要保人未據實說明事項「重要性」之認定、保險人就告知事項之說明義務與解除權阻卻事由–評臺灣高等法院101年度保險上字第11號民事判決 Determining the Materiality

摘要
　　臺灣高等法院101年度保險上字第11號民事判決中，法院以「酒精成癮等病症足以影響自發性腦溢血之發生機率」為由據以認定重要性存在，然其所採「重要性」之認定標準為何？亦即就「足以變更或減少『保險人』對於危險估計」事項，究採客觀標準抑主觀標準，尚具深究必要。又，本判決就要保人關於書面詢問事項具複雜專業性，應由業務員協助說明之爭執，縱以系爭未告知事項非要保人所不能理解為由而不採，惟關於保險人或其業務員，於締約詢問時，有無說明義務，則未論及，本文對此將予研討。另，被保險人腦溢血原因縱已經認定非屬意外，故其爭執該事故與未告知事項無因果關係，尚無理由。此結論固屬可採，然法院於判決理由中亦提及要保人得舉證「未告知或不實說明之事項與保險事故之間無關聯、無必然性」而阻卻保險人解除權之行使，則此處「因果關係不存在」如何判斷，亦有詳查必要。
關鍵詞：告知義務、不實說明、因果關係抗辯、重要性
Abstract
　　In the 101 Insurance Shangzhi No. 11 Decision delivered by the Taiwan High Court (THC), it was held that as alcoholism is connected the probability of Intracerebral Hemorrhage, insured’s failure to disclose the fact of alcoholism is sufficient to change the insurer’s risk assessment. Yet what the court did not reveal is the standard of review it applied in determining whether the non-disclosed or misrepresented facts are material to its underwriting decision. It is worthwhile to probe into whether the objective standard or the subjective standard was adopted. In addition, the THC also held that since terminologies in the application form are understandable to an ordinary insured, the insurer still owes no duty of explaining the contract and related documents to the insured. However, the THC did not respond to the issue on whether the insurer bears a duty to explain the contract. This article will address this matter. Last, pursuant to Article 64 Section II of the Taiwan Insurance Act, where the insured successfully proves the non-existence of the causal connection between the insured event and the non-disclosed or misrepresented fact, the insurer’s right of rescission is therefore deterred. The THC introduce the “absolutely no probability” standard in determining the nonexistence of the causal connection. This article will also review the appropriateness of this standard.
Keywords: Duty of Disclosure, Misrepresentation, Defense due to the non-existence of the causal connection, Materiality