傷害保險與健康保險區別之探討－以意外傷害之認定、因果關係之判斷及舉證責任之分配為中心－

Abstract

本論文主要係欲對傷害保險與健康保險做合理的區分，以意外傷害之認定、因果關係之判斷以及舉證責任之分配作為探討之核心。

第一部份關於意外傷害之認定，本文擬先介紹我國學說及實務關於傷害保險中意外傷害之判斷標準，再提出本文對學說及實務見解之質疑，最後嘗試提出新的判斷標準，並以此標準重新檢視國內外案例。

第二部份關於因果關係之判斷，本文同樣擬先介紹我國實務關於傷害保險因果關係之判斷標準，再提出本文對實務見解之質疑，最後嘗試提出更具體、明確之判斷標準，並以此標準重新檢視國內案例。 於討論完畢關於傷害保險之意外傷害與因果關係之判斷後，本文緊接著於第三部份將討論當案件進入法院後，何造應就意外傷害與因果關係負舉證責任的問題。關於舉證責任之分配，本文同樣擬先介紹我國學說及實務之見解，再提出本文之看法。

The main purpose of this thesis is to distinguish the difference between the coverage in accident insurance and health insurance. We emphasize on the definition of an accident, the judgment of causation, and the allocation of burden of proof.

In the first section, we will discuss what defines an accident in accident insurance. Initially, we will introduce the opinions of domestic courts and scholars, and point out their possible deficiencies. Ultimately, we will try to advance a new standard to define what is considered an accident in accident insurance, and use this new standard to review the related cases in Taiwan and the U.S. In the second section, we will discuss causation theory in accident insurance. In the beginning, we will introduce the opinions of domestic courts, and point out their possible deficiencies. In the end, we will try to advance a more concrete and clear standard on this issue, and use this new standard to review the related cases in Taiwan. In the last section, we will discuss the burden of proof. Namely, when a case enters into court, we need to determine which party has to prove if the insured’s death or disablement resulted from an accident, and whether or not there was a break in the chain of causation between the accident and the result of death or disablement. Similarly, we will introduce the opinions of domestic courts and scholars, and subsequently provide our opinion about how to determine the allocation of burden of proof.