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最高人民法院民二庭負責人就保險法司法解釋（三）答記者問

//cciia.org.cn　 2015-11-27 9:11:05　 來源：人民法院報

    11月26日，最高人民法院召開新聞發布會，發布《關于適用〈中華人民共和國保險法〉若干問題的解釋（三）》。該司法解釋將于12月1日實施，旨在解決近年來出現的保險合同糾紛新問題，促進我國保險業健康發展。為更好的理解和適用解釋，最高法院民二庭負責人接受了本報記者的采訪。
 
    問：《最高人民法院關于適用〈中華人民共和國保險法〉若干問題的解釋（三）》將于12月1日施行，請您談談制定該司法解釋的相關背景？
 
    答：保險業是現代金融體系的重要支柱，我國保險業近年來發展迅速，在經濟社會發展中發揮著越來越重要的作用。2011年，全國保險保費收入1.43萬億元，2012年上升至1.55萬億元，2013年上升至1.72萬億元，2014年上升至2.02萬億元。隨著保險業的繁榮發展，保險糾紛案件數量呈連續增長態勢。司法統計數據顯示：2009年全國一審保險合同糾紛案件41752件，2010年59767件，2011年73206件，2013年76430件，2014年94957件，2015年前10個月的案件數為91555件。
 
    《中華人民共和國保險法》自1995年頒布實施以來，雖經2002年第一次修訂，但因受歷史條件所限，實踐中很多問題一直未得到很好解決。2009年保險法的修訂，為維護金融秩序穩定，促進保險業健康發展，特別是保護投保人、被保險人利益方面發揮了積極的作用。但就保險合同部分而言，保險法的規定仍然比較原則，對一些問題的規定不夠具體。同時，保險市場發展日新月異，保險行業內部結構和外部環境發生了較大變化，實踐中出現了一些新情況、新問題。基于以上原因，保險合同糾紛案件的審理存在爭議較多，裁判標準不夠統一問題較為突出，個別案件審理結果甚至截然相反，影響了司法權威和法制統一，也不利于保險行業的健康發展。鑒于此，最高人民法院啟動了保險法司法解釋的起草工作。
 
    問：本解釋是對保險法保險合同章人身保險部分的解釋，請問人身保險合同具有哪些不同于財產保險合同的特征？這對我們起草司法解釋有什么影響？
 
    答：人身保險是以人的壽命和身體為保險標的的保險，包括人壽保險、健康保險、意外傷害保險等。人身保險合同的投保人通常是個人，存在保險合同存續期間較長、法律關系較為復雜等特征，保險市場創新活躍，道德風險防范、保險消費者保護、鼓勵保險創新、明晰法律關系等需求更為突出。因此，我們在司法解釋起草中，堅持以下指導原則：
 
    一是注重防范道德風險。人身保險以人的壽命和身體為保險標的，道德風險的發生意味著被保險人的生命健康受到侵害。人身保險不適用損害填補原則，保險金額不受限制，相關利益主體更可能存在實施道德風險騙取保險金的意圖，因此，防范道德風險在人身保險合同中的任務更加繁重。
 
    二是注重保護保險消費者。保險合同的一方主體為專門經營風險的保險公司，另一方是普通投保人，雙方在經濟實力和專業知識存在明顯不對等，因此，加強保險消費者保護，是各國保險合同立法的基本原則，我國保險法也不例外。保險消費者保護一直是歷次保險法修訂的基本理念，也是近些年保險監管部門的監管工作的重要內容。《解釋三》也延續這一原則。
 
    三是支持保險創新。隨著保險市場的發展，人身保險產品不再局限于傳統的人壽保險、醫療保險、意外傷害保險，而是發展出具有投資功能的萬能險、分紅險、投連險等保險產品。這些保險產品兼具保障與投資功能，且投資性內容所占比例逐步增大，市場上圍繞這些保險產品發展出了新的交易模式。對于這些新類型保險產品及其交易模式，因相關法律規則不明確，實踐中存在不少爭議，亟需規范。《解釋三》一方面確立規則，為新型保險產品的發展創造條件，另一方面適當留白，為新型保險產品的不斷創新留下空間。
 
    四是厘清保險合同法律關系。人身保險合同的主體，除保險人與投保人外，還有被保險人和受益人，理論界與實務界對被保險人與受益人的法律地位存在不同認識。盡管保險法明確投保人是保險合同當事人，但仍有觀點認為被保險人也是保險合同當事人。《解釋三》遵循合同相對性基本原理，以投保人作為保險合同當事人來構建保險合同法律關系，同時注重維護被保險人的合法權益。
 
    問：人身保險利益以及死亡險特殊規定是人身保險合同中防范道德風險的重要制度，《解釋三》對此是如何規定的？
 
    答：為防范道德風險，保險法第三十一條要求，投保人為他人訂立人身保險合同必須具有保險利益；第三十四條規定，投保人為他人訂立死亡險，需要經過被保險人同意并認可保險金額。以上規定目的在于為防止他人圖謀保險金傷害甚至殺害被保險人，關系社會公共利益，直接影響合同效力。根據民事訴訟的基本原理，對于此類影響合同效力、關系社會公共利益的事項，法院在審理案件時應主動審查。為此，《解釋三》第三條要求各級人民法院審理人身保險合同糾紛案件時，主動審查投保人訂立保險合同時是否具有保險利益，以及以死亡為給付保險金條件的合同是否經過被保險人同意并認可保險金額，目的在于強化各級人民法院防范道德風險的意識，以更好地保護被保險人。
 
    對于以死亡為給付保險金條件的合同，保險法第三十四條規定，未經被保險人同意并認可保險金額，合同無效。實踐中，有保險人為展業需要，在訂立合同時不主動審查死亡險是否經過被保險人同意，甚至明知死亡險未經被保險人同意仍然承保，收取保險費，但在保險事故發生后，卻以該合同未經被保險人同意為由主張合同無效，拒絕給付保險。該規定成為個別保險人規避責任的工具之一，引發了不少糾紛。針對該問題，《解釋三》第一條規定，被保險人的同意可以采取書面、口頭或者其他形式作出，并對可以認定被保險人同意的幾種情形進行列舉，引導審理案件的法官正確認定被保險人是否同意，一方面防范可能存在的道德風險，另一方面規制保險人的不誠信拒賠行為。
 
    問：保險法規定，人身保險訂立時，投保人需對被保險人有保險利益，如果保險合同訂立后，投保人喪失保險利益的，應怎么對待？
 
    答：人身保險合同期限較長，投保人與被保險人的關系可能在合同存續期間發生變化，從而使在保險合同訂立時對被保險人有保險利益的投保人喪失了保險利益，此時保險合同效力是否受到影響，實務中存在不同認識。最為典型的情況是，夫妻一方在婚姻關系存續期間為另一方投保人身險，后雙方離婚，此時保險合同效力是否受到影響，存在有效與無效兩種觀點。針對該問題，《解釋三》規定，保險合同的效力不因投保人在合同存續期間喪失保險利益受到影響，理由在于：一是保險法第三十一條第三款僅要求投保人在訂立保險合同時需對被保險人具有保險利益，并沒有要求整個合同存續期間都有保險利益；二是投保人在合同存續期間喪失保險利益，不會增加被保險人的道德風險，不應影響保險合同的效力；三是維護保險合同的效力更符合投保人的真實意愿，有利于鼓勵交易。第四，被保險人保護問題可通過其他制度來解決。
 
    問：人身保險合同的投保人通常都是自然人，需要更加注重保險消費者的保護，《解釋三》如何貫徹這一原則？
 
    答：保護保險消費者，是歷次保險法修訂的基本理念，也是保險法司法解釋起草以及保險合同糾紛案件審理的指導思想。對此，保險法第十七條、第十九條、第三十條均有相應規定，《解釋二》第九條至第十四條、第十七條亦對此做了細化，這些規定同樣適用于人身保險合同。
 
