“中间性保险”及其私法规制

健康保险、意外伤害保险既不同于采取定额给付的生命保险,也不同于补偿财物损失的财产保险,而是介于传统人身保险和财产保险之间的一种"中间性保险"。就保险合同规制而言,依其目的而区分为填补具体损害(财产损失)的损失补偿合同和填补抽象损害(人身损害)的定额给付合同,并由此确定超额保险、重复保险、保险代位权等规则之适用对象,才是符合法理的立法模式。健康保险、意外伤害保险中的医疗费用部分,不应排除损害填补原则之适用,亦即存在超额保险问题,故应受重复保险规则规制。意外伤害保险在应由第三者对保险事故负侵权之责的情形下,对其医疗费用应容许适用保险代位权。     

保险损害补偿原则研究——兼论我国保险合同立法分类之重构

保险损害补偿是保险合同法上诸多制度体系的一个基石。我国保险立法虽确立了该原则并初步构建了制度体系,但由于该原则在保险法理论研究上并未受到应有的重视,迄今学理解释上对该原则多“食而未化”,仍有诸多观念上的错误或认识上的误区。本文运用法解释学、法史学及比较法学等分析方法,从保险损害补偿的范畴分析入手,对该原则的内核、规范目的、适用范围及其例外等作了深入阐释,以正本清源。从保险损害补偿原则及其制度的适用角度来考量,主张摒弃我国现行保险法所采的“财产保险”与“人身保险”之“二分法”,代之以“补偿性保险”与“定额性保险”之“二分法”,以利于法律的正确适用。     

Reforming the relationship between medicine and the law of tort

The Australian Government's medical indemnity package is predicated on the belief that the current crisis is primarily one of insurance. However, an examination of the fault-based tort system illustrates that, irrespective of their insurance status, doctors are profoundly affected by the adversarial process and their response to it is leading to sub-optimal patient care. This article argues that the adversarial system of medical negligence fails to satisfy the main aims of tort law, those being equitable compensation of plaintiffs, correction of mistakes and deterrence of negligence. Instead, doctors experience litigation as a punishment and, in order to avoid exposure to the system, have resorted not to corrective or educational measures but to defensive medicine, a practice which the evidence indicates both decreases patient autonomy and increases iatrogenic injury. This is unacceptable and suggests that the package has missed the point. This article proposes an alternative medico-legal tort scheme which attempts to overcome some of these problems.     

Nurses, midwives and the requirement for "appropriate" professional indemnity insurance

The Health Practitioner Regulation National Law Act 2009 (the National Law) imposes the obligation on nurses and midwives to have appropriate professional indemnity insurance coverage as a condition of applying for, or renewing, their registration to practise in Australia. The National Law also empowers the Nursing and Midwifery Board of Australia to develop a registration standard and guidelines in relation to professional indemnity insurance and to enforce compliance through the registration process. Though not previously a requirement for their registration, nurses and midwives must now understand the nature and extent of the professional indemnity insurance under which they practise and declare that they will not practise their profession unless they have appropriate professional indemnity insurance arrangements which cover the full scope of their practice. This column provides an overview of the obligations and responsibilities imposed on nurses and midwives under the National Law and the Nursing and Midwifery Board of Australia's registration standard and guidelines. It is imperative that nurses and midwives understand the National Law provisions and the standard and guidelines developed by the Board before making decisions about their professional indemnity insurance and self-declaring that they have "appropriate" professional indemnity arrangements in place.     

海上重复保险若干法律问题评析

海上重复保险制作为海上保险法律制度的一部分 ,法律对它的规定很简略 ,历来的著述中对它的研究也都很少 ,且有一定的误解。本文对海上重复保险的含义加以澄清和重新界定 ,对于重复保险的效力根据超额保险、非超额保险和善意保险、恶意保险几种情况加以分析 ,并对于重复保险赔付过程中和赔付后、保险人与被保险人及保险人之间的特殊的法律关系加以分析论述 ,指出立法上存在的需要完善和改进的若干问题。     

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。     

保险受益人研究

狭义上的保险受益人是指于被保险人死亡时有权请求和受领身故保险金的人。他只能是被保险人之外的人,包括指定受益人和法定受益人。投保人有受益人的指定权,被保险人或其监护人有最终的决定权,受益人指定不明时应合理解释。被保险人的法定继承人是其法定受益人,法定受益人的受益顺序依法定继承人的继承顺序,同一顺序的法定受益人受益份额相同。保险受益人原则上为可变更受益人,其变更应采书面形式,并自通知保险人时生效。     

