本文選題：交強(qiáng)險(xiǎn) + 醫(yī)療費(fèi)�。� 參考：《西南政法大學(xué)》2015年碩士論文

【摘要】：近年來(lái),我國(guó)汽車(chē)行業(yè)的發(fā)展越來(lái)越快,各大城市的汽車(chē)保有量呈現(xiàn)出飛速上漲的趨勢(shì),比如深圳市過(guò)去幾年的汽車(chē)保有量增長(zhǎng)率都維持在16%以上的高位,導(dǎo)致交通不堪重負(fù),汽車(chē)數(shù)量的增加以及城市交通的擁堵同時(shí)也導(dǎo)致了交通事故數(shù)量的上升1。在這樣的背景下,傳統(tǒng)的民事法律顯然不足以高效和公平地處理頻發(fā)的交通事故糾紛,為此我國(guó)實(shí)行了機(jī)動(dòng)車(chē)交通事故強(qiáng)制責(zé)任險(xiǎn)制度,也即交強(qiáng)險(xiǎn)制度是我國(guó)處理交通事故糾紛的核心制度,故這項(xiàng)制度是否完善,決定了我國(guó)交通事故糾紛的核心解決機(jī)制是否完善。然而,我國(guó)的交強(qiáng)險(xiǎn)制度在實(shí)踐中已暴露出很多問(wèn)題,本文所關(guān)注的問(wèn)題是日常生活中交強(qiáng)險(xiǎn)賠付問(wèn)題上最為常見(jiàn)和廣泛存在的醫(yī)療費(fèi)用的賠付問(wèn)題,幾乎所有經(jīng)歷過(guò)交通事故交強(qiáng)險(xiǎn)賠付的當(dāng)事人都能夠體會(huì)到保險(xiǎn)公司在醫(yī)療費(fèi)賠付問(wèn)題上的“霸權(quán)主義”,無(wú)論是作為格式合同的《交強(qiáng)險(xiǎn)條款》,還是保險(xiǎn)公司的實(shí)際執(zhí)行工作,都無(wú)一例外的傾向于在醫(yī)療費(fèi)問(wèn)題上免除自身的保險(xiǎn)責(zé)任,諸如非社保用藥不予賠付、檢查費(fèi)用部分賠付等做法在實(shí)踐中引起了很多糾紛。然而我國(guó)法律對(duì)交強(qiáng)險(xiǎn)的醫(yī)療費(fèi)賠償問(wèn)題又語(yǔ)焉不詳,僅有保險(xiǎn)協(xié)會(huì)制定的《交強(qiáng)險(xiǎn)條款》“可堪大用”,但這份格式合同系保監(jiān)會(huì)制定,具有十分明顯的行業(yè)色彩,在非社保用藥、檢查費(fèi)等方面采用了完全保護(hù)保險(xiǎn)公司的立場(chǎng)。文章分為四部分,第一部分是介紹案例,引出爭(zhēng)議焦點(diǎn),即是否應(yīng)當(dāng)遵從《交強(qiáng)險(xiǎn)條款》的約定,按照社保報(bào)銷范圍來(lái)理賠醫(yī)療費(fèi)以及交強(qiáng)險(xiǎn)醫(yī)療費(fèi)賠付中索賠方的維權(quán)方成本是否過(guò)高。第二部分著重探討保險(xiǎn)公司在醫(yī)療費(fèi)賠償范圍的現(xiàn)狀以及保險(xiǎn)公司醫(yī)療費(fèi)賠付不合理的法律依據(jù)。第三部分主要是對(duì)焦點(diǎn)問(wèn)題二進(jìn)行分析,強(qiáng)調(diào)維權(quán)成本的問(wèn)題。在第四部分中,作者給出了幾點(diǎn)交強(qiáng)險(xiǎn)醫(yī)療費(fèi)賠付的法律建議。如,完善相關(guān)立法,構(gòu)建第三方審查機(jī)制以及對(duì)保險(xiǎn)公司故意拖延的行為進(jìn)行懲罰。
[Abstract]:In recent years, the automobile industry in our country has developed more and more rapidly, and the number of automobile ownership in major cities has shown a trend of rapid increase. For example, the growth rate of car ownership in Shenzhen has remained at a high level of more than 16% in the past few years, resulting in a heavy traffic burden. The increase in the number of cars and congestion in urban traffic has also led to a 1. 1% increase in the number of traffic accidents. Under this background, the traditional civil law is obviously not enough to deal with frequent traffic accident disputes efficiently and fairly. Therefore, our country has implemented the compulsory liability insurance system for motor vehicle traffic accidents. That is, traffic insurance system is the core system of handling traffic accident disputes in China, so whether this system is perfect or not determines whether the core settlement mechanism of traffic accident disputes in China is perfect or not. However, the traffic insurance system of our country has exposed many problems in practice, the problem that this article pays attention to is the most common and widespread medical expense compensation problem in daily life. Almost all the parties who have experienced traffic accident insurance claims are able to understand the "hegemonism" of insurance companies on the issue of medical claims. Whether it is the traffic insurance clause as a form of contract, or the actual implementation of the insurance company, there is a tendency, without exception, to exempt itself from insurance on the issue of medical expenses, such as non-social security drugs not to be paid. Inspection fee partial compensation and other practices in practice caused a lot of disputes. However, the law of our country is not clear about the issue of compensation for medical expenses in traffic insurance. Only the "traffic insurance clause" formulated by the insurance association "can be used as much as possible." however, this format contract was formulated by the CIRC, and it has a very obvious industry color. In non-social security medication, inspection fees and other aspects of the full protection of the insurance company position. The article is divided into four parts, the first part is to introduce the case, leading to the focus of the dispute, that is, whether to comply with the provisions of the Jiaotang insurance agreement, According to the scope of social security reimbursement to compensate for medical expenses, as well as in the payment of health insurance costs claimants are too high costs. The second part mainly discusses the current situation of insurance company's medical expense compensation scope and the unreasonable legal basis of insurance company's medical expense compensation. The third part mainly focuses on the analysis of issue two, emphasizing the cost of safeguarding rights. In the fourth part, the author gives some legal suggestions on the payment of medical expenses. For example, improve relevant legislation, construct third-party review mechanism and punish insurance companies for deliberate delay.
【學(xué)位授予單位】：西南政法大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2015
【分類號(hào)】：D923;D922.284

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1 林齊平;交強(qiáng)險(xiǎn)醫(yī)療賠償案例分析[D];西南政法大學(xué);2015年

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本文編號(hào)：1822869