傷害保險理賠糾紛之探討－以交通事故理賠糾紛為例The Claim Disputation of Personal Accident Insurance– the case studies of car

民國90年再次修正的保險法，進一步允許產險業可以以主契約方式經營傷害保險。其結果為，整個傷害保險的市場，因產險業者的加入，讓市場的競爭更趨白熱化，消費者的選擇更加多樣化，但同時保險理賠爭議亦隨之屢見不鮮。
本研究介紹常見的傷害保險理賠爭議事故種類，並以交通事故訴訟案為例，加以分析。實證結果發現，最容易產生糾紛的原因為“意外”與“疾病”之間的認定，亦有因疑有道德危險所產生的糾紛。最後針對保戶、保險公司、政府及法令三方面進行建議，以期減少因理賠所產生的爭議，讓社會大眾有一個公平、合理、快速的求償作業。
關鍵字：傷害保險、理賠糾紛、交通事故
Abstract
In the year of 2001, the Insurance Law was amended again to further allow the property insurance companies to undertake the risks of accident insurance with a main certificate of insurance. Owing to the joining of the property insurance companies, the whole accident insurance market faces a mounting competition and thus consumers have various selections. Of course, the disputes come up with the events of compensation.
This research considers the insured and the insurance companies when they encounter an insurance lawsuit, the preparation for the lawsuit, and distribution of responsibilities of evidence collection. At the same moment, this research introduces the most common types of claim disputation and analyses cases of the claim disputations of car accidents.
The results show that the most common cause for such disputation is the identification of “accident” or “disease”. There are also problems regarding to the suspected moral hazard. At the last part, the authors make suggestions for the insured, insurance companies and the authorities to reduce the disputations on insurance claims and provide a fair, reasonable, and rapid claim operation procedure to the public.
Keywords: accident insurance, claim disputations, car accidents