论海上重复保险——兼论对我国《海商法》第225条的修改

海上重复保险制度能有效地防止因被保险人重复投保而可能产生的道德风险 ,对维护保险赔偿原则起了重要的作用 ,但《海商法》的规定仍有疏漏之处。本文对重复保险的含义、重复保险合同的效力以及被保险人的索赔权作了分析 ,并对保险人之间的权利、义务规定不足的地方给予了补充     

论互有过失船舶碰撞造成船员人身伤亡的责任负担

分析了一般人身损害赔偿案件中工伤保险赔偿与民事侵权损害赔偿的关系,讨论了互有过失船舶碰撞造成船员人身伤亡案件中的工伤保险和民事损害赔偿的关系,明确了此类案件中的责任承担问题。     

论建筑物抛掷物、坠落物致害道义补偿责任——兼论建筑物抛掷物、坠落物强制责任保险制度的建立

《侵权责任法》第87条规定的建筑物抛掷物、坠落物致害补偿责任的性质不是侵权责任,也不是公平责任,而是道义补偿责任。该道义补偿责任的适用范围,受到“建筑物”、“抛掷物”或者“坠落物”和“难以确定”三个方面的限制。其责任限制又主要通过抗辩举证、数额确定及责任分担来实现。另外,建议将该道义补偿责任纳入强制责任保险的范畴,并由法定责任主体通过物业费代为征收的方式予以缴纳。     

论保险代位求偿权的法律性质

保险代位求偿权是财产保险的一项重要法律制度,源自赔偿合同原则。财产保险合同本质上是一种赔偿合同,如果被保险人所遭受的财产损失,已通过保险合同得到补偿,那么,被保险人因该损失而在法律上可获得的减轻或弥补损失的救济和利益便应归保险人,否则,被保险人就可能获得过量补偿而诱发道德风险。中国保险法在借鉴英国海上保险法保险代位求偿制度的基础上,将保险代位求偿权定性为法定债权转让,并考虑到中国的实际情况,通过最高人民法院的司法解释对保险代位求偿权作出了延伸保护。     

Who Has to Pay for Periods of Insolvent Insurance in Long-Tail Coverage Claims? New Jersey High Court Changes the Game in Favor of Policyholders

Two new cases have changed the game in New Jersey for allocating defense and indemnity costs in long-tail environmental or toxic tort claims. The high court has established that solvent insurers must absorb insolvent insurers’ share of costs in long-tail claims until all solvent insurance is exhausted, at which time insolvent shares will be borne by the Property-Liability Guaranty Association. In addition, the high court has established that insurers have a right of contribution against other insurers when they pay more than their allocated share of defense or indemnity.     

Health care financing reforms in Germany: the case for rethinking the evolutionary approach to reforms

Health care reform has been a perpetual issue in German politics since reunification. Reform initially focused on restructuring the health care system of the former East Germany. It has subsequently focused on questioning whether the financing of the German social health insurance (SHI) system is sustainable, in light of economic malaise that characterized the 1990s and heightened global competition. In this article, we document twelve significant attempts to reform health care financing in Germany and critically appraise them according to the principles of solidarity and subsidiarity on which SHI systems were built. While the reforms in the aggregate offered the prospect of addressing the challenges faced by the system, the modest results of the reforms and remaining deficiencies of the system underscore the limitations of the evolutionary approach to reforms. This suggests that reformers should consider a more revolutionary approach.     

工伤案件赔偿请求权竞合问题研究

工伤案件往往同时涉及工伤保险待遇和人身损害赔偿两种不同的请求权,在这两种请求权竞合时如何处理,我国现有法律显得很不完善.通过对工伤保险待遇和人身损害赔偿两种不同的请求权进行比较,分析我国现有法律规范关于工伤案件赔偿请求权竞合时如何处理的相关规定及其存在的问题,介绍国外处理工伤案件赔偿请求权竞合问题的四种不同模式,提出解决工伤案件赔偿请求权竞合问题的建议.     

