保險詐欺與契約效力──日本與英國保險法制之發展

A Study on Fraudulent Claims and Insurer's Remedy

契約訂立時要求要保人或被保險人應本於誠信原則之基礎締結契約，即以保險法第六四條告知義務之規範最為顯著。惟對於契約存續期間則分別散見於各項規範內，諸如保險法第五九條第二與三項之危險增加通知義務，又如保險法第二九條第二項但書故意致保險事故發生保險人得主張免責。但如涉及契約當事人或關係人之詐欺性（如故意致保險事故發生或虛偽假造事故之發生）請求時，保險人僅得就現有保險法第二九條第二項但書原則性規定（其他免責事由，如人壽保險契約所適用之保險法第一○九條、第一二一條第一與三項等），得主張免責（故意致保險事故發生）或因保險事故並未發生而不負保險責任（虛偽假造事故之發生）。除此之外，如被保險人仍生存（如假造保險事故發生），契約效力不因此即行終止。但觀諸現行保險法規範，並無使保險人得直接適用之相關條文。而實際上詐欺性請求行為業已嚴重違反保險契約所應遵循之誠信原則，因此尤有另行規範之必要性。如何於現行法之架構中，建構其法理基礎以及應如何妥適規範，即為本文所欲探討之重點。本文即就近年來日本於二○○八年頒布之新法中關於重大事由解除權之發展以及英國法律改革委員會（Law Commission）於二○一四年甫發布對於詐欺性請求（Insurers’ Remedies for對象，並就其發展以得出可供我國立法研議之殷鑑。

Insurance is a contract of utmost good faith. Most significantly, a duty of disclsoure in section 64 of Insurance Code is the primary illsutration of ultimate good faith in terms of a pre-contractual duty. It should be noted, however, that a duty of good faith applied throughout the entire contrat at various stages such as a duty to disclose increase of risk in Section 59 (1)(2) of Insurance Code, and intentional act in Section 29(2) of Insurance Code. In the event of fraudulent claims, the remedy for breach is not entirely clear in Insurance Code. An insurer is entitled to refuse such a claim but this would not lead to the avoidance of insurance contract. As insurance fraud is a major cost to the insurance industry, there is a need to a clear statutory remedy in detetting fraud. In this work, we will analyze the recent insurance law reform both in Japan and United Kingdom. Based on the observation of these developments in fraudulent claims and insurers remedy, we will propose several suggestions for statutory reform.