    《解釋三》針對人身保險合同特點，從以下幾個方面加強保險消費者保護：
 
    一是維持合同效力，防止保險人隨意拒賠。人身保險以被保險人的壽命和身體為保險標的，防范道德風險的問題較為突出，人身保險合同立法中一些對保險合同效力有影響的規定在實踐中存在被濫用可能。鑒于此，《解釋三》第一條、第三條、第六條對相關規定進行細化，明確適用標準，盡可能維持保險合同效力，防止保險人以保險合同違法無效為由拒賠。
 

二是(shi)明確(que)保(bao)(bao)(bao)(bao)(bao)(bao)險(xian)(xian)(xian)合同(tong)中止條(tiao)件，保(bao)(bao)(bao)(bao)(bao)(bao)障投(tou)保(bao)(bao)(bao)(bao)(bao)(bao)人(ren)(ren)申(shen)請(qing)(qing)恢復(fu)(fu)效(xiao)力的(de)(de)(de)權利。人(ren)(ren)身保(bao)(bao)(bao)(bao)(bao)(bao)險(xian)(xian)(xian)合同(tong)存(cun)續期(qi)間較長。實(shi)踐中，投(tou)保(bao)(bao)(bao)(bao)(bao)(bao)人(ren)(ren)可能(neng)因各方面原(yuan)因未及時(shi)支(zhi)付(fu)某期(qi)保(bao)(bao)(bao)(bao)(bao)(bao)險(xian)(xian)(xian)費，違反合同(tong)義務，此(ci)時(shi)有保(bao)(bao)(bao)(bao)(bao)(bao)險(xian)(xian)(xian)人(ren)(ren)可能(neng)會要求解(jie)除(chu)合同(tong)，這對已經交納(na)長時(shi)間保(bao)(bao)(bao)(bao)(bao)(bao)險(xian)(xian)(xian)費的(de)(de)(de)投(tou)保(bao)(bao)(bao)(bao)(bao)(bao)人(ren)(ren)而言并非(fei)(fei)有利，因此(ci)，保(bao)(bao)(bao)(bao)(bao)(bao)險(xian)(xian)(xian)法(fa)確(que)立了(le)保(bao)(bao)(bao)(bao)(bao)(bao)險(xian)(xian)(xian)合同(tong)的(de)(de)(de)復(fu)(fu)效(xiao)制度(du)(du)，允許投(tou)保(bao)(bao)(bao)(bao)(bao)(bao)人(ren)(ren)在逾期(qi)支(zhi)付(fu)保(bao)(bao)(bao)(bao)(bao)(bao)險(xian)(xian)(xian)費之后的(de)(de)(de)一定(ding)期(qi)限內(nei)補(bu)交保(bao)(bao)(bao)(bao)(bao)(bao)險(xian)(xian)(xian)費，恢復(fu)(fu)合同(tong)效(xiao)力。但保(bao)(bao)(bao)(bao)(bao)(bao)險(xian)(xian)(xian)法(fa)第三(san)十七條(tiao)關于復(fu)(fu)效(xiao)條(tiao)件的(de)(de)(de)表述為“經保(bao)(bao)(bao)(bao)(bao)(bao)險(xian)(xian)(xian)人(ren)(ren)與(yu)投(tou)保(bao)(bao)(bao)(bao)(bao)(bao)人(ren)(ren)協商并達(da)成協議(yi)”，這意(yi)味(wei)著投(tou)保(bao)(bao)(bao)(bao)(bao)(bao)人(ren)(ren)的(de)(de)(de)申(shen)請(qing)(qing)恢復(fu)(fu)效(xiao)力必須征得保(bao)(bao)(bao)(bao)(bao)(bao)險(xian)(xian)(xian)人(ren)(ren)同(tong)意(yi)，否則不能(neng)復(fu)(fu)效(xiao)，實(shi)際(ji)上(shang)剝奪了(le)投(tou)保(bao)(bao)(bao)(bao)(bao)(bao)人(ren)(ren)申(shen)請(qing)(qing)復(fu)(fu)效(xiao)的(de)(de)(de)權利，不符合保(bao)(bao)(bao)(bao)(bao)(bao)險(xian)(xian)(xian)法(fa)設置復(fu)(fu)效(xiao)制度(du)(du)的(de)(de)(de)目的(de)(de)(de)。針對該(gai)問(wen)題，《解(jie)釋(shi)三(san)》第八條(tiao)規定(ding)，投(tou)保(bao)(bao)(bao)(bao)(bao)(bao)人(ren)(ren)提出恢復(fu)(fu)效(xiao)力申(shen)請(qing)(qing)并同(tong)意(yi)補(bu)交保(bao)(bao)(bao)(bao)(bao)(bao)險(xian)(xian)(xian)費的(de)(de)(de)，保(bao)(bao)(bao)(bao)(bao)(bao)險(xian)(xian)(xian)人(ren)(ren)原(yuan)則上(shang)不得拒(ju)絕恢復(fu)(fu)效(xiao)力，除(chu)非(fei)(fei)被保(bao)(bao)(bao)(bao)(bao)(bao)險(xian)(xian)(xian)人(ren)(ren)的(de)(de)(de)危險(xian)(xian)(xian)程度(du)(du)在中止期(qi)間顯著增加。

三是規范(fan)醫(yi)(yi)(yi)療(liao)(liao)保(bao)(bao)險(xian)(xian)(xian)(xian)(xian)格式條(tiao)(tiao)款(kuan)，解決醫(yi)(yi)(yi)療(liao)(liao)保(bao)(bao)險(xian)(xian)(xian)(xian)(xian)中的(de)理賠(pei)(pei)難(nan)。醫(yi)(yi)(yi)療(liao)(liao)保(bao)(bao)險(xian)(xian)(xian)(xian)(xian)格式條(tiao)(tiao)款(kuan)中通常會有定(ding)點(dian)(dian)醫(yi)(yi)(yi)院條(tiao)(tiao)款(kuan)和醫(yi)(yi)(yi)保(bao)(bao)標準條(tiao)(tiao)款(kuan)，要求被(bei)保(bao)(bao)險(xian)(xian)(xian)(xian)(xian)人(ren)在定(ding)點(dian)(dian)醫(yi)(yi)(yi)院就醫(yi)(yi)(yi)，且所支出(chu)醫(yi)(yi)(yi)療(liao)(liao)費用(yong)不得(de)超出(chu)基(ji)本醫(yi)(yi)(yi)療(liao)(liao)保(bao)(bao)險(xian)(xian)(xian)(xian)(xian)范(fan)圍，否則保(bao)(bao)險(xian)(xian)(xian)(xian)(xian)人(ren)可(ke)以拒賠(pei)(pei)。《解釋三》第十九條(tiao)(tiao)、第二十條(tiao)(tiao)基(ji)于對價平衡原理，認(ren)可(ke)以上條(tiao)(tiao)款(kuan)的(de)效力，但同時(shi)規定(ding)：被(bei)保(bao)(bao)險(xian)(xian)(xian)(xian)(xian)人(ren)因(yin)情況(kuang)緊急必須在非(fei)定(ding)點(dian)(dian)醫(yi)(yi)(yi)院就醫(yi)(yi)(yi)的(de)，保(bao)(bao)險(xian)(xian)(xian)(xian)(xian)人(ren)不得(de)拒賠(pei)(pei)；被(bei)保(bao)(bao)險(xian)(xian)(xian)(xian)(xian)人(ren)支出(chu)的(de)醫(yi)(yi)(yi)療(liao)(liao)費用(yong)超過基(ji)本醫(yi)(yi)(yi)療(liao)(liao)保(bao)(bao)險(xian)(xian)(xian)(xian)(xian)范(fan)圍的(de)，保(bao)(bao)險(xian)(xian)(xian)(xian)(xian)人(ren)仍(reng)應參照基(ji)本醫(yi)(yi)(yi)療(liao)(liao)保(bao)(bao)險(xian)(xian)(xian)(xian)(xian)同類醫(yi)(yi)(yi)療(liao)(liao)費用(yong)標準給付保(bao)(bao)險(xian)(xian)(xian)(xian)(xian)金。

