医疗费用类保险损失补偿原则适用的实证研究

在医疗保险费用类保险存在重复保险或第三方先行给付的情况下,不应适用损失补偿原则。保险人认为被保险人可能获得额外利益并诱发道德风险,可以事先在保险合同中约定特定情形下的免责条款并作明确说明。第三者侵权导致保险事故发生时,免责条款的约定没有法律效力。

Empirical Research on Principle of Indemnity Applied in Medical Expenses Insurance

Principle of indemnity should not be applied under the circumstance that there exist double medical insurance or prior compensation from the third party.If insurers think insurants may achieve additional benefits and induce moral risks,they can set exemption clause beforehand and set out a clear explanation.The exemption clause has no legal force when insurance accident is caused by a tort from the third party.