| Summary: | 碩士 === 朝陽科技大學 === 保險金融管理系碩士班 === 98 === With the continued increase in insurance rates, popularization of insurance-related knowledge, and rising consumer awareness, the insured are placing more and more attention on self-interests protection. According to statistics published by Financial Supervisory Commission, Executive Yuan, there was a total of 3,759 life insurance appeal cases in 2009, an increase of 579 cases from the 3,180 cases received in 2008, of which the number of life insurance claim-related appeal cases showed a greater increase of 456 cases.
The fast-changing modern medical technology, many of the invasive surgical procedures have gradually developed into smaller-scale mini-invasive surgery, or have been replaced by laser, ultrasound, electrical burn, radiation, or other treatments with the same results. For the traditional surgery that have replaced by newly developed methods of treatment or surgery due to technological advances, one often can not obtain surgery and medical insurance payout, or only receives a lesser amount at a lower surgery tariff level, leading to claims disputes and controversy.
Hopefully through the application of the principle of reasonable expectation, the disputes and controversy in commercial health insurance claims can be reduced, and the original intent of the insurance system can be restored, thereby providing a satisfactory explanation to the majority of the insured. This will align with the consideration of different background setting and progress in technological development, and fulfill the reasonable expectations of most people. It is hoped that this will reduce insurance claims disputes and controversies, so that the insured can receive the claim payout he or she deserves. This will also alleviate the pressure of claims staff, maintain a good image for the insurance company, and realize the true meaning of the insurance system.
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