保險法上對價平衡原則之規範拘束力

Abstract

透過對價平衡原則之要求，保險人所收取之保險費與保險人所承擔的危險之間須具有平衡性，以維護保險經濟制度之運行。儘管對價平衡原則於法並無明文，惟學說與實務解釋適用保險法時，同時提及對價平衡原則之規範所在多有，如第64條（要保人訂約前之告知義務）、第59條與第60條（危險增加的效果和通知義務），以及第26條（危險減少）的規定。然而，在對價平衡之外，基於保險契約雙方當事人經濟地位、專業知識與磋商力量的不對等，保險法也同樣重視保險消費者（如要保人、被保險人與受益人）之保護。本文分析權衡後認為，上開規定應該解釋為追求對價平衡之下，保護保險消費者基本權益所設置的最低限度保障，而為相對強行規定。保險契約若有不同約定，且其結果不利於被保險人者，應認為該約定無效（保險法第54條第1項）。至於在該等規定的適用範圍之外，尚不宜逕將對價平衡原則解為一個具有規範上拘束力的法律原則，以免破壞私法自治原則與市場機制。在保險契約（尤其是承保範圍）的解釋問題上，雖可以將對價平衡原則與危險共同體原則作為疑義解釋之考量因素，惟保險契約為典型的定型化契約，故契約疑義有利於被保險人解釋（保險法第54條第2項），仍應作為優先的契約解釋原則。

By insurance`s very nature, it is an economic system to distribute risk among risk pooling. Owing to the principle of equilibrium, the insurer should maintain the equilibrium between the premium and the risk so as to sustain the operation of insurance economic system. Although there is no specific statute named as the principle of equilibrium in the Taiwan Insurance Act, the scholars and courts in Taiwan usually refer the principle of equilibrium in the the interpretion of Insurance Act, such as article 64 (duty of disclosure), article 59 and 60 (legal effects of rising hazard and duty of notification) and article 26 (the decrease of hazard). Nevertheless, there are tremendous disparities in the economic position, professional knowledge and bargaining power between the insured and the insurer. In addition to the principle of equilibrium, Taiwan Insurance Act highly emphasizes the importance of insurance consumer protection (e.g. policyholder, the insured and beneficiary). This paper proposes that regulations regarding the principle of equilibrium mentioned above should be the minimum of insurance consumers protection and be interpreted as unilaterally compulsory provisions because of the principle of equilibrium. According to section 1 of article 54 of Taiwan Insurance Act, if there is any insurance clause differed from the above regulations, it should be considered invalid. As for the scope out of these regulations, it is improper to directly interpret the principle of equilibrium as a binding norm in order to prevent destroying the self-rule of private law and market mechanism. In the interpretation of insurancecontracts (especially coverage), the principle of equilibrium can be regarded as one of the factors in explaining insurance contract clause. As a typically standard form contract, the ambiguity rule of insurance contract (i.e. section 2 of article 54 of Taiwan Insurance Act) should be placed in top priority for the interpretation of contract.