四是明(ming)確(que)宣告(gao)死(si)(si)亡(wang)(wang)(wang)屬于死(si)(si)亡(wang)(wang)(wang)險(xian)保(bao)(bao)(bao)險(xian)事(shi)(shi)(shi)故(gu)，解(jie)決死(si)(si)亡(wang)(wang)(wang)險(xian)的理(li)賠爭議。死(si)(si)亡(wang)(wang)(wang)險(xian)以(yi)被(bei)(bei)保(bao)(bao)(bao)險(xian)人死(si)(si)亡(wang)(wang)(wang)為(wei)(wei)保(bao)(bao)(bao)險(xian)事(shi)(shi)(shi)故(gu)。針對實踐中(zhong)宣告(gao)死(si)(si)亡(wang)(wang)(wang)是否屬于死(si)(si)亡(wang)(wang)(wang)險(xian)的保(bao)(bao)(bao)險(xian)事(shi)(shi)(shi)故(gu)的爭議，《解(jie)釋(shi)三》第二(er)十四條第一(yi)款規定(ding)(ding)，被(bei)(bei)保(bao)(bao)(bao)險(xian)人宣告(gao)死(si)(si)亡(wang)(wang)(wang)的時(shi)(shi)間在保(bao)(bao)(bao)險(xian)責(ze)任(ren)期(qi)間內(nei)的，則保(bao)(bao)(bao)險(xian)事(shi)(shi)(shi)故(gu)發生(sheng)(sheng)，保(bao)(bao)(bao)險(xian)公司應(ying)(ying)當按照保(bao)(bao)(bao)險(xian)合(he)同約(yue)定(ding)(ding)給付(fu)保(bao)(bao)(bao)險(xian)金(jin)。針對被(bei)(bei)保(bao)(bao)(bao)險(xian)人下落不明(ming)之日(ri)與宣告(gao)死(si)(si)亡(wang)(wang)(wang)之日(ri)不一(yi)致時(shi)(shi)，應(ying)(ying)以(yi)哪個時(shi)(shi)間點(dian)作(zuo)為(wei)(wei)死(si)(si)亡(wang)(wang)(wang)險(xian)保(bao)(bao)(bao)險(xian)事(shi)(shi)(shi)故(gu)發生(sheng)(sheng)時(shi)(shi)點(dian)的問題，《解(jie)釋(shi)三》第二(er)十四條第二(er)款規定(ding)(ding)，被(bei)(bei)保(bao)(bao)(bao)險(xian)人宣告(gao)死(si)(si)亡(wang)(wang)(wang)時(shi)(shi)間雖不在保(bao)(bao)(bao)險(xian)責(ze)任(ren)期(qi)間之內(nei)，但如有證據證明(ming)其下落不明(ming)之日(ri)在保(bao)(bao)(bao)險(xian)責(ze)任(ren)期(qi)間之內(nei)的，保(bao)(bao)(bao)險(xian)人應(ying)(ying)當按照保(bao)(bao)(bao)險(xian)合(he)同約(yue)定(ding)(ding)給付(fu)保(bao)(bao)(bao)險(xian)金(jin)。

五是規范故(gu)意(yi)(yi)犯(fan)罪(zui)條(tiao)(tiao)款，防(fang)止保(bao)(bao)(bao)險(xian)人(ren)不當(dang)拒(ju)賠。保(bao)(bao)(bao)險(xian)法第(di)四十(shi)五條(tiao)(tiao)規定，因被保(bao)(bao)(bao)險(xian)人(ren)故(gu)意(yi)(yi)犯(fan)罪(zui)或(huo)者(zhe)抗(kang)拒(ju)依(yi)法采取的(de)刑事強(qiang)制(zhi)措施導致其傷殘或(huo)者(zhe)死亡的(de)，保(bao)(bao)(bao)險(xian)人(ren)不承擔給付保(bao)(bao)(bao)險(xian)金的(de)責任。實踐中，保(bao)(bao)(bao)險(xian)公司(si)存在不當(dang)擴大適(shi)用該條(tiao)(tiao)款的(de)趨勢，只要(yao)被保(bao)(bao)(bao)險(xian)人(ren)存在犯(fan)罪(zui)行為(wei)，則無(wu)論該犯(fan)罪(zui)行為(wei)與(yu)保(bao)(bao)(bao)險(xian)事故(gu)發生有(you)沒有(you)關(guan)系(xi)，均根(gen)據該規定拒(ju)賠。鑒(jian)于(yu)此，《解釋三(san)》第(di)二十(shi)三(san)條(tiao)(tiao)限制(zhi)故(gu)意(yi)(yi)犯(fan)罪(zui)條(tiao)(tiao)款的(de)適(shi)用，要(yao)求被保(bao)(bao)(bao)險(xian)人(ren)故(gu)意(yi)(yi)犯(fan)罪(zui)或(huo)者(zhe)抗(kang)拒(ju)依(yi)法采取的(de)刑事強(qiang)制(zhi)措施與(yu)保(bao)(bao)(bao)險(xian)事故(gu)發生存在因果關(guan)系(xi)，保(bao)(bao)(bao)險(xian)人(ren)才可以(yi)拒(ju)賠，防(fang)止保(bao)(bao)(bao)險(xian)人(ren)不當(dang)拒(ju)賠。

問：人壽保(bao)險產(chan)品，尤其是投資(zi)性保(bao)險產(chan)品，通常存在保(bao)險單現金價值(zhi)(zhi)，實(shi)踐中(zhong)對于(yu)保(bao)險單現金價值(zhi)(zhi)歸誰所有存在諸多爭議，《解釋三》如(ru)何看待？

