保險法的因果關係

Causation in Insurance Law

因果關係問題是法律適用上最基本的問題，也是最困難的問題。而保險法之因果關係，除探討原因與結果之間的聯絡關係外，必須再討論保險事故，因此會加重探討的困難度。換言之，肇致損害發生的原因是保險事故？或是除外事故？將影響保險人之給付責任甚鉅。而保險法之因果關係又有單一與多重之別，如係單一原因造成損害結果，則判斷因果關係較無困難。如因保險事故產生損害結果，則保險人應予負責；若係因除外事故產生損害結果，則保險人即無須負責。惟在多重因果關係中，若有保險事故與除外事故合併產生損害結果，此種情形稱為「併存因果關係」，此時保險人應否依保險契約理賠？再者，保險人為提前減輕責任，可否事前在保險契約條款中約定當發生「併存因果關係」現象時，保險人均不須負責呢？這種條款即是「反併存因果關係條款」。美國法院在保險訴訟糾紛中，面臨「併存因果關係」與「反併存因果關係條款」難題時，各州法院立場不盡一致，引起許多爭議，學者對此作有精闢討論。我國法院實務雖未見「併存因果關係」與「反併存因果關係條款」之名詞，但實際上「併存因果關係」現象與「反併存因果關係條款」已經存在於保險法訴訟訴案件之中。美國法院的處理經驗與學界討論，正可供研究保險法上因果關係之借鑑。

The causation is the most basic and difficult problem in the law. Especially in insurance law, not only discussing the connection between cause and effect, but also discussed insurance perils, which will increase the difficulty to make decision. In other words, the cause of the damage was an insurance perils? Or excepted perils? It will affect the insurer’s payment responsibilities. Furthermore, the causation of insurance law is different between single and multiple. If the result of damage is caused by a single cause, it maybe easy to judge the causation. The insurer shall be responsible for the damage caused by the insurance perils; if the damage is caused by the excepted perils, the insurer shall not be liable. However, in multiple causal relationships, if an insured perils and an excepted perils are combined to produce damage, this situation is called“the concurrent causation”Should the insurer make claims in accordance with the insurance contract? Furthermore, in order to reduce the liability in advance, can the insurer stipulate in the insurance contract in advance that when the phenomenon of“the concurrent causation”occurs, the insurer shall not be liable? This kind of clause is the“anti-concurrent causation clauses”. When American courts faced the difficult problems of“the concurrent causation”and“anti-concurrent causation clauses”in insurance litigation disputes, the courts of various states did not agree with each other, causing many disputes, and scholars had insightful discussions on this. Although the terms of“the concurrent causation”and“anti-concurrent causation clauses”have not been seen in the practice of courts in Taiwan, in fact, the phenomenon of“the concurrent causation”and“anti-concurrent causation clauses”already exist in insurance lawsuits. The handling experience of the American courts and academic discussions can be used as a reference for studying the causality in insurance law.