【作者】 李炎杰；

【导师】 孙蓉；

【作者基本信息】 西南财经大学 ， 保险学， 2011， 博士

【摘要】 保险对社会经济的发展有不容忽视的作用,随着1980年我国国内保险业务的恢复,其重要价值日益显现,保险业的发展日新月异。然而繁荣的背后也存在隐忧,由于保险市场主体、市场环境等诸方面原因,保险合同纠纷数量不断上升,成为制约保险业发展的重要因素之一。如何有效预防及处理保险合同纠纷成为我国保险业发展亟待解决的问题。保险合同纠纷的防范和处理是两个紧密相关的命题。从契约理论的角度出发,保险合同纠纷防范机制的交易成本属于“事前”成本,保险合同纠纷处理机制的交易成本属于“事后”成本,二者在一定程度上存在相互联系乃至此消彼长的关系。防范机制有利于减少保险合同纠纷的数量,从而降低处理机制的成本；而处理机制则有利于抑制机会主义行为,节约防范机制的费用。此外,在纠纷处理过程中搜集的关于纠纷发生频率、产生原因等信息,可以为纠纷的防范提供导向。二者之间的紧密相连正是本文把它们合并作为研究对象的原因所在。在对现有文献进行梳理的过程中,笔者发现对于保险合同纠纷防范的相关研究,多是列举引起纠纷的违规代理行为及相应的治理措施,或由个案出发探讨与其相关的法律法规、保险原则或合同条款应如何改进等等；而对于保险合同纠纷处理的相关研究则多数从法律角度出发,以保险原则及法律法规为工具,分析其在具体案例中的应用。专门针对保险合同纠纷处理机制进行研究的文献较少,从保险自身特点出发,探讨其处理机制的文献主要集中于应用仲裁机制解决保险合同纠纷的优点。2005年中国保监会提倡并推进建立保险合同纠纷快速处理机制(保险行业内处理机制)后,关注行业内处理机制的学者才逐渐增多。然而,从经济学的角度出发,把保险合同纠纷的防范及处理作为制度安排,综合应用经济、管理及法律等工具对其进行研究的文献仍可谓是凤毛麟角。对保险合同纠纷防范及处理机制的研究,离不开对保险合同纠纷本身的特点及成因的分析。本文在有针对性地分析了保险合同纠纷的内涵、类型、特点及成因的基础上,以新制度经济学及行业协会的相关理论为基础,从微观、中观及宏观三个层次分析了保险合同纠纷的防范机制；同时,运用成本收益分析法及制度变迁理论分析了保险合同纠纷处理机制；并在借鉴发达国家和地区经验的基础上,结合我国防范及处理机制的现状,初步对我国的保险合同纠纷防范及处理机制进行重构。本文共分为7章,具体内容如下：第1章是保险合同纠纷防范及处理机制的理论基础,阐述了与论文相关的新制度经济学及行业协会的部分理论。其中新制度经济学的相关理论为本文提供了微观和宏观的理论基础和分析工具,而行业协会的相关理论则为本文提供了中观的理论基础和分析工具。新制度经济学中的契约理论、委托代理理论、交易费用理论、制度变迁理论以及国家理论之间有千丝万缕的联系,为便于理解各理论在本文中的作用,笔者在阐述时把它们并列起来。同时,每个理论都涉及许多流派和观点,为使重点突出,笔者仅阐述与本文相关的部分。第2章是保险合同纠纷防范及处理机制概述。这一章首先解析了保险合同纠纷的相关概念和基本类型,分析了保险合同纠纷的特点和成因,以期有针对性的构建防范及处理机制。随后,初步界定了本文中保险合同纠纷防范及处理机制的基本框架和主要内容。第3章是保险合同纠纷的防范机制分析,从微观、中观、宏观三个层面对保险合同纠纷防范机制涉及的相关问题进行了分析。其中,微观层面部分运用完全信息动态博弈模型研究投保人及保险人的诚信选择及其影响因素,运用多任务委托代理模型探讨保险公司经理人及保险代理人的激励机制及其对保险合同纠纷防范机制的影响,运用声誉模型分析信用体系对保险公司经理人及保险代理人行为的影响；中观层面是研究如何通过发挥行业协会的各项职能防范保险合同纠纷；宏观层面则是分析政府的法律及行政手段对保险合同纠纷防范机制的影响。第4章是保险合同纠纷的处理机制分析,运用成本收益方法,定性地比较当事人选择不同处理机制的成本收益,以及国家建立不同处理机制的成本收益,对保险合同纠纷当事人选择不同的处理机制解决纠纷进行了经济学解释,并阐述了政府建立多元化保险合同纠纷处理机制的经济学依据。同时,在制度变迁理论的基础上,分析了建立多元化处理机制的主体、动因、方式及过程。第5章是中国保险合同纠纷防范及处理机制的历史演进及现状分析,对我国的防范及处理机制的历史演进做了简述,以明确现存的问题从何而来。同时,对防范及处理机制的现状进行分析,以明确有待解决的问题及可能的解决途径。第6章是保险合同纠纷防范及处理机制的国际比较与借鉴,分析了英、日、韩、港等四个国家和地区的政府及行业协会在保险合同纠纷防范及处理机制中的地位和作用,并对其进行了比较,以便提供适合我国目前发展状况的有益借鉴。第7章是中国保险合同纠纷防范及处理机制的重构。这一章首先明确了我国重构保险合同纠纷防范及处理机制的目标及原则。其后,阐述了机制重构过程中保险企业、保险行业及政府的地位和作用,初步对我国保险合同纠纷的防范及处理机制进行了重构。本文可能的创新之处在于：第一,论文的研究视角具有新意。研究保险合同纠纷问题和解决机制问题的相关文献不少,但是专门研究保险合同纠纷防范及处理机制并将二者结合研究的文献则可谓匮乏。本文试图从微观、中观和宏观三个层次出发,构建完整而协调的体系,以有效的资源配置方式防范保险合同纠纷的产生、处理保险合同纠纷,并整合保险合同纠纷的防范与处理机制。第二,论文初步搭建了保险合同纠纷防范机制的框架。保险合同纠纷的防范目前仍是一个开放性和实践性的命题,其中包括哪些内容和主体仍有待研究和考察。本文在阅读现有文献的基础上,分析归纳与防范保险合同纠纷相关的制度、政策及措施等,初步搭建了包括保险人、行业协会以及政府等主体,内容涵盖保险人经营管理、保险合同条款设计、保险信用体系建设、保险知识宣传推广、保险欺诈防范等在内的统一体系。第三,论文采用成本收益分析法对保险合同纠纷的处理机制进行分析,对保险合同纠纷当事人选择不同的处理机制解决纠纷进行了经济学解释,并为政府建立多元化纠纷的处理机制提供了经济学依据。同时,把制度变迁理论应用于建立多元化的保险合同纠纷处理机制中,从主体、动因、方式及过程的角度分析了处理机制的构建问题。更多还原

【Abstract】 Insurance has significant impact on the development of our society.Since China recovered domestic insurance business in 1980, insurance has influenced all aspects of Peoples’life, and has gradually shown its own value. The insurance industry has developed rapidly. However, there is also hidden trouble behind the boom. Because of opportunistic behavior in the insurance market, the insurants’ lack of knowledge of insurance, the incompleteness of the insurance contract and so on, the number of insurance contract disputes has increased notably, which has become an obstacle to the development of the insurance industry. How to prevent and resolve insurance contract disputes has become a problem to be solved.The prevention and the resolution of insurance contract disputes are closely related. Based on the contract theory, there is a connection between the cost of insurance contract disputes’prevention and the cost of insurance contract disputes’ resolution. Sometimes one goes up, the other goes