论保险合同的疑义利益解释原则

【作者】 李卫东；

【导师】 李秀芬；

【作者基本信息】 山东大学 ， 法律， 2007， 硕士

【摘要】 在今天,保险制度不仅使得发生危险的个人经济得以稳定,而且与整个社会经济生活和政治生活的和谐安定与创建和谐社会息息相关。当保险这一理念深入中国百姓的生活,保险行为越来越频繁时,也随之涌现了大量的保险合同纠纷案件。由于大部分的保险合同都是一种典型的格式合同,通常情况下不论是投保单还是保险单,都是由保险人起草拟定并印制在保险单上。往往被保险人只有同意或不同意的,很少有选择权,加上由于保险合同中使用的语言文字或专门性名词术语具有较强的技术性,因此,保险合同双方当事人在主张权利和履行义务过程中难免发生纠纷,乃至引起仲裁或诉讼,而此时就涉及到必须对保险合同进行较为科学合理的解释,从而在双方利益纠纷中寻求一个平衡点。然而,由于我国保险合同乃至整个合同解释制度的不完善,在实践中经常会出现对保险合同解释原则的不当理解和适用,一旦出现纠纷需要仲裁或诉讼,法院或仲裁机关往往就简单地按照我国《保险法》第31条的规定的"疑义利益解释原则"来处理,该原则的援引和创设,初始是针对保险人与被保险人(投保人)之间不平等的交易地位而进行司法调整以实现公平交易,并体现对保险交易中的弱势群体──被保险人倾斜性保护的价值关怀。由于我国《保险法》对该原则规定得过于原则和笼统,法院往往会过于适用此条款,作出不利于保险人之解释与判决,以致于保险公司屡屡败诉,从而会造成一种形式上公平而实质上不公平的结果,不利于保险业的发展。有鉴于此,本文从如何理解和适用保险法第31条的规定出发,对"疑义利益解释原则"在法律适用的位阶如何、其适用的条件是什么?范围有多大?等等,进行了全面的客观的分析,认为有必要对此原则作出具体的立法解释和司法适用,从而合理地平衡保险合同双方当事人的利益,在二者之间形成一个必要的张力,促进我国保险业的发展,也更好地保护被保险人和投保人的合法权益,从而更好地促进和谐社会的发展。本文从以下几个方面进行阐述:一、我国保险合同疑义利益的现状。目前存在着把疑义利益解释原则扩大为争议利益解释原则,将疑义利益解释原则奉为一旦争议就自动首先适用的"优先原则";将疑义利益解释原则误用于合同条款的一切类型;将疑义利益解释原则误解为保险合同解释的单一原则这三种情形;二、疑义利益解释原则的理论基础。其法理依据归纳起来有:保护弱者说、格式条款说与专门技术说。三种学说和理论各自从不同角度和层面揭示了该原则的法理依据及其目的。综合三种学说与理论,可知保险合同疑义利益解释原则所追求的是实体之公平与正义价值之实现;三、疑义利益解释原则在各国法律中的体现,介绍了大陆法系与英美法系的保险合同解释原则,并重点介绍疑义利益解释原则在各国的适用;四、疑义利益解释原则的适用条件。首先介绍关于疑义利益解释原则的使用位阶的三种学说,赞同"折衷说"的观点,认为保险合同解释原则的正确适用位次是:首先适用保险合同的一般解释原则,在其他解释原则无法确定保险合同的含义的情况下才方可采用疑义利益解释原则。然后介绍了疑义性的表现形式和判断标准;五、疑义利益解释原则的适用范围。根据保险条款制定主体及程序的不同,保险合同中的条款分成由保险人拟定的条款、由保险人和投保人双方协商所拟定的议商性条款、由保险监管机构制定的法定条款、由保险监管机构审批的条款四种,疑义利益解释原则对于各种条款的适用是各不相同的。应从所争议的保单是否系手写保单、被保险人是否拥有与保险人相当的保险经验、被保险人是否与保险人一样均为保险公司、被保险人是否与保险人的总体谈判实力不相上下等标准来判断被保险人是否弱者。更多还原

