保险合同纠纷：赔与不赔

在签订保险合同时．投保人应当如实反映自己的情况．保险人更应当具有为投保人实现最大利益的善良注意义务．比如对免责条款的特别提示与解释。笔者特撰此文,通过法院对保险合同纠纷的处理,能够让人们对保险合同的相关法律规定有所了解．以便维护自己的权利;同时也希望保险公司通过诉讼,能够促进其在保险服务方面趋于完善。     

刍议保险人说明义务对免责条款效力的影响

我国《保险法》自1995年颁布以来,都有对保险人不履行提示及明确说明义务则免责条款不产生效力的法律规定,然而经过2002年和2009年的两次修订,却一直没有对＂免除保险人责任的条款＂的范围加以明确,从而引起对此法律条款的歧义乃至误判。因此,本文将以保险合同免责条款的歧义与辨析为基础,探讨保险人说明义务对。     

保险合同免责条款正当性实证研究

免责条款作为保险合同的核心要素,其正当性直接关系着保险消费者能否获得赔偿的重大利益诉求。本文基于机动车辆保险合同典型案例的实证分析,在对免责条款涉诉焦点问题客观分类的基础上,着重从免责条款效力评价规则和法律规制的构建,开展免责条款正当性研究。     

论我国《保险法》中不可抗辩条款在投保欺诈情形下的法律适用

我国2009年修改的《保险法》增设了＂不可抗辩条款＂,试图通过限制保险人行使抗辩权利的期限,约束保险人解除保险合同的权利,实现保障被保险人利益的目的。但其尚未解决在投保欺诈情形下的法律适用难题,从而导致在保险理论界和实务界存在较大争议和分歧。为此,本文将从理论和实践的角度进行分析,以解决不可抗辩条款在投保欺诈情形下的法律适用难题。     

论保险合同免责条款和保险人明确说明义务——《保险法》第17条和第19条的理解和适用

2009年修订后的《中华人民共和国保险法》（以下简称“新保险法”）根据保险市场信息的高度不对称性,即保险人处于相对强势地位的特点,强化了对投保人、被保险人、受益人利益的保护,其中一个重要表现就是规范格式条款。新保险法在免责条款的明确说明义务、无效免责条款的规定上做出了进一步修改和完善。本文从免责条款的性质及法律效果等角...     

论财产险理赔分歧及处理对策

财产险理赔是指保险财产发生保险事故造成损失后,被保险人提出赔偿,保险人依据保险合同的规定对其履行经济补偿义务的过程。理赔处理的基本原则是重合同、守信用。以事实为依据,以条款为准绳。因为,保险合同是投保人与保险人约定保险权利义务关系的协议,是保障保险当事人利益和     

司法解释保险免责条款坚守文意为本原则——以某寿险公司驾驶员意外保险免责条款争议为例证

保险条款是保险合同当事人约定权利与义务的通用载体。保险人在各种保险产品设定的保险条款中,不仅会列明保险责任范围,而且为了避免风险的无限扩大,还会通过制订责任免除方面的内容去限定保险责任范围。保险责任免除的内容,作为格式合同的重要组成部分,是由保险公司单方面事先制作的,保险相对人对其了解的深度远不及保险人,双方之间必然会产生严重的信息不对称。为了平衡合同双方权益,尽力实现相对公平,《保险法》不仅对免责条款的提示与说明义务作了严格规定(详见《保险法》第十七条),而且对格式条款的无效情形也作了明确规定(详见《保险法》第十九条)。     

保险合同的法律效力刍议

<正> 保险企业作为经济的一个部门,其保险业务活动与法有着密切的关系,自觉运用法律手段,这对保险业务健康发展,增强保险的美誉度不无裨益。一、保险实践无不体现保险的法律行为保险实践的法律行为是由保险性质所决定。保险的整个过程是通过保险人和投保人双方用订立保险契约(亦即保险合同)的形式确定保险合同双方当事人的权利和义务来完成。也就是投保人根据合同规定,对保险人交付保险费,保险人则根据合同规定的责任范围.对被保险人负损失补偿责任或约定给付责任。     

浅析《〈保险法〉司法解释二》对保险人明确说明义务的新要求

明确说明作为保险人的一项法定义务,可追溯至1983年颁布的《财产保险合同条例》,该条例第7条第1款规定：“在订立保险合同时,保险方应当将办理保险的有关事项告知投保方.”1995年《保险法》从法律层面规定了保险人的明确说明义务,该法第16条第1款规定：“订立保险合同,保险人应当向投保人说明保险合同的条款内容.”第17条规定：“保险合同中规定有关于保险人责任免除条款的,保险人在订立保险合同时应当向投保人明确说明,未明确说明的,该条款不产生效力.”     