opposite. Prevention mechanism helps to reduce the number of insurance contract disputes, thereby reduce the cost of resolution mechanism. Resolution mechanism is conducive to curb opportunistic behavior, thereby save the cost of prevention mechanism. In addition, the process of dealing with disputes helps to collect information on the frequency and causes of disputes. The connection between the prevention mechanism and the resolution mechanism is the reason why the author studies them at the same time.In the process of studying the existing literature, the author has found that study on insurance contract disputes focus on how to avoid opportunistic behaviors of insurance agent, how to improve laws, regulations and terms of the contract, how to deal with specific cases with laws and principles of insurance and so on. Study on the mechanism of the insurance contract dispute resolution is less than that of general dispute resolution. Study specially on resolution mechanism of insurance contract disputes is mostly about arbitration mechanism. In 2005, the Chinese Insurance Regulatory Commission proposed to establish insurance contract disputes handling mechanism (mechanism for the insurance industry to handle disputes).It has attracted the attention of scholars on disputes handling mechanism of the insurance industry. However, study on the prevention and resolution of the insurance contract disputes, using economics, principles of management and law, is still to be developed.Study on the prevention and resolution mechanism requires analysis of characteristics and causes of insurance contract disputes. In this thesis, the author has analyzed the connotation, types, characteristics and causes of insurance contract disputes. Based on the theory of new institutional economics and trade associations, the author has also analyzed problems of the prevention mechanism of insurance contract disputes with micro, meso and macro economics, and tried to figure out how to solve them. With cost-benefit method and theory of institutional change, the author analyzed resolution mechanism of insurance contract disputes. Combining experience of developed countries, and regions and the situation in China, the author has tied to establish the prevention and resolution mechanism of the insurance contract disputes which would be fit for Chinese condition.This thesis is divided into seven chapters, as follows:Chapter 1 is the theoretical basis, In this part, the author has introduced theory of new institutional economics and trade association. The contract theory, agency theory, transaction cost theory, institutional change theory, state theory are inextricably linked. In order to understand of the role of theory in this thesis better, the author put them side by side. Besides, each theory contains different schools and ideas; in order to focus the author has only explained the part related to this article. Chapter 2 is an overview of the prevention and resolution mechanism of insurance contract disputes. In this chapter the connotation, types, characteristics and causes of insurance contract disputes have been analyzed first, in order to help to build prevention and resolution mechanism. Then, the framework and content of prevention and resolution mechanism in the thesis have been defined basically. Chapter 3 is an analysis of prevention mechanism of insurance contract disputes. With micro, meso and macro economics, related issues of prevention mechanism of insurance contract disputes have been discussed. In the part of microeconomics, complete information dynamic game model