A Study on Application of Full Medical Expense Reimbursement Insurance on Double Insurance in Taiwan

• Main Authors: CHU, SHU-CHEN, 朱淑珍
• Other Authors: HSU, EN-TE
• Format: Others
• Language: zh-TW
• Published: 2016
• Online Access: http://ndltd.ncl.edu.tw/handle/40260187241772108102

碩士 === 東海大學 === 會計學系 === 104 === The insured bought AHSR Medical Expense Insurance, after hospitalization of insurance accident, the insured paid the medical expense and then apply for settlement of claims to insurance company within the insured limits, and this is a matter of course. But the competent authority stipulates the Notice on Personal Insurance Commodity Review and Example Clause of Hospital Medical Treatment Policy of Insurance that the policy conforms to the duplicate receipt of claims, it shall receive the copy receipt of claims on 1st October, 2006. It stipulates that the insured who had bought the AHSR Medical Expense Insurance, if the insured paid the medical expense and probably receive more than two times compensation. The medical insurance company maybe also gets profit. As is the following, the insurance salesmen advertise the profit of repeat claims and encourage the insured to double insurance for better performance. On the one hand, they instruct the insured that the more medical expense paid, the more insurance claim will gain. The hospitals and doctors could no longer consider the payment capability of insured to induce medical needs. For the reason of competent authority stipulates this regulation maybe is the Justice No. 576 Explanation Letter of on 23rd April, 2004 and it considers that the purpose of personal insurance is not compensation for property of insured and repeated insurance is not applicable for personal insurance. So AHSR Medical Expense Insurance for personal accident insurance and health insurance is excluded from repeated insurance. Since repeated insurance is not V applicable, there is no inappropriate profit issue and without prejudice to the harm fills. There is no appropriate reason for original receipt, so the claims can be accepted by duplicate receipt. According to Notice on Personal Insurance Commodity Review issued by competent authority, it specifies that the compensation shall be completed by duplicate receipt. The paper considers that the phenomenon of opportunistic attitude and medical resource waste is just the render result. It shall clarify that if repeated insurance specification is applicable for AHSR Medical Expense Insurance based on the cause of evolution of regulation (claims based on original receipt to copy of receipt). It is controversial that if repeated assurance is applicable for personal insurance, the judiciary is the judgment of free evaluation of evidence. Justice No. 576 Explanation Letter assumes that personal insurance is not applicable for repeated insurance. So the insured shall be responsible for check on responsibility of underwriting contract and cannot sign the insurance for opportunistic. And when claims occur, the insured will use repeated insurance as guarantee. Similarly, the settled regulation can be stipulated only by the definition of if the AHSR Medical Expense Insurance is applicable for repeated insurance. Otherwise, copy receipt of receipt is the explanation of Justice No. 576 Explanation Letter and it maybe the voice from the public, authority could open this channel and also close this channel. The regulation is lack of consistency, it will cause the disorder of insurance market. This paper is the study of AHSR Medical Expense Insurance is applicable for repeated insurance. First, it discuses and demonstrate the examples. Theoretical discussion on part one, from theory of repeated insurance policy and review the related literatures and judgment of judiciary. A study on if AHSR Medical Expense Insurance is applicable for repeated insurance. Next, it discusses the medical market and insurance market. For demonstration, it compared the average data of claims during three periods of before, after and recent regulation. Next, it theoretically and practically analyses based on the market discussion and practical results. At last, it puts forwards the conclusion and suggestion.