答：保(bao)(bao)(bao)(bao)(bao)(bao)(bao)(bao)(bao)單(dan)(dan)(dan)現(xian)(xian)(xian)(xian)(xian)金(jin)(jin)價(jia)(jia)值(zhi)(zhi)，是(shi)(shi)(shi)指帶有(you)(you)(you)(you)儲(chu)蓄性(xing)質的(de)(de)(de)(de)(de)人(ren)(ren)(ren)身保(bao)(bao)(bao)(bao)(bao)(bao)(bao)(bao)(bao)險(xian)(xian)(xian)(xian)單(dan)(dan)(dan)所具(ju)有(you)(you)(you)(you)的(de)(de)(de)(de)(de)價(jia)(jia)值(zhi)(zhi)。從(cong)保(bao)(bao)(bao)(bao)(bao)(bao)(bao)(bao)(bao)險(xian)(xian)(xian)(xian)原(yuan)理(li)來(lai)看，保(bao)(bao)(bao)(bao)(bao)(bao)(bao)(bao)(bao)單(dan)(dan)(dan)現(xian)(xian)(xian)(xian)(xian)金(jin)(jin)價(jia)(jia)值(zhi)(zhi)是(shi)(shi)(shi)投(tou)(tou)保(bao)(bao)(bao)(bao)(bao)(bao)(bao)(bao)(bao)人(ren)(ren)(ren)在保(bao)(bao)(bao)(bao)(bao)(bao)(bao)(bao)(bao)險(xian)(xian)(xian)(xian)期間早期支付(fu)的(de)(de)(de)(de)(de)超過自然(ran)保(bao)(bao)(bao)(bao)(bao)(bao)(bao)(bao)(bao)險(xian)(xian)(xian)(xian)費(fei)部分的(de)(de)(de)(de)(de)金(jin)(jin)額的(de)(de)(de)(de)(de)積累。實踐中(zhong)，投(tou)(tou)保(bao)(bao)(bao)(bao)(bao)(bao)(bao)(bao)(bao)人(ren)(ren)(ren)與(yu)被(bei)(bei)保(bao)(bao)(bao)(bao)(bao)(bao)(bao)(bao)(bao)險(xian)(xian)(xian)(xian)人(ren)(ren)(ren)不(bu)(bu)一(yi)致時(shi)，保(bao)(bao)(bao)(bao)(bao)(bao)(bao)(bao)(bao)單(dan)(dan)(dan)現(xian)(xian)(xian)(xian)(xian)金(jin)(jin)價(jia)(jia)值(zhi)(zhi)歸誰(shui)所有(you)(you)(you)(you)存在較大爭(zheng)議，理(li)論界與(yu)實務(wu)界均有(you)(you)(you)(you)觀(guan)點認為被(bei)(bei)保(bao)(bao)(bao)(bao)(bao)(bao)(bao)(bao)(bao)險(xian)(xian)(xian)(xian)人(ren)(ren)(ren)有(you)(you)(you)(you)權(quan)(quan)領取(qu)保(bao)(bao)(bao)(bao)(bao)(bao)(bao)(bao)(bao)單(dan)(dan)(dan)的(de)(de)(de)(de)(de)現(xian)(xian)(xian)(xian)(xian)金(jin)(jin)價(jia)(jia)值(zhi)(zhi)，甚至有(you)(you)(you)(you)觀(guan)點認為受(shou)益(yi)人(ren)(ren)(ren)也有(you)(you)(you)(you)權(quan)(quan)領取(qu)保(bao)(bao)(bao)(bao)(bao)(bao)(bao)(bao)(bao)單(dan)(dan)(dan)現(xian)(xian)(xian)(xian)(xian)金(jin)(jin)價(jia)(jia)值(zhi)(zhi)。我們認為，該觀(guan)點也不(bu)(bu)符合(he)保(bao)(bao)(bao)(bao)(bao)(bao)(bao)(bao)(bao)單(dan)(dan)(dan)現(xian)(xian)(xian)(xian)(xian)金(jin)(jin)價(jia)(jia)值(zhi)(zhi)產生(sheng)(sheng)原(yuan)理(li)，也與(yu)保(bao)(bao)(bao)(bao)(bao)(bao)(bao)(bao)(bao)險(xian)(xian)(xian)(xian)合(he)同(tong)(tong)(tong)的(de)(de)(de)(de)(de)基(ji)(ji)本原(yuan)理(li)相(xiang)悖(bei)。第一(yi)，保(bao)(bao)(bao)(bao)(bao)(bao)(bao)(bao)(bao)單(dan)(dan)(dan)現(xian)(xian)(xian)(xian)(xian)金(jin)(jin)價(jia)(jia)值(zhi)(zhi)是(shi)(shi)(shi)投(tou)(tou)保(bao)(bao)(bao)(bao)(bao)(bao)(bao)(bao)(bao)人(ren)(ren)(ren)交付(fu)的(de)(de)(de)(de)(de)保(bao)(bao)(bao)(bao)(bao)(bao)(bao)(bao)(bao)險(xian)(xian)(xian)(xian)費(fei)形(xing)成(cheng)的(de)(de)(de)(de)(de)，但(dan)該保(bao)(bao)(bao)(bao)(bao)(bao)(bao)(bao)(bao)險(xian)(xian)(xian)(xian)費(fei)因(yin)超過與(yu)被(bei)(bei)保(bao)(bao)(bao)(bao)(bao)(bao)(bao)(bao)(bao)險(xian)(xian)(xian)(xian)人(ren)(ren)(ren)可能遭受(shou)的(de)(de)(de)(de)(de)風(feng)險(xian)(xian)(xian)(xian)相(xiang)對應的(de)(de)(de)(de)(de)自然(ran)保(bao)(bao)(bao)(bao)(bao)(bao)(bao)(bao)(bao)險(xian)(xian)(xian)(xian)費(fei)，故實際上(shang)是(shi)(shi)(shi)投(tou)(tou)保(bao)(bao)(bao)(bao)(bao)(bao)(bao)(bao)(bao)人(ren)(ren)(ren)的(de)(de)(de)(de)(de)儲(chu)蓄和投(tou)(tou)資，不(bu)(bu)是(shi)(shi)(shi)保(bao)(bao)(bao)(bao)(bao)(bao)(bao)(bao)(bao)險(xian)(xian)(xian)(xian)金(jin)(jin)。第二，人(ren)(ren)(ren)身保(bao)(bao)(bao)(bao)(bao)(bao)(bao)(bao)(bao)險(xian)(xian)(xian)(xian)合(he)同(tong)(tong)(tong)中(zhong)，與(yu)保(bao)(bao)(bao)(bao)(bao)(bao)(bao)(bao)(bao)險(xian)(xian)(xian)(xian)人(ren)(ren)(ren)訂立(li)保(bao)(bao)(bao)(bao)(bao)(bao)(bao)(bao)(bao)險(xian)(xian)(xian)(xian)合(he)同(tong)(tong)(tong)的(de)(de)(de)(de)(de)投(tou)(tou)保(bao)(bao)(bao)(bao)(bao)(bao)(bao)(bao)(bao)人(ren)(ren)(ren)承擔交付(fu)保(bao)(bao)(bao)(bao)(bao)(bao)(bao)(bao)(bao)險(xian)(xian)(xian)(xian)費(fei)的(de)(de)(de)(de)(de)義(yi)務(wu)，是(shi)(shi)(shi)保(bao)(bao)(bao)(bao)(bao)(bao)(bao)(bao)(bao)險(xian)(xian)(xian)(xian)合(he)同(tong)(tong)(tong)的(de)(de)(de)(de)(de)當事(shi)人(ren)(ren)(ren)，享(xiang)(xiang)有(you)(you)(you)(you)基(ji)(ji)于保(bao)(bao)(bao)(bao)(bao)(bao)(bao)(bao)(bao)險(xian)(xian)(xian)(xian)合(he)同(tong)(tong)(tong)產生(sheng)(sheng)的(de)(de)(de)(de)(de)各項權(quan)(quan)利(li)(li)，例如解(jie)除合(he)同(tong)(tong)(tong)權(quan)(quan)利(li)(li)、請(qing)求(qiu)(qiu)保(bao)(bao)(bao)(bao)(bao)(bao)(bao)(bao)(bao)單(dan)(dan)(dan)現(xian)(xian)(xian)(xian)(xian)金(jin)(jin)價(jia)(jia)值(zhi)(zhi)權(quan)(quan)利(li)(li)、保(bao)(bao)(bao)(bao)(bao)(bao)(bao)(bao)(bao)險(xian)(xian)(xian)(xian)費(fei)返還請(qing)求(qiu)(qiu)權(quan)(quan)等。被(bei)(bei)保(bao)(bao)(bao)(bao)(bao)(bao)(bao)(bao)(bao)險(xian)(xian)(xian)(xian)人(ren)(ren)(ren)是(shi)(shi)(shi)保(bao)(bao)(bao)(bao)(bao)(bao)(bao)(bao)(bao)險(xian)(xian)(xian)(xian)合(he)同(tong)(tong)(tong)的(de)(de)(de)(de)(de)保(bao)(bao)(bao)(bao)(bao)(bao)(bao)(bao)(bao)障對象，并不(bu)(bu)是(shi)(shi)(shi)保(bao)(bao)(bao)(bao)(bao)(bao)(bao)(bao)(bao)險(xian)(xian)(xian)(xian)合(he)同(tong)(tong)(tong)的(de)(de)(de)(de)(de)當事(shi)人(ren)(ren)(ren)，其權(quan)(quan)利(li)(li)來(lai)源(yuan)于投(tou)(tou)保(bao)(bao)(bao)(bao)(bao)(bao)(bao)(bao)(bao)人(ren)(ren)(ren)與(yu)保(bao)(bao)(bao)(bao)(bao)(bao)(bao)(bao)(bao)險(xian)(xian)(xian)(xian)人(ren)(ren)(ren)之間的(de)(de)(de)(de)(de)約定，在保(bao)(bao)(bao)(bao)(bao)(bao)(bao)(bao)(bao)險(xian)(xian)(xian)(xian)合(he)同(tong)(tong)(tong)沒(mei)有(you)(you)(you)(you)賦予(yu)被(bei)(bei)保(bao)(bao)(bao)(bao)(bao)(bao)(bao)(bao)(bao)險(xian)(xian)(xian)(xian)人(ren)(ren)(ren)取(qu)得保(bao)(bao)(bao)(bao)(bao)(bao)(bao)(bao)(bao)險(xian)(xian)(xian)(xian)合(he)同(tong)(tong)(tong)權(quan)(quan)利(li)(li)的(de)(de)(de)(de)(de)情(qing)況下，被(bei)(bei)保(bao)(bao)(bao)(bao)(bao)(bao)(bao)(bao)(bao)險(xian)(xian)(xian)(xian)人(ren)(ren)(ren)不(bu)(bu)享(xiang)(xiang)有(you)(you)(you)(you)保(bao)(bao)(bao)(bao)(bao)(bao)(bao)(bao)(bao)險(xian)(xian)(xian)(xian)合(he)同(tong)(tong)(tong)的(de)(de)(de)(de)(de)各項權(quan)(quan)利(li)(li)，不(bu)(bu)享(xiang)(xiang)有(you)(you)(you)(you)保(bao)(bao)(bao)(bao)(bao)(bao)(bao)(bao)(bao)單(dan)(dan)(dan)現(xian)(xian)(xian)(xian)(xian)金(jin)(jin)價(jia)(jia)值(zhi)(zhi)請(qing)求(qiu)(qiu)權(quan)(quan)。第三，受(shou)益(yi)人(ren)(ren)(ren)是(shi)(shi)(shi)投(tou)(tou)保(bao)(bao)(bao)(bao)(bao)(bao)(bao)(bao)(bao)人(ren)(ren)(ren)或者被(bei)(bei)保(bao)(bao)(bao)(bao)(bao)(bao)(bao)(bao)(bao)險(xian)(xian)(xian)(xian)人(ren)(ren)(ren)指定的(de)(de)(de)(de)(de)享(xiang)(xiang)有(you)(you)(you)(you)保(bao)(bao)(bao)(bao)(bao)(bao)(bao)(bao)(bao)險(xian)(xian)(xian)(xian)金(jin)(jin)請(qing)求(qiu)(qiu)權(quan)(quan)的(de)(de)(de)(de)(de)主體(ti)。受(shou)益(yi)人(ren)(ren)(ren)不(bu)(bu)是(shi)(shi)(shi)保(bao)(bao)(bao)(bao)(bao)(bao)(bao)(bao)(bao)險(xian)(xian)(xian)(xian)合(he)同(tong)(tong)(tong)的(de)(de)(de)(de)(de)當事(shi)人(ren)(ren)(ren)，而是(shi)(shi)(shi)受(shou)益(yi)第三人(ren)(ren)(ren)。受(shou)益(yi)人(ren)(ren)(ren)在保(bao)(bao)(bao)(bao)(bao)(bao)(bao)(bao)(bao)險(xian)(xian)(xian)(xian)事(shi)故發生(sheng)(sheng)后才取(qu)得保(bao)(bao)(bao)(bao)(bao)(bao)(bao)(bao)(bao)險(xian)(xian)(xian)(xian)金(jin)(jin)請(qing)求(qiu)(qiu)權(quan)(quan)，在保(bao)(bao)(bao)(bao)(bao)(bao)(bao)(bao)(bao)險(xian)(xian)(xian)(xian)事(shi)故發生(sheng)(sheng)前(qian)享(xiang)(xiang)有(you)(you)(you)(you)期待(dai)性(xing)質的(de)(de)(de)(de)(de)受(shou)益(yi)權(quan)(quan)，但(dan)不(bu)(bu)享(xiang)(xiang)有(you)(you)(you)(you)保(bao)(bao)(bao)(bao)(bao)(bao)(bao)(bao)(bao)單(dan)(dan)(dan)現(xian)(xian)(xian)(xian)(xian)金(jin)(jin)價(jia)(jia)值(zhi)(zhi)請(qing)求(qiu)(qiu)權(quan)(quan)。基(ji)(ji)于以上(shang)原(yuan)因(yin)，《解(jie)釋三》第十六條規(gui)定，保(bao)(bao)(bao)(bao)(bao)(bao)(bao)(bao)(bao)單(dan)(dan)(dan)現(xian)(xian)(xian)(xian)(xian)金(jin)(jin)價(jia)(jia)值(zhi)(zhi)屬于投(tou)(tou)保(bao)(bao)(bao)(bao)(bao)(bao)(bao)(bao)(bao)人(ren)(ren)(ren)，投(tou)(tou)保(bao)(bao)(bao)(bao)(bao)(bao)(bao)(bao)(bao)人(ren)(ren)(ren)喪(sang)失權(quan)(quan)利(li)(li)的(de)(de)(de)(de)(de)，由被(bei)(bei)保(bao)(bao)(bao)(bao)(bao)(bao)(bao)(bao)(bao)險(xian)(xian)(xian)(xian)人(ren)(ren)(ren)及其繼承人(ren)(ren)(ren)享(xiang)(xiang)有(you)(you)(you)(you)。

