保险人明确说明义务的司法实证

发布时间：2018-04-22 23:29

本文选题：实证研究 + 明确说明义务　；参考：《西南政法大学》2015年硕士论文

【摘要】：我国《保险法》第十七条规定了保险人格式条款提供义务、提示义务、免责条款明确说明三个层次的义务,旨在消弭保险人与投保人之间因交易地位的不平等而导致信息不对称的鸿沟。司法实践中,对特定条款是否属于明确说明对象仍存在争议,对作为义务履行证据固定的投保人声明的效力认定亦无统一裁判标准,旨在合理配置当事人间的交易注意义务的“明确说明义务履行推定规则”是否适用,各法院莫衷一是。因此本文通过对保险人明确说明义务司法裁判中的争点与矛盾判决的整理,以上诉率、改判率、地域分布、裁判理由为切入点对争点判例统计,观察并分析该类判决裁判的整体情况,并综合运用合同原理、社会伦理、法经济学、法社会学的分析方法得出结论,以期探索司法实践中统一的裁判标准。本文除引言外,正文分为三个部分:第一部分,特定条款是否属于明确说明对象。“医保外不赔”条款虽与作为社会医疗保险中条款相似,因其为商业保险条款实质上免除了保险人应承担的义务应认定为免责条款而非普通条款,是保险人明确说明对象。“以法律、行政法规的禁止性规定作为免责事由”条款通常为常识性条款,虽为免责条款但非保险人明确说明对象。第二部分,投保人声明的效力判断。当保险人履行了提供条款与提示义务时,投保人声明签章可以免除保险人免责条款明确说明义务。投保人声明是保险合同的一部分即保险合同条款,投保人声明的签订是其真实意思表示,因此投保人声明的内容对双方当事人有拘束力,保险人明确说明义务履行的证明责任得以免除。第三部分,保险人明确说明义务履行推定规则。当投保人为保险专业消费者时,且保险人履行了条款提供及提示义务时,应推定投保人明确理解免责条款的含义,保险人说明义务履行有效。保险专业消费者包括一般保险专业消费者与特殊保险专业消费者。
[Abstract]:Article 17 of the Insurance Law of our country stipulates the obligation to provide for the form clause of the insurer, the obligation to prompt, and the exemption clause to specify the obligations of three levels. The aim is to eliminate the gap of information asymmetry between insurers and policy holders due to the unequal status of transactions. In judicial practice, there is still a dispute about whether a specific clause belongs to the object of explicit explanation, and there is no uniform standard of adjudication for the validity of the declaration of the policyholder, which is fixed as the evidence for the performance of the obligation. There is no agreement among the courts on whether the rule of presumption of obligation to perform is applicable to the reasonable allocation of the duty of care between the parties. Therefore, through the arrangement of the disputes and contradictory judgments in the insurer's clear explanation of the compulsory judicial decisions, the paper makes statistics on the disputes' cases by taking the appeal rate, the revision rate, the regional distribution, and the reasons of the adjudication as the starting point. The author observes and analyzes the whole situation of this kind of judgment and makes use of the principles of contract, social ethics, law and economics, and sociology of law to draw a conclusion, in order to explore the unified judgment standard in judicial practice. In addition to the introduction, the text is divided into three parts: the first part, whether a specific clause belongs to the explicit object. Although the clause of "non-indemnity outside medical insurance" is similar to that in social medical insurance, because it is a commercial insurance clause, the obligation that the insurer should undertake should be regarded as an exemption clause rather than an ordinary clause, which is clearly stated by the insurer. "the prohibition of laws and administrative regulations as the subject matter of exemption" is usually a common-sense clause, although it is an exemption clause, but not the insurer clearly stated the object. The second part is the judgment of the validity of the policy-holder's declaration. When the insurer fulfils the obligation of offering and presenting, the policyholder's declaration of signature can exempt the insurer from the obligation specified by the exemption clause. The policyholder's declaration is a part of the insurance contract, that is, the terms of the insurance contract, and the signing of the policyholder's declaration is the expression of its true meaning. Therefore, the contents of the policyholder's declaration are binding on both parties, The insurer is exempt from the burden of proof that the insurer clearly states that the obligation shall be fulfilled. The third part, the insurer clearly describes the presumption of obligation to perform the rules. When the insured is a professional consumer of insurance, and the insurer has fulfilled the obligation to provide terms and prompt, it should be presumed that the policyholder clearly understands the meaning of the exemption clause, and the insurer explains that the obligation is performed effectively. Insurance professional consumers include general insurance professional consumers and special insurance professional consumers.
【学位授予单位】：西南政法大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：D922.284

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