has been used to discuss the integrity of the insured and the insurer; multi-task principal-agent model has been used to discuss of the incentive mechanism of insurance company managers and insurance agents; the reputation model has been used to discuss how the credit system would affect behaviors of insurance company managers and insurance agents. In the part of mesoeconomics, the author has analyzed how trade associations would help to decrease the number of insurance contract disputes. In the part of macroeconomics, how the law system and government’s administration would affect the prevention mechanism has been analyzed. Chapter 4 is an analysis of the resolution mechanism of insurance contract disputes. The cost-benefit method has been use to explain why different resolution mechanisms have been chosen by different parties as well as why different mechanisms exist at the same time. Meanwhile, theory of institutional change has been used to discuss the main executor, motivation, methods and processes of the establishment of the resolution mechanism. Chapter 5 is an analysis of history and situation of Chinese prevention and resolution mechanism of insurance contract disputes. Chapter 6 is an introduction of the prevention and resolution mechanism of insurance contract disputes in England, Japan Korea and Hong Kong. This part contains how governments and industry associations have established the prevention and resolution mechanism in those four countries or regions. Chapter 7 is the contradiction of Chinese prevention and resolution mechanism of insurance contract disputes. In this chapter, the author has defined goals and principles of establishment of prevention and resolution mechanism. Then, the author has discussed the role of insurance companies, insurance industry and the government in the process of establishing the prevention and resolution mechanism of insurance contract disputes.The main contribution of this thesis is as follows:firstly, the subject is a novelty. There is a great deal of literature relevant to insurance contract disputes and resolution mechanism, less of which specializes in both the prevention and the resolution mechanism of insurance contract disputes. This thesis concentrate on how to build a complete and unisonous system with the effort of the insurance companies, the insurance industry and the government, in order to prevent and deal with insurance contract disputes in an efficient way and integrate the resources of the prevention with that of the resolution mechanism. Secondly, the framework and contents of the prevention mechanism of insurance contract disputes is still an open and practical subject. Based on existing literature, the author has established a basic framework of the prevention mechanism of insurance contract disputes, which includes issues of insurance company management, insurance contract design, credit system, insurance knowledge publicity and insurance fraud prevention and so on. Insurers, trade associations and the government are all involved in those issues mentioned above in one way or another. Thirdly, in the analysis of the resolution mechanism of insurance contract disputes, the author has applied cost-benefit method to explain why different parties choose different resolution mechanism and why the government establishes diversified resolution mechanisms. Meanwhile, the theory of institutional change has been used in the analysis of the establishment of the resolution mechanism. It contains the main executor, motive, method and process of the construction of the resolution mechanism.更多还原