保險法上因果關係：兼論最高法院意外傷害保險判決

On causality in insurance law: Analysis of the Supreme Court’s Ruling on Personal Accident Insurance Cases

關於因果關係之認定為學說亂流區，保險法上主要學說大致可分為相當因果關係與主力近因說，仍為不確定又複雜之概念。我國最高法院實務見解多傾向採取「相當因果關係」。簡言之，無此意外，亦不生此結果；有此意外，按一般情形足生此結果，意外傷害保險公司應負理賠責任。而其次係採取主力近因說，認為如無意外事故即不會提前死亡，故意外事故係導致死亡結果之主動的、有效的原因。觀察我國最高法院之判決，雖以相當因果關係與主力近因原則為兩大原則審查因果關係，不過皆未有明確詳述其思考過程，僅草率交代採取之標準，使得保險訴訟案件徒增紛擾。在併存因果關係爭議問題下，除了主力近因原則外，尚有反併存因果關係條款之適用，本文將參考美國法院實務上通常之作法，並以其作為檢視我國最高法院判決之依據。

"Regarding the identification of causality as the theory of turbulent flow, the main doctrines of the insurance law can be roughly divided into the concept of Adequate Causation Theory and the Efficient Proximate Cause Rule, which is still the concept of uncertainty and complexity. Supreme Court’s practical views tend to adopt a “Adequate Causation Theory”. In short, there is no such accident and no such result; in the case of this accident, the accidental insurance company should be responsible for the claim. The second is to take the main reason and say that if there is no accident, it will not die in advance, so the accident is the active and effective cause of the death result. Observing the judgment of the Supreme Court of Taiwan, although Adequate Causation Theory and the Efficient Proximate Cause Rule is examined by the principle of causality, there is no clear detailed description of the process of thinking, and only the criteria adopted by the sloppy account have caused the insurance lawsuits to increase. This article will refer to the usual practice of the United States courts. In addition to the main reason principle, there are provisions for the anti-coexistence reasons, and the United States judgment standards are used as the basis for examining the judgment of the Supreme Court of Taiwan."