保險法上道德危險規制之研究

Abstract

保險契約為最大善意契約，要保人或被保險人違反最大善意，保險人得否拒卻責任？在評論違反最大善意契約的法律效果妥適性前，有必要先就最大善意內容為釐清。我國司法實務對於最大善意的內容，存有一套認定標準。在保險法欠缺相關規定時，司法實務利用最大善意原則，作為防範道德危險之工具。尤其在法院遭遇個案時，無法確定要保人或被保險人係故意致保險事故，基於防範道德危險的情感，則透過最大誠信原則使保險人拒卻責任。反之，當法院在個案認定上無道德危險之虞，則作有利於要保人或被保險人之法律適用，以保險法第29條第2項但書為由，要求保險人給付保險金。我國司法實務如此適用法律，人民將無法有效預測判決結果，造成法律不安定狀態。觀察我國司法實務採去上述作法之背後原因，似是保險法相關規定有所欠缺。由於我國保險法第29條第2項但書規定採取全有全無原則的立法方式，容易招致法院在個案認定上，無法依據個案情況給予妥適的法律效果。此一情形與過去德國司法實務在舊保險契約法第61條第2項規定操作情形頗為相同，而德國在2008年修法時完全納入對應調整原則，使類似情形不再發生。本文建議在立法政策上，或許可參照現行德國保險契約法第81條第2項規定，將現行保險法第29條第2項但書規定改為對應調整原則之立法。在現行法的操作上，司法實務應避免以最大誠信原則為由，拒卻保險人的責任。

A contract of insurance is a contract based upon the utmost good faith (uberrimae fidei), and, if the utmost good faith be not observed by proposer or insured, may the insurer voids liability? Before assessing the adequacy of legal effect, this article shall clarify the extent of utmost good faith principle. Taiwan judiciary has a set of standard to recognize the extent of utmost good faith. When the matters not specifically provided for Taiwan Insurance Act, Taiwan judiciary takes utmost good faith as mechanism to solve moral hazard issue. Especially court faces the fact whether proposer or insured deliberately caused insured event in the case, based on moral hazard prevention consideration, court may discharge insurer’s liability. In contrast to previous circumstance without moral hazard probability, court may make decision in favor of proposer or insured, asking the insurer pay the insurance money according to Taiwan Insurance Act Art.29 Sec.2 proviso. Taiwan judiciary takes previous approach to interpret Insurance Act, it makes the public can’t foresee court decision, and caused unstable legal environment. Looking the reasoning behind the approach, maybe Insurance Act provision has some kind of defect. Because Taiwan Insurance Act Art. 29 Sec. 2 proviso takes all-or-nothing legislation, it makes court can’t decide proper legal consequence in the case, and the circumstance is alike to German judiciary adopting Insurance Contract Act 1908 Art.61 Sec.2. However, German has amended Insurance Contract Act in 2008, the Act fully takes pro rata principle, and the circumstance can’t be happened in German Insurance Contract Act 2008. This article suggests that maybe we can refer to German Insurance Contract Act 2008 Art.81 Sec.2, and takes pro rata principle to amend Taiwan Insurance Act 29 Sec. 2 proviso.Under existing Taiwan Insurance Act, this article suggests that Taiwan judiciary shall avoid discharge insurer liability by utmost good faith.