保险人恶意不当理赔的法律规制——从违约责任到侵权责任

发布时间：2018-06-15 10:20

本文选题：保险法 + 不当理赔　；参考：《法商研究》2016年05期

【摘要】：保险人缺乏法律或事实依据的恶意不当理赔是近年来我国保险"理赔难"日益蔓延的重要成因。保险合同"关系型"与"顺序型"的特殊架构导致保险人的不当理赔具有显著的恶意违约的动因。由于一般性的合同规范无法涵盖保险消费者的经济保障以及内心安宁的特殊权益,对保险人的恶意不当理赔,违约责任既无法充分补偿被保险人或受益人由此所蒙受的间接损失,也难以形成有效的威慑效应。为了化解这一制度困境,应当从违约责任跨越到侵权责任,将保险消费者的经济保障与内心安宁上升到"固有利益"的范畴,解除由合同的"履行利益"所造成的束缚:将保险人理赔义务的关注点从给付结果扭转到给付过程,通过侵权责任的规制来达到充分补偿与有力威慑的双重功能,进而实现对保险人恶意不当理赔的有效规制。
[Abstract]:In recent years, the malevolent and improper settlement of claims by insurers without legal or factual basis is an important cause of the increasing spread of insurance claims in China. The special structure of "relation type" and "order type" of insurance contract causes the insurer's improper claim to have the obvious motive of malicious breach of contract. Because the general contract norms cannot cover the economic protection of insurance consumers and the special rights and interests of the inner peace, the malicious and improper settlement of claims against the insurer, The liability for breach of contract can not fully compensate the indirect losses suffered by the insured or beneficiary, nor can it form an effective deterrent effect. In order to resolve the predicament of this system, we should leap from breach of contract liability to tort liability, and raise the economic security and inner peace of insurance consumers to the category of "inherent interests". Lifting the bondage caused by the "performance benefit" of the contract: turning the attention of the insurer's claim obligation from the result of payment to the process of payment, and achieving the dual function of full compensation and powerful deterrence through the regulation of tort liability. Then realize the effective regulation to the insurer maliciously and improperly settle the claim.
【作者单位】：西南财经大学法学院;
【基金】：国家社会科学基金一般项目(15BFX177) 四川省哲学社会科学重点研究基地中国金融法研究中心年度规划项目
【分类号】：D922.284

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