【摘要】：海上保險(xiǎn)領(lǐng)域中欺詐性索賠問題頻繁出現(xiàn)。英國在對(duì)欺詐性索賠相關(guān)法律問題的研究中處于領(lǐng)先地位。在《1906海上保險(xiǎn)法》中,并沒有對(duì)欺詐性索賠的法律問題進(jìn)行專門的規(guī)定。因此,在對(duì)被認(rèn)定為是欺詐性索賠的案件進(jìn)行具體處理時(shí),法官往往會(huì)將其劃歸為后合同誠信義務(wù)后將其交由最大誠信原則進(jìn)行處理。而在英國2015《保險(xiǎn)法》頒布實(shí)施后,欺詐性索賠的問題被單獨(dú)規(guī)定在其第十二、十三條之中。這兩個(gè)條款對(duì)欺詐性索賠的法律問題有了全新的規(guī)定,使欺詐性索賠不必再依靠后合同誠信義務(wù)能夠獨(dú)立存在。并且,先行賠付部分是否應(yīng)予返還這一問題也通過法律明文確定下來。英國2015《保險(xiǎn)法》第十二條對(duì)法律責(zé)任的劃分做出了更合理的規(guī)定,這一劃分方式能夠更好的保護(hù)合同雙方當(dāng)事人的權(quán)益。而第十三條對(duì)團(tuán)體保險(xiǎn)中出現(xiàn)的欺詐性索賠的情形進(jìn)行了明確的規(guī)定。這兩條法律規(guī)定能夠?qū)Ρ槐ｋU(xiǎn)人等相關(guān)人的權(quán)利起到更好的保護(hù)作用。英國2015《保險(xiǎn)法》對(duì)欺詐性索賠的法律問題規(guī)定的并不全面,對(duì)欺詐性索賠的含義沒有進(jìn)行明確的界定。這導(dǎo)致在對(duì)較為特殊的案例進(jìn)行處理時(shí)無法明確對(duì)案件進(jìn)行定性。并且從體系的完整性上來看,欺詐性索賠沒有明確含義這一缺陷對(duì)欺詐性索賠的發(fā)展是極其不利的。而且,欺詐性索賠的具體認(rèn)定標(biāo)準(zhǔn)問題也沒有通過明確的法律規(guī)定得到解決。這一問題在實(shí)踐中只能依靠法官的自由裁量。欺詐性索賠的認(rèn)定標(biāo)準(zhǔn)不能明確對(duì)欺詐性索賠在實(shí)務(wù)中的適用也是沒有益處的。比照中國法下對(duì)于欺詐性索賠相關(guān)法律問題的規(guī)定,欺詐性索賠的含義在中國法下也沒有進(jìn)行界定。并且,對(duì)團(tuán)體保險(xiǎn)中個(gè)別被保險(xiǎn)人等相關(guān)人進(jìn)行欺詐性索賠應(yīng)如何處理這一問題,中國法下也沒有對(duì)進(jìn)行規(guī)定。筆者建議,在中國《保險(xiǎn)法》中加入團(tuán)體保險(xiǎn)欺詐性索賠的法律規(guī)定。中國法對(duì)這一問題的法律規(guī)定的確立可以借鑒英國2015《保險(xiǎn)法》第十三條進(jìn)行制定。并且,在中國《保險(xiǎn)法》中應(yīng)當(dāng)明確團(tuán)體保險(xiǎn)欺詐性索賠的規(guī)定不僅適用于人身保險(xiǎn)中,也適用于針對(duì)財(cái)產(chǎn)的團(tuán)體保險(xiǎn)。為使欺詐性索賠這一制度更加完善,中國《保險(xiǎn)法》中還應(yīng)當(dāng)明確規(guī)定保險(xiǎn)人對(duì)被保險(xiǎn)人等相關(guān)人進(jìn)行欺詐行為的民事救濟(jì)方法。從而能夠?qū)Ρ槐ｋU(xiǎn)人等相關(guān)人的權(quán)利進(jìn)行更全面的保護(hù)。此外,在學(xué)理上也要對(duì)欺詐性索賠的含義進(jìn)行進(jìn)一步明確的界定,以達(dá)到欺詐性索賠制度體系完整性的要求,還能夠?qū)唧w案件的定性提供相應(yīng)的幫助。更有利于欺詐性索賠制度的發(fā)展。
[Abstract]:Fraudulent claims appear frequently in the field of marine insurance. Britain is leading the way in the study of legal issues related to fraudulent claims. In the 1906 Maritime Insurance Act, there are no specific provisions on the legal issues of fraudulent claims. Therefore, when dealing with a case deemed to be a fraudulent claim, the judge often classifies it as a post-contractual bona fide obligation to be dealt with by the principle of maximum good faith. After the enactment of the British Insurance Act 2015, the issue of fraudulent claims was separately provided for in articles 12 and 13 of the Act. These two clauses have completely new provisions on the legal issues of fraudulent claims, so that fraudulent claims do not have to rely on post-contractual fiduciary obligations to exist independently. Moreover, the question of whether the advance payment should be returned is also explicitly determined by law. Article 12 of the British Insurance Act 2015 makes more reasonable provisions on the division of legal liability, which can better protect the rights and interests of both parties to the contract. Article 13 provides a clear definition of fraudulent claims in group insurance. These two legal provisions can better protect the rights of the insured and other related persons. The British Insurance Act 2015 does not provide for the legal issues of fraudulent claims completely, and the meaning of fraudulent claims is not clearly defined. This makes it impossible to clearly define the case when dealing with a more specific case. And from the integrity of the system, the lack of clear meaning of fraudulent claims is extremely detrimental to the development of fraudulent claims. Moreover, the issue of specific criteria for the identification of fraudulent claims has not been resolved through clear legal provisions. In practice, this problem can only depend on the discretion of the judge. The identification criteria of fraudulent claims are not specific to the application of fraudulent claims in practice. The meaning of fraudulent claim is not defined under Chinese law. Moreover, there is no provision under Chinese law on how to deal with the problem of fraudulent claims by individual insured and other related persons in group insurance. The author suggests that the legal provisions of group insurance fraudulent claims should be added to China's Insurance Law. The establishment of Chinese law on this issue can draw lessons from Article 13 of British Insurance Law 2015. Moreover, in China's Insurance Law, it should be made clear that the provisions of group insurance fraud claim apply not only to personal insurance, but also to group insurance against property. In order to make the system of fraudulent claims more perfect, China's Insurance Law should also clearly stipulate the civil remedies for the insurer's fraudulent acts against the insured and other related persons. Thus can carry on the more comprehensive protection to the insurant and so on related person's rights. In addition, it is necessary to define the meaning of fraudulent claims in theory, so as to meet the requirements of the integrity of the system of fraudulent claims, and to provide corresponding help for the qualitative analysis of specific cases. More conducive to the development of fraudulent claims system.
【學(xué)位授予單位】：遼寧大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：D956.1;DD912.28

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