危險事故發生後保險人之調查義務－－以美國法之發展為核心

The Insurer's Duty to Investigate in Post Loss Stage – Focusing on the Development in the United States

現代保險之目的，為提供被保險人財務安全與心境安寧之保障，欲達到此目的，則在危險事故發生後，保險人對於危險事故，應予以調查。保險人不得僅單方地要求被保險人提出損失之證據，然而，卻不自行著手為適當之調查。保險人之調查，除須及時為之並為完整及徹底之調查外，並應就事實及法律層面為之，顧及到所有之證據，以符合誠信原則之要求。美國為全球保險最為發達的國家之一，各州法院於近百年間已將學者發展之相關理論，作為判決基礎而實際運用於司法實務中，並藉以建構保險人調查義務之法律內涵。本文以美國法制發展為立論重心，探討保險人處理賠案義務之性質、內涵及發展。最後，剖析我國現況與缺失，參酌美國法令與實務見解，提出相關建建議，期能成為立法機關與相關單位之參考。

The purpose of modern insurance is to provide the insured with financial security and peace of mind. In order to achieve the said purpose, the insurer should act appropriately to process the investigation in post loss stage. The insurer cannot unilaterally request the insured for the related information and evidences of loss without making the appropriate investigation of the claim voluntarily. In addition to prompt, full and thorough investigation, the insurer should do the investigation into factual and legal aspects of the claim and discover all the evidences, which conforms to the principle of good faith. The United State is one of the blooming markets in the world and the state courts have adjudged the insurance case based on the scholar's theories in the recent hundred years and established the legal contents of the insurer's duty to investigate the claim. This paper will focus on the development in the United States to examine the characteristics, contents, and the development of the insurer's duty to investigate the claim. In conclusion, this paper will analyze the current legislative conditions and policy clauses in Taiwan and presents the suggestions for legislation with references to the regulations and judicial precedents in the United States.