新《保险法》不可抗辩条款之立法不足与完善建议

2009年2月28日,第十一届全国人民代表大会常务委员会第七次会议对我国制定于1995年的《保险法》进行了大幅度修订。新《保险法》在制度设计上出现了许多前所未有的突破,将“不可抗辩条款”引入保险合同法律规范之中,以限制保险人的合同解除权,维护被保险人及受益人的权利,这是本次《保险法》修订最明显的变化和亮点之一。不可抗辩条款被引入保险法中,无论是对保险人还是对保险相对人的利益而言,都将产生深远影响。     

Insurance law and incomplete contracts

We analyze how insurance law can mitigate moral hazard by allowing insurers to reduce or cancel coverage in some circumstances. We consider an incomplete contract setting in which the insurer may obtain information related to the policyholder's behavior through a costly audit of the circumstances of the loss. Court decisions are based on a standard of proof such as the balance of probabilities. We show that an optimal insurance law brings efficiency gains compared to the no-audit case. We also highlight the conditions under which the burden of proof should be on the insured, provided that insurers are threatened with sanctions for bad faith.     

On the Possibility of Profitable Self-Selection Contracts in Competitive Insurance Markets

Several studies extend the Rothschild–Stiglitz model of competitive insurance contracting with adverse selection by incorporating additional dimensions of private information and conclude that some insurers may earn positive profit in a separating, self-selection equilibrium, provided each insurer is restricted to making a single contract offer. The main result of this article is that these profitable configurations are not sustainable when individual insurers can offer multiple contracts. It is also shown that the ability to offer multiple contracts overturns equilibria that have applicants from different risk classes pooled as well as those where profits are dissipated by a fixed entry cost.     

不真正连带债务理论在保险活动中的应用——兼评“无责免赔”问题

保险活动中,保险人与其他责任人对同一损失同时负有补偿义务的情形时常发生,保险界对其如何处理至今尚未找到明确统一的、具有说服力的理论或者法律依据,以致于虽然《保险法》第60条对相关问题进行了规定,但保险实务中仍然出现了包括机动车保险中"无责免赔"这类被法院认定为无效条款的约定,交通事故人身损害赔偿纠纷中保险人也被不当地判决承担连带责任。将不真正连带债务理论应用于保险活动中,能够为保险竞合和包括保险人补偿义务在内的补偿义务竞合情形提供广为接受的处理方案,能够为保险条款和《保险法》的完善提供理论指导,能够为"无责免赔"争议和交通事故人身损害赔偿纠纷中保险人权利义务合理确定等现实问题的解决提供思路。     

非寿险公司赔款准备金与盈余管理——中国市场的经验分析

利用我国非寿险公司2001~2007年的财务数据,采用分位数回归方法探讨非寿险公司赔款准备金调整的动机,并比较非寿险业务准备金评估方法改变前后公司实现盈余管理动机的差异。研究发现,非寿险公司存在实现盈余管理的现象,相比规避递延税收的目的而言,管理层故意调整公司当年赔款准备金数字进行盈余平滑的动机更为显著。当公司当期盈余表现差于前一期时,管理者倾向于低估当期赔款准备金提升账面盈余;若当期盈余表现优于前一期时,则高估准备金平滑盈余。在当年承保业务不佳,赔付率较高时,非寿险公司具有低估准备金掩饰承保质量的动机。2005年非寿险业务赔款准备金评估方法的改变,显著增强了非寿险公司利用赔款准备金进行盈余管理的动机。     

The Use of Dynamic Financial Analysis to Determine Whether an Optimal Growth Rate Exists for a Property-Liability Insurer

Prior research on the aging phenomenon has demonstrated that new business for property‐liability (P‐L) insurers generates high loss ratios that gradually decline as a book of business goes through successive renewal cycles. Although the experience on new business is initially unprofitable, the renewal book of business eventually becomes profitable over time. Within this context, insurers need to manage their exposure growth in order to maximize long run profitability. Dynamic financial analysis (DFA), a relatively new tool for P‐L insurers, utilizes Monte Carlo simulation to generate the overall financial results for an insurer under a large number of scenarios. This article uses a publicly available DFA model—along with the estimated market value of an insurer, based on 1990–2001 data for stock P‐L insurers and underlying financial variables—to determine optimal growth rates of a P‐L insurer based on mean–variance analysis, stochastic dominance, and constraints on leverage.     