問(wen)：您剛才講(jiang)到，被保(bao)(bao)險(xian)人不是(shi)保(bao)(bao)險(xian)合同(tong)當事人，但(dan)其畢竟(jing)是(shi)保(bao)(bao)險(xian)事故(gu)承(cheng)載的(de)對(dui)象，《解(jie)釋三(san)》對(dui)保(bao)(bao)護(hu)被保(bao)(bao)險(xian)人的(de)合法(fa)利(li)益有(you)無(wu)體現？

答：被保(bao)(bao)險(xian)(xian)(xian)人不(bu)是保(bao)(bao)險(xian)(xian)(xian)合同(tong)的(de)(de)當事人，但(dan)卻是保(bao)(bao)險(xian)(xian)(xian)合同(tong)不(bu)可缺少的(de)(de)主體。作為保(bao)(bao)險(xian)(xian)(xian)事故的(de)(de)承載(zai)對象(xiang)，被保(bao)(bao)險(xian)(xian)(xian)人以自己的(de)(de)壽命和身體作為保(bao)(bao)險(xian)(xian)(xian)合同(tong)的(de)(de)標的(de)(de)，當然應該給予保(bao)(bao)護。《解釋三》從以下(xia)幾個方面強化被保(bao)(bao)險(xian)(xian)(xian)人的(de)(de)保(bao)(bao)護：

