| Summary: | 碩士 === 淡江大學 === 保險學系保險經營碩士在職專班 === 103 === In Taiwan, a full medical expense reimbursement insurance is currently regulated in accordance with the provisions prescribed in the Directions for the Reviewing of Life Insurance Products and in the Templates and Directions for Life Insurance Contracts. In the event that an insured (policyholder) has informed the insurer that he/she has purchased a full medical expense reimbursement insurance plan from another insurance company, and the insurer still sold an insurance product to the insured, the insured shall be entitled to an insurance claim provided that the insured submits a copy of the purchase receipt.
Following the enactment of this administrative regulation, cases of unjust enrichment through double insurances emerged, which not only distorted the principle of insurance indemnity, but also engendered bad social customs and damaged the rights and interests of other policyholders. In light of this phenomenon, this study attempts to elucidate the principle of indemnity according to the concept of a full medical expense reimbursement insurance, and describe the difference between a full medical expense reimbursement insurance and a fixed-sum insurance. Furthermore, based on practical court cases, this study provides a discourse, asserting that the explanations afforded in the Judicial Yuan Interpretation No. 576 are not applicable to the full medical expense reimbursement insurance. Although the full medical expense reimbursement insurance is categorized as health and personal injury insurances in life insurance packages, its function is to indemnify the medical expenses incurred to the insured person as a result of personal accidents. Therefore, a full medical expense reimbursement insurance still indemnifies financial property losses and therefore should be applicable in a case of double insurance.
Therefore, the aforementioned administrative regulation regarding repeated claims not only violates the principle of an insurance system, thus causing unjust enrichment, but also contravenes the legal hierarchy. Thus, this study suggests that the provisions prescribed in the Insurance Act and the aforementioned administrative regulation should be amended.
|
|---|
