從保險契約法之觀點論保險詐欺之防制

Abstract

保險詐欺向來頻繁發生於保險實務界，故為保險業中及保險法上所上亟欲防範之問題。惟不論從保險業之作法或保險法之規範觀察，對於保險詐欺之防制，均集中於事前防範，且規範對象均為保險事故實際發生之保險詐欺類型，此固然無誤，惟保險詐欺之類型變化多端，除不限於保險事故必然發生外（如偽裝保險事故發生），另有保險事故發生後，以詐術為高額保險金之請求等類型存在。再者，現行保險法第29條第二項之免責規定，在健康保險、傷害保險等保險類型中，因被保險人之保險詐欺行為，而使保險事故發生後，保險契約仍然存在，但在要保人、被保險人與保險人之信賴關係已蕩然無存之狀況下，現行法亦欠缺使保險人得終止保險契約之規範存在，此均為現行保險法中規範有所欠缺之處。 對於現行保險法中，在保險詐欺問題上規範有所不足之處，可以民法上之情事變更原則、繼續性契約之法理及保險法上特約條款之相關規範作為解決方式，惟此等方式均有若干不足之處，如情事變更原則有適用條件之限制；繼續性契約之法理，若無具體條文支持，在實務上亦恐難運作；保險法上之特約條款，則亦有遭保險法第54-1條限縮條款內容之問題，均無法作為徹底解決問題之方式。 對此問題，日本於平成20年（2008年）制訂了新保險法，其中並增訂在保險實務及學理上存在已久之「重大事由解除權」，規範要保人、被保險人等於保險金請求時為詐欺行為，保險人得解除保險契約，在相當程度上，對於保險詐欺之問題，提供了法制上之具體規範，值得我國參考，並提供未來修法之方向，本文並對此提出保險法之建議修正條文，作為立法論上之參考。

Insurance fraud which occurs frequently has been tackled by insurance practice and related regulations. With more observation, they put more efforts to establish the preventive norms, especially on the fraudulent claim after the occurrence of insurance accident. However, there are varieties of insurance fraud which is not limited to the cases mentioned above. Besides, according to Article 29 Section2 at Insurance Law, the insurance contract can survive even though the fraud done by the insured wrecks a havoc on the reliance between the insurer and insured, needless to say the insurer is able to terminate the contract by Insurance Law. Taiwan Insurance Law contains myriads of disadvantages. In lieu of these, it is suggested to adopt with some rule such as clausula rebus sic stantibus, the rule of continuous contract in civil law and regulations on special provisions in Insurance Law. Albeit, there are still insufficient to handle all problems. As to clausula rebus sic stantibus, the conditions of the rule is not so concrete and full of limitation to fulfill its purpose. Take the rule of continuous contract for another example, judges would be reluctant to utilize it because of lack of accurate regulations. Even though we put more hopes on special provisions in Insurance Law, it is still limited to Article 54-1and eventually becomes unavailable on solutions. With the perception of these problems, there is the tremendous amendment in Japanese Insurance Law in 2008, including the addition on fundamental termination regulation to provides with more concrete and instructive solutions to insurance fraud. In a nutshell, the thesis try to provides with legislative suggestion and proposes some drafts with the introduction these development to Taiwan Insurance Law .