COVID-19防疫保險適用情事變更原則之研究

Abstract

防疫保險契約係以傳染病疫情對個人所造成之損害為承保標的。為因應COVID-19這類全球性重大傳染病，我國政府陸續推動多項防疫政策，以達成疫情管控之目的。然該等政策之施行與變動，對社會運作、經濟秩序乃至商業契約之履行均產生深遠影響，尤以保險契約領域所引發之爭議最為顯著，堪稱保險實務史上前所未見之挑戰。 本論文擬探討COVID-19疫情期間，防疫保險契約在防疫政策持續滾動調整之情境下之理賠爭議，並進一步思考此類契約爭議是否得適用民法第227條之2所規定之「情事變更原則」，作為調整契約內容或請求解除契約之依據。鑑於學理上對於情事變更原則之適用仍存在歧異，本文結合實務判決加以分析，探討情事變更原則實際運用之可能性，並由法律競合角度檢視保險法第59條、第60條「危險增加」條款之適用，最終回歸民法規範對防疫保險契約適用情事變更原則之正當性與界限。 本文檢視政府因應疫情所調整之防疫政策是否屬於重大且客觀之情事變更，研究結果顯示，防疫政策對民間契約履行構成民法上客觀情事變更要件。 其次說明我國防疫政策發展迥異於其他國家，導致保險契約所承擔之理賠風險範圍擴大，非契約成立時保險人所能合理預見者，已構成訂約基礎之重大失衡。 繼則以「對價衡平」原則為分析核心，探討防疫保險契約中保險費率與實際風險發生率是否失衡，並檢視再保險分出之拒賠爭議是否影響對「公平性」之判斷。研究發現，疫情期間防疫保險理賠次數隨防疫政策改變而暴增，較契約預期保險事故發生率增加逾千倍，導致保險人實際承擔之損失與契約對價顯不相當，足以構成「顯失公平」之要件。 文末進一步指出，現行保險契約示範條款雖部分涵蓋承保巨災或系統性風險（如戰爭），但現行保險法體系並無完善法條機制可處理疫情等突發性巨災風險所衍生之制度性問題。此次「防疫險之亂」已揭示我國保險法制之空缺與總體風險管理機制之不足，未來實有必要從法制層面進行全面檢討與強化。 為此，本文提出以下兩點修正建議，期能作為我國處理類似重大突發事件之制度參考，亦有助於保險法制之穩健發展：一、修正保險契約示範條款，將巨災風險承保排除於定型條款之外，改採附加條款方式由雙方另行約定。二、保險法應增訂「總額對價衡平」機制，建構處理巨災風險之情事變更法律基礎。

This thesis seeks to explore the disputes arising from pandemic insurance claims during the COVID-19 outbreak, particularly in the context of rapidly evolving government policies. The core inquiry lies in whether the principle of circumstance changed under Article 227-2 of the Taiwan Civil Code may be invoked to redefine insurance contracts or even to terminate them. Given the academic divergence on this issue, this research incorporates analysis of judicial decisions to assess the practical applicability of the doctrine. Additionally, it evaluates the overlap and conflict between this principle and Articles 59 and 60 of the Insurance Act, which address the concept of “increased risk,” ultimately aiming to clarify the legitimacy and boundaries of applying the change of circumstances doctrine to pandemic insurance contracts. First, this thesis examines whether changes in epidemic prevention policies implemented in response to the pandemic qualify as significant and objective changes in circumstances. The findings suggest that such government measures, which are administrative responses to epidemic emergencies, have a substantial impact on the performance of private contracts and fulfill the criteria for objective change under the Taiwan Civil Code. Second, this thesis illustrates that Taiwan’s uniquely dynamic and interventionist approach to epidemic prevention policies significantly expanded the insurance liability in ways that were unforeseeable at the time of contract formation. This imbalance undermines the foundation upon which the original contracts were based. Third, the thesis centers on the principle of equivalence of consideration, analyzing whether the original premium rates fairly reflect the actual risk occurrence during the pandemic. It also examines the controversy surrounding reinsurer’s refusal to cover claims and how these influences assessments of fairness. Research shows that, following epidemic prevention policy changes, the claim frequency for pandemic insurance increased by over a thousandfold compared to original expectations. This dramatic shift created a significant imbalance between the insurer’s losses and the contractual consideration, satisfying the conditions for unconscionability. In conclusion, although existing model insurance clauses in Taiwan partially account for catastrophic or systemic risks (such as war), the current insurance legal framework lacks sufficient mechanisms to address institutional issues arising from sudden disasters like pandemics. A thorough legal reform is thus warranted to strengthen the system’s resilience in the face of future crises.