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论保险人的理赔核定义务 被引量:2

A Study of Insurers' Duty to Adjust Claims
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摘要 从规范保险人的理赔行为而言,有必要将保险人的理赔核定义务提升为统辖保险人核定保险事故的基本要求。保险人的理赔核定义务的法律性质是不真正义务。这一性质可作为对理赔核定义务予以解释和建构的法理基础。核定期间的有关规定是判断保险人是否违反了理赔核定义务的标准。核定期间的起始点应当是被保险人在发生保险事故后通知保险人的时间;2009年修订《保险法》时新增要求保险人对情形复杂的保险事故在30日内完成核定的规定应予坚持;《保险法》对于危险事故属于保险责任的情形并未规定该通知义务的具体内容,未来修法时极有必要继续完善和充实。当保险人违反理赔核定义务时,将面临失权和可能要承担损害赔偿的不利后果。 The legislation and interpretation of the rules for insurers to adjust claims ought to be based on the policy of fast and justifiable payment.Upon this agreement,it is necessary to improve the status of insurers’duty to adjust claims so as to better regulate the insurance claims.The endowment of such an independent duty contributes to rising to prominence in the legal system of claim settlement,which can also serve the purpose of defining the legal character of the duty to adjust claims and implement efficient claim settlements.The legal nature of the duty to adjust claims can be categorized as'obliegenheit'.In this case,insurers’duty to adjust claims can be understood from the perspective of the rationale of the obliegenheit rather than trying to start from scratch.Thus,insurers’duty to adjust claims would be integrated into the existing system.On the other hand,the obliegenheit could be strongly in support of the systemization of the rules concerning the duty to adjust claims.To establish whether an insurer breaches its duty,it is meaningful that the required time limits in law are employed to show if the insurer carries his duty to adjust claims.To be specific,in contrast with the current rule,the starting point for insurers to adjust claims should be set at the time the insured notice the insured risk to the insurer.Nevertheless,the 2009 amendment of finishing complicated adjustments in 30 days should be hold on in the insurance law.Additionally,extra requirement of the duty to inform concerning the insured risk should be added in the amendment of insurance law.Once an insurer breaches its duty to adjust claims,the insurer shall face the consequences of the deprivation of the capacity to adjust claims and possible compensation for damages.The deprivation of the capacity to adjust claims results from insurers’indifference to the time limits set in law for insurers’duty to adjust claims.As for the compensation for damages,it is because of the inextricable link of insurers’duty to adjust claims and t
作者 李飞 Li Fei(School of Law,Nankai University,Tianjin 300350,China)
机构地区 南开大学法学院
出处 《上海财经大学学报(哲学社会科学版)》 CSSCI 北大核心 2019年第3期136-152,共17页 Journal of Shanghai University of Finance and Economics
基金 中央高校基本科研业务费专项资金"比例原则与注重人权的商业决策"(63182041) 中央高校基本科研业务费专项资金"司法公正回应社会公正问题研究"(63192419)
关键词 理赔核定义务 不真正义务 核定期间 失权 损害赔偿 the duty to adjust claims obliegenheit time limits for adjustment the deprivation of the capacity to adjustment compensation for damages
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参考文献2

  • 1许崇苗,李利著..最新保险法适用与案例精解[M].北京:法律出版社,2009:494.
  • 2白彦,张怡超著..保险消费者权利保护研究[M].北京:中国法制出版社,2016:289.

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