交强险医疗赔偿案例分析

发布时间：2018-04-30 03:24

本文选题：交强险 + 医疗费　；参考：《西南政法大学》2015年硕士论文

【摘要】：近年来,我国汽车行业的发展越来越快,各大城市的汽车保有量呈现出飞速上涨的趋势,比如深圳市过去几年的汽车保有量增长率都维持在16%以上的高位,导致交通不堪重负,汽车数量的增加以及城市交通的拥堵同时也导致了交通事故数量的上升1。在这样的背景下,传统的民事法律显然不足以高效和公平地处理频发的交通事故纠纷,为此我国实行了机动车交通事故强制责任险制度,也即交强险制度是我国处理交通事故纠纷的核心制度,故这项制度是否完善,决定了我国交通事故纠纷的核心解决机制是否完善。然而,我国的交强险制度在实践中已暴露出很多问题,本文所关注的问题是日常生活中交强险赔付问题上最为常见和广泛存在的医疗费用的赔付问题,几乎所有经历过交通事故交强险赔付的当事人都能够体会到保险公司在医疗费赔付问题上的“霸权主义”,无论是作为格式合同的《交强险条款》,还是保险公司的实际执行工作,都无一例外的倾向于在医疗费问题上免除自身的保险责任,诸如非社保用药不予赔付、检查费用部分赔付等做法在实践中引起了很多纠纷。然而我国法律对交强险的医疗费赔偿问题又语焉不详,仅有保险协会制定的《交强险条款》“可堪大用”,但这份格式合同系保监会制定,具有十分明显的行业色彩,在非社保用药、检查费等方面采用了完全保护保险公司的立场。文章分为四部分,第一部分是介绍案例,引出争议焦点,即是否应当遵从《交强险条款》的约定,按照社保报销范围来理赔医疗费以及交强险医疗费赔付中索赔方的维权方成本是否过高。第二部分着重探讨保险公司在医疗费赔偿范围的现状以及保险公司医疗费赔付不合理的法律依据。第三部分主要是对焦点问题二进行分析,强调维权成本的问题。在第四部分中,作者给出了几点交强险医疗费赔付的法律建议。如,完善相关立法,构建第三方审查机制以及对保险公司故意拖延的行为进行惩罚。
[Abstract]:In recent years, the automobile industry in our country has developed more and more rapidly, and the number of automobile ownership in major cities has shown a trend of rapid increase. For example, the growth rate of car ownership in Shenzhen has remained at a high level of more than 16% in the past few years, resulting in a heavy traffic burden. The increase in the number of cars and congestion in urban traffic has also led to a 1. 1% increase in the number of traffic accidents. Under this background, the traditional civil law is obviously not enough to deal with frequent traffic accident disputes efficiently and fairly. Therefore, our country has implemented the compulsory liability insurance system for motor vehicle traffic accidents. That is, traffic insurance system is the core system of handling traffic accident disputes in China, so whether this system is perfect or not determines whether the core settlement mechanism of traffic accident disputes in China is perfect or not. However, the traffic insurance system of our country has exposed many problems in practice, the problem that this article pays attention to is the most common and widespread medical expense compensation problem in daily life. Almost all the parties who have experienced traffic accident insurance claims are able to understand the "hegemonism" of insurance companies on the issue of medical claims. Whether it is the traffic insurance clause as a form of contract, or the actual implementation of the insurance company, there is a tendency, without exception, to exempt itself from insurance on the issue of medical expenses, such as non-social security drugs not to be paid. Inspection fee partial compensation and other practices in practice caused a lot of disputes. However, the law of our country is not clear about the issue of compensation for medical expenses in traffic insurance. Only the "traffic insurance clause" formulated by the insurance association "can be used as much as possible." however, this format contract was formulated by the CIRC, and it has a very obvious industry color. In non-social security medication, inspection fees and other aspects of the full protection of the insurance company position. The article is divided into four parts, the first part is to introduce the case, leading to the focus of the dispute, that is, whether to comply with the provisions of the Jiaotang insurance agreement, According to the scope of social security reimbursement to compensate for medical expenses, as well as in the payment of health insurance costs claimants are too high costs. The second part mainly discusses the current situation of insurance company's medical expense compensation scope and the unreasonable legal basis of insurance company's medical expense compensation. The third part mainly focuses on the analysis of issue two, emphasizing the cost of safeguarding rights. In the fourth part, the author gives some legal suggestions on the payment of medical expenses. For example, improve relevant legislation, construct third-party review mechanism and punish insurance companies for deliberate delay.
【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】：D923;D922.284

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