。既然有病就有醫療需求,對於自己健康的不確定感亦油然而生,故相關的風險保障應運而生,逐漸以健康保險分擔風險的觀念受到重視。投保商業醫療健康保險(下稱健康保險)是為了彌補社會全民健保保障的不足。而最大誠信原則在保險活動中,是以人們應該盡最大的誠信和善意,享有權利、履行義務的原則。該原則是誠實信用原則在保險法律體系中的延伸也是首要原則。本論文主要採取比較分析法、案例分析法、理論與實踐相結合的研究方法,透過對最大誠信原則的解析,以其在保險雙方當事人為出發點就理論聯繫實務,系統闡述了最大誠信原則的含義、內容、國內外研究結果、法律規定等。 全文分為十章,第一章為緖論。先就本論文之研究動機、目的、範圍與限制及預期結果等逐一說明。第二章健康保險契約中最大誠信原則,首就健康保險介紹,次由起源與最大誠信原則和誠信原則的區別適用不同加以探討。第三章最大誠信原則在健康保險契約中的法律地位介紹,針對保險基本原理加以比較分析。第四章健康保險之要保人告知義務,除介紹主體分類、內容與目的;保證、棄權與禁反言作論述外,並就不可抗辯與未告知之事由說明。第五章重要事實的認定標準分析,針對告知時間、範圍與重要事實認定標準以及免除、免責條款詳加介紹,最後以緩和告知義務作出結語。第六章違反告知義務的法律效果，介紹救濟方式，並探討因果關係說與對價衡平說利弊。第七章大陸與英美法系健康保險要保人告知義務法制介紹,就各國要保人告知義務與保險人說明義務之判斷標準、履行時點作出比較。第八章我國健康保險中要保人告知義務法制比較異同、利弊作出結語。第九章告知義務在實務上運用,以我國人身保險實務案例作出法院見解評析。第十章結論與建議,本論文認為我國應比照大陸法系國家保險法制加入最大誠信原則規定,而我國現行告知義務制度所採因果關係說亦有修正必要,應改為比例賠付標準以符合善意與衡平原則要求。本論文亦建議我國應引進保險人說明義務,以加強對投保大眾之保障。文末並提出對我國保險法之修正建議為結論。 AbstractIn the modern society of industry and commerce, people eat crops but cannot avoid illness. When people get ill, they have the need for medical attention. Accordingly, a sense of health uncertainty has developed among people and the supply of protection from such risks has also emerged. Health insurance gets increasing attention of people under these circumstances. Commercial health insurance (hereinafter, “health insurance”) is designed as supplementary protection for the national health insurance system. The principle of good faith in insurance refers to the optimal good faith and good will of people, the entitlement to the rights and to be bound by the obligations. Such principle is also the foremost principle derived from the legal aspect of insurance. In this paper, the method of comparative analysis, case study, combination of theories and practices will be addressed. Through the diagnosis of the principle of optimal good faith, the meaning, content, research findings at home and abroad, and applicable legal rules for the contracting parties of insurance will be addressed to from the theories and practices between the contracting parties of insurance. This paper contains 10 chapters. Chapter I is the introduction specifying the motive, objective, scope, limitation, and anticipated effect of this paper. In Chapter II, the principle of optimal good faith in health insurance contract will be elaborated through the introduction of health insurance. The origins of and the difference between the principle of optimal good faith and the principle of good faith will be explored. Chapter III gives an overview of the legal role of the optimal principle of good faith in health insurance contract with an analysis pointing at the fundamental principle of insurance with comparison. In Chapter IV, the obligation of the proposer of disclosure will be explained. Further to the classification of the subject, content, and purpose of insurance, the guarantee, abandonment of right, and denial of previous statement, refutation and failure of disclosure will also be discussed. Chapter V deals with the analysis of the affirmation of facts under relevant criteria, with introduction to the timing, scope, and the criteria for the determination of essential facts, and the exclusionary and disclaimer clauses, with conclusion from the obligation of disclosure in a courtesy manner. Chapter VI deals with the legal effect of the obligation of disclosure with introduction to the means of remedy and the elaboration of the advantage and disadvantage of the mean-end consequence and the principle of equity in pricing. In Chapter VII, the system of obligation of the proposer of health insurance in disclosure under the Anglo-American legal system with a comparison of the criteria of determination, the time of performing obligations of the proposer and the insurer in disclosure. In Chapter VIII, a comparison of the obligation of the proposer of health insurance in disclosure under different legal systems will be compared with a conclusion on the advantages and disadvantages under different systems. In Chapter IX, the obligation of disclosure in practice will be discussed with the case study on the life insurance of Taiwan under court ruling. In Chapter X, a conclusion with recommendation will be presented. This paper holds that Taiwan should take the insurance law system of the continental system, thereby incorporated the principle of optimal good faith into the system. It is high time to amend the mean-end consequence principle of the obligation of disclosure system currently in effect in Taiwan. It should be changed to proportional compensation to make it congruent with the principle of good will and equity. This paper also suggests the introduction of accountability for the insurers for better protection of the insured public. This paper ends with the recommendation for the amendment to the Insurance Act of Taiwan. |