一是(shi)被(bei)(bei)(bei)保(bao)(bao)(bao)險(xian)(xian)(xian)(xian)人(ren)(ren)(ren)(ren)(ren)可(ke)以(yi)撤(che)銷其(qi)同(tong)意(yi)(yi)(yi)(yi)他人(ren)(ren)(ren)(ren)(ren)為(wei)其(qi)訂(ding)立(li)死(si)亡險(xian)(xian)(xian)(xian)的意(yi)(yi)(yi)(yi)思表示(shi)。投(tou)保(bao)(bao)(bao)人(ren)(ren)(ren)(ren)(ren)為(wei)被(bei)(bei)(bei)保(bao)(bao)(bao)險(xian)(xian)(xian)(xian)人(ren)(ren)(ren)(ren)(ren)訂(ding)立(li)死(si)亡險(xian)(xian)(xian)(xian)，必須(xu)經過被(bei)(bei)(bei)保(bao)(bao)(bao)險(xian)(xian)(xian)(xian)人(ren)(ren)(ren)(ren)(ren)的同(tong)意(yi)(yi)(yi)(yi)并(bing)認可(ke)保(bao)(bao)(bao)險(xian)(xian)(xian)(xian)金(jin)額。實踐中，被(bei)(bei)(bei)保(bao)(bao)(bao)險(xian)(xian)(xian)(xian)人(ren)(ren)(ren)(ren)(ren)雖在(zai)訂(ding)立(li)保(bao)(bao)(bao)險(xian)(xian)(xian)(xian)合同(tong)時同(tong)意(yi)(yi)(yi)(yi)投(tou)保(bao)(bao)(bao)人(ren)(ren)(ren)(ren)(ren)為(wei)其(qi)訂(ding)立(li)死(si)亡險(xian)(xian)(xian)(xian)，但(dan)合同(tong)存(cun)續期間(jian)，其(qi)與投(tou)保(bao)(bao)(bao)人(ren)(ren)(ren)(ren)(ren)的關系可(ke)能發生(sheng)變化，甚至惡(e)化，被(bei)(bei)(bei)保(bao)(bao)(bao)險(xian)(xian)(xian)(xian)人(ren)(ren)(ren)(ren)(ren)不愿(yuan)意(yi)(yi)(yi)(yi)投(tou)保(bao)(bao)(bao)人(ren)(ren)(ren)(ren)(ren)繼續為(wei)其(qi)投(tou)保(bao)(bao)(bao)死(si)亡險(xian)(xian)(xian)(xian)的，應該(gai)允許被(bei)(bei)(bei)保(bao)(bao)(bao)險(xian)(xian)(xian)(xian)人(ren)(ren)(ren)(ren)(ren)撤(che)銷同(tong)意(yi)(yi)(yi)(yi)的意(yi)(yi)(yi)(yi)思表示(shi)，故《解釋三》第二條借鑒(jian)域外相關規定(ding)，明確被(bei)(bei)(bei)保(bao)(bao)(bao)險(xian)(xian)(xian)(xian)人(ren)(ren)(ren)(ren)(ren)可(ke)以(yi)撤(che)銷之前作出的同(tong)意(yi)(yi)(yi)(yi)的意(yi)(yi)(yi)(yi)思表示(shi)，尊(zun)重(zhong)被(bei)(bei)(bei)保(bao)(bao)(bao)險(xian)(xian)(xian)(xian)人(ren)(ren)(ren)(ren)(ren)的自主決(jue)定(ding)權。

二(er)是(shi)被(bei)保(bao)(bao)(bao)險(xian)人(ren)(ren)(ren)(ren)可(ke)以(yi)代投保(bao)(bao)(bao)人(ren)(ren)(ren)(ren)支付保(bao)(bao)(bao)險(xian)費(fei)。人(ren)(ren)(ren)(ren)身保(bao)(bao)(bao)險(xian)合(he)同的交(jiao)費(fei)義務主體是(shi)投保(bao)(bao)(bao)人(ren)(ren)(ren)(ren)。實踐中，投保(bao)(bao)(bao)人(ren)(ren)(ren)(ren)可(ke)能(neng)因(yin)交(jiao)費(fei)能(neng)力(li)不足(zu)或者與被(bei)保(bao)(bao)(bao)險(xian)人(ren)(ren)(ren)(ren)、受益人(ren)(ren)(ren)(ren)關系惡化(hua)而(er)沒(mei)有繼續交(jiao)納保(bao)(bao)(bao)險(xian)費(fei)，此(ci)時的被(bei)保(bao)(bao)(bao)險(xian)人(ren)(ren)(ren)(ren)可(ke)基(ji)于自身的利益代為交(jiao)付保(bao)(bao)(bao)險(xian)費(fei)，以(yi)維持保(bao)(bao)(bao)險(xian)合(he)同的效力(li)。

三(san)是投保(bao)人指定(ding)或(huo)者變更(geng)受益人必(bi)須(xu)經過被(bei)保(bao)險(xian)人同(tong)(tong)意。根(gen)據保(bao)險(xian)法第三(san)十(shi)九條和(he)第四十(shi)一條的(de)規定(ding)，投保(bao)人可以指定(ding)或(huo)者變更(geng)受益人，但須(xu)經被(bei)保(bao)險(xian)人的(de)同(tong)(tong)意。《解釋三(san)》第九條、第十(shi)條明(ming)確(que)，投保(bao)人指定(ding)或(huo)者變更(geng)受益人未(wei)經被(bei)保(bao)險(xian)人同(tong)(tong)意的(de)，指定(ding)或(huo)者變更(geng)行為不(bu)發生效力。

四是被(bei)保(bao)(bao)(bao)(bao)險人在投保(bao)(bao)(bao)(bao)人解(jie)除(chu)合(he)(he)同(tong)時有介入權。投保(bao)(bao)(bao)(bao)人與(yu)被(bei)保(bao)(bao)(bao)(bao)險人不一(yi)致時，投保(bao)(bao)(bao)(bao)人解(jie)除(chu)保(bao)(bao)(bao)(bao)險合(he)(he)同(tong)無需(xu)經過(guo)被(bei)保(bao)(bao)(bao)(bao)險人同(tong)意，但被(bei)保(bao)(bao)(bao)(bao)險人可以向投保(bao)(bao)(bao)(bao)人支付相(xiang)當于(yu)保(bao)(bao)(bao)(bao)險單(dan)現(xian)金價(jia)值的款(kuan)項來維持合(he)(he)同(tong)效力。

問：受益(yi)人享有人身保(bao)險(xian)(xian)合同的保(bao)險(xian)(xian)金請(qing)求(qiu)權，如何(he)確定受益(yi)人直接影響保(bao)險(xian)(xian)金的歸(gui)屬。實踐中，受益(yi)人的確定存在不少爭議，《解釋三》如何(he)處理？

答(da)：受(shou)(shou)益(yi)人的(de)指定(ding)(ding)實踐中(zhong)(zhong)一般(ban)都是由保(bao)險(xian)格(ge)式條(tiao)款提前擬定(ding)(ding)，由投保(bao)人或者受(shou)(shou)益(yi)人進行(xing)選(xuan)擇。由于保(bao)險(xian)格(ge)式條(tiao)款不夠規范(fan)以(yi)及被保(bao)險(xian)人身份關系(xi)的(de)變化，導致審判實踐中(zhong)(zhong)受(shou)(shou)益(yi)人如何確(que)定(ding)(ding)存在爭議(yi)(yi)，《解釋三(san)》第(di)九條(tiao)針(zhen)對(dui)實踐中(zhong)(zhong)容易產生(sheng)爭議(yi)(yi)的(de)幾種情形進行(xing)規定(ding)(ding)。