【Abstract】 Today, the insurance system not only makes the personal danger to economic stability, butalso the entire socio-economic and political life of harmony and stability and create aharmonious society are closely related. When this concept of insurance in depth the lives of theordinary people in China, the increasingly frequent acts of insurance, also will have emerged alarge number of insurance contract dispute case. As most of the insurance contract is a typicalformat of the contract, under normal circumstances, whether insured or single insurance policy,drafted by the insurer developed and published in the insurance policy. Insurance is often onlyagree or disagree with the nearly rarely have the right to choose, coupled with the use of theinsurance contract language or specialized terminology has strong technical, therefore, in theinsurance contract that the parties to fulfill their obligations and rights in the process inevitablythere is a dispute, arbitration or litigation arising from deposits, at the time when the need toinvolve the insurance contract more scientific and rational explanation, in which the interests ofboth sides in the dispute to seek a balance point. However, as China’s insurance contractinterpretation of the contract and the whole system is imperfect, in practice there were alwaysright insurance contracts improper understanding of the principles of interpretation andapplication.Once the disputes need to arbitration or litigation, the court or arbitration bodies oftensimple in accordance with China’s "insurance law" provisions of article 31 of the "indisputableinterests of the principles of interpretation" to handle, the invocation of the principle of thecreation and initial against the insurer and the insured person (insured) transactions betweenunequal status of a judicial adjusted to achieve fair trade, and reflect on the insurancetransactions vulnerable groups-the insured person inclined to protect the value of caring.Because of China’s "insurance law" provides the principles and the principle is too general andtoo often the courts apply the provisions, not to explain to the insurance people and judgment,so insurance companies often lose, thereby creating a form of a fair and equitable result inessence not is not conducive to the insurance industry development.In view of this, to understand how this from the insurance law and apply the provisions ofArticle 31 proceeding, the "interests of the principles of doubt" law applies in order to, theapplicable conditions? the scope? And so on, a comprehensive and objective analysis, thisprinciple that it is necessary to make specific legislative and judicial interpretation applicable toinsurance contracts reasonable balance the interests of the parties, forming one of the twonecessary tension and promote the development of China’s insurance industry, to better protectinsurance policyholders and the legitimate rights and interests in order to better to promoteharmonious social development. Based on the following aspects:One, my insurance contracts doubt the interests of the status quo. At present there aredoubts about the interests of the principles of interpretation for the controversial expansion ofthe principles of interpretation interests, the interests will doubt the principles of interpretationas a controversial automatically once the first application "priority principle"; Doubt will bemistaken for the interests of the principles of interpretation of all types of contract terms; Doubtwill be mistaken for the interests of the principles of interpretation of all types of contract terms.Second, the interests of the principles of interpretation beyond doubt the theoreticalfoundation. Its legal basis be summed up in: protecting the weak, format and technical articlesthat said. Three of their doctrine and from different angles and dimensions of the principlesenshrined in a legal basis and its purpose. Three comprehensive doctrine and theory shows thatthe interests of the insurance contract doubt explained by the pursuit of the principle of fairnessand justice entities in the realization of value.Third, doubt in the interests of all the principles embodied in the law on the civil law andcommon law principles of contract interpretation of insurance, with an emphasis on doubt in theinterests of all the principles of interpretation apply.Forth. Doubt interests of the application of the principles of interpretation; First introduceddoubt on the benefits of using the principles of the three-band theory, endorsed the"compromise" of the view that insurance contract interpretation of the correct application of theprinciple of precedence is: first application of the general insurance contract interpretationprinciples, the other unable to confirm the principles of interpretation of the meaning of theinsurance contract circumstances a doubt before the interests of the principles of interpretation,and then introduced a form of expression of doubt and judgment.Fifth, indisputable interests scope of the principles of interpretation. According to theterms and procedures of the main differences in terms of the insurance contract by the insurerdeveloped into the terms of the insurance policy holders and consultations by the two sides todevelop the proposed provisions, the insurance regulators statutory provisions enacted by theinsurance regulator approval of four articles, doubt explained interests principles for theapplication of various provisions is not the same. Should the controversial policy is the policyof handwriting, whether insured and the insurer has considerable experience in insurance, theinsured person is with the insurance companies are the same people, whether insured and theinsurer’s overall bargaining power similar standards to judge whether the insurance was weak.更多还原