被保險人喪失保險保障之主觀要件及其一致性之研究

A Research on the Subjective Elements Leading to the Loss of Insurance Coverage by the Insured and Their Consistency

在保險契約訂立與履行之過程中，被保險人可能因為各種法定或約定之原因，直接或間接地導致其喪失原本因保險契約而享有的保險保障。而現行保險法對於被保險人喪失保障事由的主觀要件規範並不一致，有時候以故意為要件，有時候又以過失為要件。例如：違反訂約時之告知義務者，僅限出於「故意」時，保險人方得解約；違反特約條款者，無論其是否有故意或過失，保險人均得解除契約；於違反保護、救助標的物的義務時，保險人對於「因而增加之損失」不負給付責任，但法條未明定義務違反是否須具有一定的主觀要件。於主觀危險增加時，要保人或被保險人若有違反通知義務，保險人得解除保險契約，從而免負保險給付之責。若為可歸責於要保人或被保險人導致保險事故發生，保險法第29條第2項但書規定，保險人僅對於故意行為所致損害，始不負給付責任。立法者對於保險人免除保險給付責任的各種原因之主觀要件為差別規範，是否立基於一定的規範原則和正當理由，容有疑義。目前國內缺乏對於各種義務注意標準的整合研究，面對如此不一致的情形，本文針對要保人與被保險人喪失權利的主觀要件一致化可能性進行探討，以期許作為未來保險法立法修正更穩定的依循標準。

In the process of establishing and fulfilling insurance contracts, the insured may directly or indirectly lead to the loss of the insurance coverage originally enjoyed under the insurance contract, due to various legal or contractual reasons. The current Insurance Law does not consistently regulate the subjective elements for the insured's loss of coverage. Sometimes intent is required as a condition, while at other times negligence is the criterion. For example, in the case of a breach of the duty to inform at the time of contract formation, termination by the insurer is only allowed if it is“intentional”; for a violation of special provisions, regardless of whether it is intentional or negligent, the insurer is entitled to terminate the contract. When there is a breach of the obligation to protect or assist the subject matter, the insurer is not obligated to pay for“losses resulting from it”, but the law does not specify whether the breach must have a certain subjective element. In the case of increasing subjective risk, if the policyholder or insured violates the duty to notify, the insurer may terminate the insurance contract and be exempt from the obligation to pay insurance benefits. If the insured perils are caused by the policyholder or insured and is attributable to them, according to Insurance Act Article 29, Paragraph 2, the insurer is only responsible for damages caused by willful acts. The legislator's establishment of subjective elements for various reasons for exempting the insurer from the obligation to pay insurance benefits is a differentiated regulation. Whether it is based on certain regulatory principles and legitimate reasons for differential treatment raises doubts. Currently, there is a lack of integrated research on the standard of care for various obligations in the country. With such inconsistencies, this article aims to explore the possibility of standardizing the subjective elements for the insured and the policyholder's loss of rights, in the hope that it will serve as a stable reference for future amendments to insurance law.