1.受(shou)益(yi)人(ren)約(yue)定(ding)(ding)(ding)為(wei)“法(fa)定(ding)(ding)(ding)”或者“法(fa)定(ding)(ding)(ding)繼承(cheng)(cheng)人(ren)”的(de)(de)，實(shi)務中(zhong)存在未指定(ding)(ding)(ding)受(shou)益(yi)人(ren)以(yi)及以(yi)法(fa)定(ding)(ding)(ding)繼承(cheng)(cheng)人(ren)為(wei)受(shou)益(yi)人(ren)兩(liang)種(zhong)觀(guan)點(dian)，鑒于這兩(liang)種(zhong)情形均可根(gen)據繼承(cheng)(cheng)法(fa)關于法(fa)定(ding)(ding)(ding)繼承(cheng)(cheng)人(ren)的(de)(de)規定(ding)(ding)(ding)予以(yi)確定(ding)(ding)(ding)，我們(men)認(ren)為(wei)應以(yi)繼承(cheng)(cheng)法(fa)規定(ding)(ding)(ding)的(de)(de)法(fa)定(ding)(ding)(ding)繼承(cheng)(cheng)人(ren)為(wei)受(shou)益(yi)人(ren)。

2.受益(yi)(yi)(yi)人(ren)(ren)(ren)(ren)(ren)僅約(yue)定為(wei)(wei)身(shen)(shen)份(fen)關系(xi)，但(dan)保(bao)(bao)(bao)(bao)險(xian)(xian)(xian)(xian)事(shi)故(gu)(gu)(gu)發生(sheng)(sheng)時(shi)(shi)身(shen)(shen)份(fen)關系(xi)發生(sheng)(sheng)變化，應(ying)以保(bao)(bao)(bao)(bao)險(xian)(xian)(xian)(xian)合(he)同(tong)(tong)成立(li)時(shi)(shi)的(de)(de)(de)身(shen)(shen)份(fen)關系(xi)還是保(bao)(bao)(bao)(bao)險(xian)(xian)(xian)(xian)事(shi)故(gu)(gu)(gu)發生(sheng)(sheng)時(shi)(shi)的(de)(de)(de)身(shen)(shen)份(fen)關系(xi)來判(pan)斷(duan)受益(yi)(yi)(yi)人(ren)(ren)(ren)(ren)(ren)？例如(ru)，保(bao)(bao)(bao)(bao)險(xian)(xian)(xian)(xian)合(he)同(tong)(tong)約(yue)定的(de)(de)(de)受益(yi)(yi)(yi)人(ren)(ren)(ren)(ren)(ren)為(wei)(wei)“配(pei)偶(ou)”的(de)(de)(de)，被(bei)(bei)(bei)保(bao)(bao)(bao)(bao)險(xian)(xian)(xian)(xian)人(ren)(ren)(ren)(ren)(ren)如(ru)在保(bao)(bao)(bao)(bao)險(xian)(xian)(xian)(xian)合(he)同(tong)(tong)存續期間離婚并(bing)再婚，導致保(bao)(bao)(bao)(bao)險(xian)(xian)(xian)(xian)合(he)同(tong)(tong)成立(li)時(shi)(shi)的(de)(de)(de)配(pei)偶(ou)與(yu)(yu)(yu)保(bao)(bao)(bao)(bao)險(xian)(xian)(xian)(xian)事(shi)故(gu)(gu)(gu)發生(sheng)(sheng)時(shi)(shi)的(de)(de)(de)配(pei)偶(ou)不(bu)一(yi)致，此(ci)時(shi)(shi)應(ying)以成立(li)時(shi)(shi)的(de)(de)(de)配(pei)偶(ou)為(wei)(wei)受益(yi)(yi)(yi)人(ren)(ren)(ren)(ren)(ren)還是事(shi)故(gu)(gu)(gu)發生(sheng)(sheng)時(shi)(shi)的(de)(de)(de)配(pei)偶(ou)為(wei)(wei)受益(yi)(yi)(yi)人(ren)(ren)(ren)(ren)(ren)，容易產生(sheng)(sheng)爭議(yi)。我們根據投(tou)保(bao)(bao)(bao)(bao)人(ren)(ren)(ren)(ren)(ren)與(yu)(yu)(yu)被(bei)(bei)(bei)保(bao)(bao)(bao)(bao)險(xian)(xian)(xian)(xian)人(ren)(ren)(ren)(ren)(ren)是否(fou)為(wei)(wei)同(tong)(tong)一(yi)主(zhu)(zhu)體(ti)區別對(dui)待(dai)，以盡可能地符合(he)當(dang)事(shi)人(ren)(ren)(ren)(ren)(ren)的(de)(de)(de)真(zhen)實意思：投(tou)保(bao)(bao)(bao)(bao)人(ren)(ren)(ren)(ren)(ren)與(yu)(yu)(yu)被(bei)(bei)(bei)保(bao)(bao)(bao)(bao)險(xian)(xian)(xian)(xian)人(ren)(ren)(ren)(ren)(ren)為(wei)(wei)同(tong)(tong)一(yi)主(zhu)(zhu)體(ti)時(shi)(shi)，根據保(bao)(bao)(bao)(bao)險(xian)(xian)(xian)(xian)事(shi)故(gu)(gu)(gu)發生(sheng)(sheng)時(shi)(shi)與(yu)(yu)(yu)被(bei)(bei)(bei)保(bao)(bao)(bao)(bao)險(xian)(xian)(xian)(xian)人(ren)(ren)(ren)(ren)(ren)的(de)(de)(de)身(shen)(shen)份(fen)關系(xi)確(que)定受益(yi)(yi)(yi)人(ren)(ren)(ren)(ren)(ren)；投(tou)保(bao)(bao)(bao)(bao)人(ren)(ren)(ren)(ren)(ren)與(yu)(yu)(yu)被(bei)(bei)(bei)保(bao)(bao)(bao)(bao)險(xian)(xian)(xian)(xian)人(ren)(ren)(ren)(ren)(ren)為(wei)(wei)不(bu)同(tong)(tong)主(zhu)(zhu)體(ti)時(shi)(shi)，根據保(bao)(bao)(bao)(bao)險(xian)(xian)(xian)(xian)合(he)同(tong)(tong)成立(li)時(shi)(shi)與(yu)(yu)(yu)被(bei)(bei)(bei)保(bao)(bao)(bao)(bao)險(xian)(xian)(xian)(xian)人(ren)(ren)(ren)(ren)(ren)的(de)(de)(de)身(shen)(shen)份(fen)關系(xi)確(que)定受益(yi)(yi)(yi)人(ren)(ren)(ren)(ren)(ren)。

3.受(shou)(shou)(shou)(shou)益(yi)(yi)人(ren)(ren)的(de)(de)(de)約定(ding)(ding)(ding)(ding)包括(kuo)姓(xing)(xing)名和身(shen)份(fen)關(guan)系，保(bao)(bao)(bao)險(xian)(xian)(xian)(xian)(xian)事故發(fa)生時(shi)身(shen)份(fen)關(guan)系發(fa)生變化的(de)(de)(de)，應(ying)以(yi)保(bao)(bao)(bao)險(xian)(xian)(xian)(xian)(xian)合(he)(he)同(tong)(tong)(tong)約定(ding)(ding)(ding)(ding)的(de)(de)(de)姓(xing)(xing)名還是(shi)以(yi)保(bao)(bao)(bao)險(xian)(xian)(xian)(xian)(xian)事故發(fa)生時(shi)符合(he)(he)身(shen)份(fen)關(guan)系的(de)(de)(de)人(ren)(ren)作為受(shou)(shou)(shou)(shou)益(yi)(yi)人(ren)(ren)？例如(ru)，張(zhang)三以(yi)自己為被保(bao)(bao)(bao)險(xian)(xian)(xian)(xian)(xian)人(ren)(ren)投保(bao)(bao)(bao)，約定(ding)(ding)(ding)(ding)受(shou)(shou)(shou)(shou)益(yi)(yi)人(ren)(ren)為配偶李四(si)，后張(zhang)三與李四(si)離婚(hun)后再婚(hun)，配偶為王(wang)五，此(ci)時(shi)應(ying)以(yi)李四(si)還是(shi)王(wang)五為受(shou)(shou)(shou)(shou)益(yi)(yi)人(ren)(ren)。我們(men)認(ren)為，保(bao)(bao)(bao)險(xian)(xian)(xian)(xian)(xian)合(he)(he)同(tong)(tong)(tong)所約定(ding)(ding)(ding)(ding)的(de)(de)(de)身(shen)份(fen)與姓(xing)(xing)名一(yi)致是(shi)確(que)定(ding)(ding)(ding)(ding)受(shou)(shou)(shou)(shou)益(yi)(yi)人(ren)(ren)的(de)(de)(de)條件，但保(bao)(bao)(bao)險(xian)(xian)(xian)(xian)(xian)事故發(fa)生時(shi)，保(bao)(bao)(bao)險(xian)(xian)(xian)(xian)(xian)合(he)(he)同(tong)(tong)(tong)所約定(ding)(ding)(ding)(ding)的(de)(de)(de)身(shen)份(fen)關(guan)系與約定(ding)(ding)(ding)(ding)的(de)(de)(de)姓(xing)(xing)名已不(bu)一(yi)致，故應(ying)認(ren)為保(bao)(bao)(bao)險(xian)(xian)(xian)(xian)(xian)合(he)(he)同(tong)(tong)(tong)約定(ding)(ding)(ding)(ding)的(de)(de)(de)受(shou)(shou)(shou)(shou)益(yi)(yi)人(ren)(ren)不(bu)明確(que)，未指(zhi)定(ding)(ding)(ding)(ding)受(shou)(shou)(shou)(shou)益(yi)(yi)人(ren)(ren)。