Health insurers' operations in the face of health care reform: An analysis of the Supplemental Health Care Exhibit

The Patient Protection and Affordable Care Act (ACA) introduced significant changes to the health insurance marketplace in the United States. The act also imposed reporting requirements on insurers. The law has required insurers since 2010 to file yearly the Supplemental Health Care Exhibit (SHCE). The SHCE provides unique information on how health insurers operate. We analyze data in the SCHE to understand how insurers have complied with one of the major new regulations affecting health insurers' operations arising from the ACA—the Medical Loss Ratio (MLR) Provision. This requires that insurers spend a minimum percentage of their premium revenue on medical claims, quality improvement expenses, and deductible fraud and abuse detection and recovery expenses. Our analysis of the 2010–2017 SHCE indicates that insurers' underwriting performance worsened in the early years of the ACA as they worked to increase MLRs to become ACA‐compliant. Analysis of the SHCE further reveals that insurers' profits from managing uninsured plans grew as the profitability of underwriting insured plans decreased. Future research on health insurer operations is warranted. The currently underutilized and data‐rich SHCE provides unique information that makes future research possible.     

Informations- und Beratungspflichten des Versicherers nach der VVG-Reform

The insurer’s duty to enable the customer to come to an appropriate decision, providing advice and information, is a central topic of the reform of the German insurance contract law. The obligations of intermediaries given by the Directive 2002/92/EC on insurance mediation are transferred to insurers and thereby enlarged in some aspects. The duty to give advice in §6 I 1 VVG depends on the objective circumstances of each individual case depending upon either the complexity of the insurance contract and problems in understanding its terms, or the characteristics and situation of the customer. Therewith, the regulation both refers to former jurisdiction and exceeds it by implementing a duty for the insurer to ask for the demands and the needs of the customer. Without reason in the special case the customer has to disclose his need for advice to obtain it. During the term of the contract the insurer is only obliged to give advice if he knows or — acting diligently — could know the needs of the policy-holder. On a European level further duties to inform and advise could help to achieve an effective internal insurance market.     

Evaluating the risk of life insurer insolvency: implications from the US for the European Union

Insolvencies of life insurers in Europe have been virtually nonexistent. The deregulation of European markets, however, is likely to dramatically alter that situation. The goal of this study is two-fold: first, to identify significant variables in the early detection of financially distressed life insurers; and second, to consider the importance of these variables to the evaluation of life insurer insolvency risk in the European Union (EU). The availability of a data sample approaching the universe of insurers in the US allows us to stratify a large sample in order to make reasonable inferences regarding the factors likely to influence insolvency experience in the EU. The most significant findings for EU consumers, regulators, and insurers relate to the importance of capital and surplus, geographic focus, asset mix, and leverage in determining the likelihood of insurer bankruptcy.     

论投保人缴纳保费或保险公司签发保单附条件条款的法律效力

我国保险实践中普遍将投保人缴纳保费或者保险公司签发保单作为保险合同的成立、生效或者保险责任开始的条件。但该条件不是新《保险法》规定的附条件保险合同所指的条件。同时该附条件条款赋予了保险公司对要约进行承诺时或者履行合同义务时不受时间限制的权利,该附条件条款因不具有合理性应为无效合同条款。     

评新《保险法》新增不可抗辩条款的修法价值与建议

2009年2月28日,新<保险法>颁布,其引入了不可抗辩条款.这一条款不仅能够规范保险人行为,保护投保方利益,更能适应国际惯例,提高我国保险人的竞争能力,迎接外资保险的挑战.本文回顾了不可抗辩条款的历史进程,并对其修法价值进行了陈述,最后立足国情,对不可抗辩条款在实际操作中提出了一些的建议.