保險法上道德風險控制機制省思

長期以來，我國保險領域的道德風險問題因理論關注的相對不足而未得到有效應對和解決。“道德風險”在保險法上是一個與道德相關的規範性概念，內涵系投保方在擁有保險保障之後故意或因重大過失而導致損失發生或擴大，包含投保欺詐行為。保險制度曾因誘發道德風險這一負外部性而遭受質疑，但由於其巨大的制度收益和社會價值，有必要且應當通過發展道德風險控制機制來降低制度成本，促進社會福利最大化。保險法上的道德風險控制機制在我國司法上已得到較多關注、確認和適用，體現為技術、條款、原則、規則四種樣態。在此基礎上，應當以“技術手段和法律手段相結合”以及“道德風險的控制應符合比例原則”作為我國保險法上道德風險控制機制的基本建構原則，並從實施維度、時間維度、主體維度三個維度對道德風險控制機制進行類型整合，通過宏觀體系的完善與微觀規範的優化破解我國保險業的道德風險難題。

For a long time, the moral hazard problem in China’s insurance industry has not been effectively dealt with due to a relative lack of theoretical concern. In the field of insurance law, the expression of’ moral hazard’is a normative concept which is concerned with morality and refers to that the insured party intentionally or gross negligently causes or expands the loss to occur or expand after having insurance coverage, including fraud during insurance contracting. The system of insurance has been doubted because of its negative externality of inducing moral hazard, but due to its huge institutional benefits and social value, it is necessary to develop moral hazard control mechanisms to reduce institutional costs and maximize social welfare. The moral hazard control mechanisms in insurance law have been extensively noticed, recognized and applied in China’s judicial practice, and are embodied in four forms: technologies, clauses, principles and rules. On this basis,’the combination of technical means and legal means’ and’the control of moral hazard shall conform to the principle of proportionality’should be taken as fundamental construction principles of the moral hazard control mechanisms in China’s insurance law. Furthermore, the moral hazard control mechanisms should be integrated through three aspects: application, time and subject. In this way, the moral hazard problem in China’s insurance industry could be solved through the improvement of the macro system and the optimization of micro norms.