Medical liability and health care reform

We examine the impact of the Affordable Care Act (ACA) on medical liability and the controversy over whether federal medical reform including a damages cap could make a useful contribution to health care reform. By providing guaranteed access to health care insurance at community rates, the ACA could reduce the problem of under-compensation resulting from damages caps. However, it may also exacerbate the problem of under-claiming in the malpractice system, thereby reducing incentives to invest in loss prevention activities. Shifting losses from liability insurers to health insurers could further undermine the already weak deterrent effect of the medical liability system. Republicans in Congress and physician groups both pushed for the adoption of a federal damages cap as part of health care reform. Physician support for damages caps could be explained by concerns about the insurance cycle and the consequent instability of the market. Our own study presented here suggests that there is greater insurance market stability in states with caps on non-economic damages. Republicans in Congress argued that the enactment of damages caps would reduce aggregate health care costs. The Congressional Budget Office included savings from reduced health care utilization in its estimates of cost savings that would result from the enactment of a federal damages cap. But notwithstanding recent opinions offered by the CBO, it is not clear that caps will significantly reduce health care costs or that any savings will be passed on to consumers. The ACA included funding for state level demonstration projects for promising reforms such as offer and disclosure and health courts, but at this time the benefits of these reforms are also uncertain. There is a need for further studies on these issues.     

An insurer's perspective on reform

Individual health insurance markets differ from state to state, and as a result approaches to individual market reforms need to be different. In evaluating approaches, policy makers need to remember that since the decision to purchase health insurance coverage is voluntary, the potential for adverse selection exists. In addition, rather than putting the focus of individual market reforms almost exclusively on access to health insurance for a small number of persons with high-cost health conditions, more attention needs to be put on how to decrease the number of uninsured persons. This includes making the premiums paid for individual health insurance 100 percent tax deductible, similar to those of employer-based health insurance. Finally, market reforms need to treat all types of coverage issued in the individual market the same, whether they are purchased direct for the insurer or through an out-of-state association.     

海峡两岸强制汽车责任保险法律制度比较研究——从国际趋势和受害人保护看两岸措施统合之必要

强制的机动车损害赔偿责任保险,是及时、妥当地救济受害人,抑制交通事故,保障机动车事业正常发展的重要法律制度。关于海峡两岸的强制机动车损害赔偿责任保险制度,我国现行法律亟待完善,台湾地区则走在世界的前列。为与国际接轨,统合两岸措施,将能极大地促进法治国家建设,利国利民。     

Medical malpractice reform and insurer claims defense: unintended effects?

In response to recent and past medical malpractice insurance crises, most states have implemented reforms meant to stabilize premiums and coverage availability. The importance of understanding whether these reforms implicitly affect the behavior and incentives of plaintiffs, attorneys, medical providers, and malpractice insurers in the intended way is crucial to policy makers, if they are to achieve their goal. This study specifically examines the effect of reforms on the claims defense efforts of insurers, given that defense expenses account for approximately 30 percent of malpractice premiums. Using state data for the period 1998-2002, we regress claims defense expenses against a variety of reform variables. These include seven tort reforms (noneconomic damage caps, punitive damage limits, attorney fee limits, modified collateral source rule, modified joint and several liability doctrine, mandatory pretrial screening, and statute of limitations) and two government-sponsored insurance mechanisms (joint underwriting associations and patient compensation funds). Claims defense expenses are found to be higher in the presence of noneconomic damage caps, punitive damage limits, and attorney fee limits--an unintended and counterproductive effect of reform--but are lower with mandatory pretrial screening and patient compensation funds.     

Implications of genetic testing: discrimination in life insurance and future directions

This article examines the possibility of genetic discrimination in life insurance and discusses the inability of current Australian legislation to deal adequately with genetic test result information. Genetic information has certain features that distinguish it from other medical information and thus a specialist legislative package is required to regulate its use. This article outlines how current practices in the life insurance industry are inconsistent with notions of human rights. Several legislative options are suggested and examined. Given the negative and damaging impact that adverse selection is likely to have on the life insurance industry should the use of all genetic test results be prohibited, an approach which modifies the current regime is recommended. This includes a comprehensive review scheme and the introduction of additional insurance products tailored to individuals suffering from various genetic illnesses or predispositions to future disease.     

工伤救济先行给付与代位求偿制度探微——兼评《社会保险法》工伤保险基金先行支付制度的得与失

先行给付与代位求偿是保险法上的通例,《社会保险法》第41、42条涉及该通例并规定为工伤保险基金先行支付制度。先行支付制度包括垫付性先行支付和保险性先行支付,也称为用人单位未依法缴纳工伤保险费型先行支付和由于第三人的原因造成工伤型先行支付。在社保强制性不足的背景下,该制度设计有着明显的缺陷,鉴于其积极的人本价值和宽容的制度理性,不宜弱化先行支付制度之实施,应当通过完善社保强制性、加大违法成本、强化惩戒措施来保证该制度的有效实施。