英日保險詐欺索賠法制比較研究──兼評我國保險法相關建議修正條文

Comparative Study on Insurance Fraudulent Claim Regulation in U.K. and Japan ─ Focus on Fraudulent Claim Rule in Taiwan Insurance Act Amendment

自有保險制度以來，保險詐欺情事從未間斷過。然而若容許保險詐欺案件頻繁發生，保險制度將會崩潰，致使無辜消費者無法透過保險制度分散風險。因此在法制上須對保險詐欺之防制有所作為，始能減少保險詐欺之發生。近來我國保險事業發展中心提出保險法修正草案，其中針對保險詐欺索賠為特別規範。由於我國司法實務與學界甚少就詐欺索賠為深入討論，本文欲藉保險事業發展中心提出保險法修正草案之機會，嘗試就英國2014 年保險契約法修正草案與日本2008 年保險法有關保險詐欺索賠法制為介紹，並比較分析該保險法修正草案之良窳，進而提出相關建議。

Insurance fraud has never been stopped ever since the beginning of insurance system. Nevertheless if we allow the insurance fraud case to occur frequently, the insurance system will collapse, leading to the innocent consumer can’t transfer risk to the insurer. Thus, in the legal system it should take different control to insurance fraud, which reduced the occurrence probability of insurance fraud. Recently, it is submitted to Insurance Act Amendment by Taiwan Insurance Institution, and the Amendment is focused on fraudulent claim regulation. Because there is not any deeply discussion regarding fraudulent claim rule in Taiwan judiciary and scholarship. When the Amendment is submitted by Taiwan Insurance Institution, this article may take the chance trying to introduce the fraudulent claim rule regarding U.K. Insurance Contract Bill 2014 and Japan Insurance Act 2008. According the comparative analysis fraudulent claim rule in U.K. and Japan, this article will point to advantage and disadvantage of the A mendment, and offer some legislative suggestion.