問(wen)：實踐中(zhong)不(bu)少爭議(yi)的(de)發生(sheng)并(bing)不(bu)是(shi)保險(xian)(xian)(xian)人不(bu)愿給(gei)(gei)付(fu)保險(xian)(xian)(xian)金(jin)，而是(shi)因保險(xian)(xian)(xian)金(jin)給(gei)(gei)付(fu)規則(ze)不(bu)清晰，保險(xian)(xian)(xian)人不(bu)敢給(gei)(gei)付(fu)保險(xian)(xian)(xian)金(jin)造成的(de)，《解(jie)釋(shi)三(san)》如何解(jie)決該問(wen)題(ti)？

答：你說的(de)確(que)實(shi)是(shi)當(dang)前(qian)保(bao)險(xian)(xian)人遇到的(de)一個突出(chu)問(wen)題。實(shi)踐中，大部分保(bao)險(xian)(xian)人還是(shi)較為誠信，在被(bei)保(bao)險(xian)(xian)人發生保(bao)險(xian)(xian)事(shi)故(gu)后，通常愿意按照保(bao)險(xian)(xian)合同約定給(gei)付(fu)(fu)保(bao)險(xian)(xian)金，但因客觀情況的(de)變化導致合同約定的(de)保(bao)險(xian)(xian)金給(gei)付(fu)(fu)對象(xiang)不清晰(xi)，其不敢(gan)支付(fu)(fu)保(bao)險(xian)(xian)金，這是(shi)造成當(dang)前(qian)社會關注的(de)理賠難問(wen)題的(de)原因之一，不符合保(bao)險(xian)(xian)消(xiao)費者的(de)利益，也損(sun)害了保(bao)險(xian)(xian)行業的(de)形象(xiang)。鑒于(yu)此，《解(jie)釋三》從以(yi)下幾個方面明確(que)保(bao)險(xian)(xian)金給(gei)付(fu)(fu)規(gui)則：

一是明確共同(tong)受(shou)(shou)(shou)益(yi)(yi)(yi)(yi)人(ren)的受(shou)(shou)(shou)益(yi)(yi)(yi)(yi)權(quan)的分(fen)(fen)(fen)配。投保人(ren)或被保險(xian)人(ren)可以指(zhi)定(ding)(ding)數人(ren)為受(shou)(shou)(shou)益(yi)(yi)(yi)(yi)人(ren)。實踐中，有(you)(you)(you)(you)部分(fen)(fen)(fen)受(shou)(shou)(shou)益(yi)(yi)(yi)(yi)人(ren)在保險(xian)事(shi)故發生(sheng)前死亡、放(fang)棄受(shou)(shou)(shou)益(yi)(yi)(yi)(yi)權(quan)或者依(yi)法喪失受(shou)(shou)(shou)益(yi)(yi)(yi)(yi)權(quan)的，該(gai)受(shou)(shou)(shou)益(yi)(yi)(yi)(yi)人(ren)應得(de)的受(shou)(shou)(shou)益(yi)(yi)(yi)(yi)份額(e)由(you)誰享(xiang)(xiang)有(you)(you)(you)(you)存(cun)在爭議。針(zhen)對該(gai)問題，《解釋三》第(di)十二(er)條(tiao)區分(fen)(fen)(fen)幾(ji)種情況分(fen)(fen)(fen)別進行規(gui)定(ding)(ding)：未約(yue)定(ding)(ding)受(shou)(shou)(shou)益(yi)(yi)(yi)(yi)順(shun)(shun)序(xu)(xu)(xu)和受(shou)(shou)(shou)益(yi)(yi)(yi)(yi)份額(e)的，由(you)其(qi)(qi)他(ta)(ta)(ta)受(shou)(shou)(shou)益(yi)(yi)(yi)(yi)人(ren)平均(jun)享(xiang)(xiang)有(you)(you)(you)(you)；未約(yue)定(ding)(ding)受(shou)(shou)(shou)益(yi)(yi)(yi)(yi)順(shun)(shun)序(xu)(xu)(xu)但約(yue)定(ding)(ding)受(shou)(shou)(shou)益(yi)(yi)(yi)(yi)份額(e)的，由(you)其(qi)(qi)他(ta)(ta)(ta)受(shou)(shou)(shou)益(yi)(yi)(yi)(yi)人(ren)按照相(xiang)應比(bi)例享(xiang)(xiang)有(you)(you)(you)(you)；約(yue)定(ding)(ding)受(shou)(shou)(shou)益(yi)(yi)(yi)(yi)順(shun)(shun)序(xu)(xu)(xu)但未約(yue)定(ding)(ding)受(shou)(shou)(shou)益(yi)(yi)(yi)(yi)份額(e)的，由(you)同(tong)順(shun)(shun)序(xu)(xu)(xu)的其(qi)(qi)他(ta)(ta)(ta)受(shou)(shou)(shou)益(yi)(yi)(yi)(yi)人(ren)平均(jun)享(xiang)(xiang)有(you)(you)(you)(you)，同(tong)一順(shun)(shun)序(xu)(xu)(xu)沒(mei)有(you)(you)(you)(you)其(qi)(qi)他(ta)(ta)(ta)受(shou)(shou)(shou)益(yi)(yi)(yi)(yi)人(ren)的，由(you)后(hou)一順(shun)(shun)序(xu)(xu)(xu)的受(shou)(shou)(shou)益(yi)(yi)(yi)(yi)人(ren)平均(jun)享(xiang)(xiang)有(you)(you)(you)(you)；約(yue)定(ding)(ding)受(shou)(shou)(shou)益(yi)(yi)(yi)(yi)順(shun)(shun)序(xu)(xu)(xu)和受(shou)(shou)(shou)益(yi)(yi)(yi)(yi)份額(e)的，由(you)同(tong)順(shun)(shun)序(xu)(xu)(xu)的其(qi)(qi)他(ta)(ta)(ta)受(shou)(shou)(shou)益(yi)(yi)(yi)(yi)人(ren)按照相(xiang)應比(bi)例享(xiang)(xiang)有(you)(you)(you)(you)，同(tong)一順(shun)(shun)序(xu)(xu)(xu)沒(mei)有(you)(you)(you)(you)其(qi)(qi)他(ta)(ta)(ta)受(shou)(shou)(shou)益(yi)(yi)(yi)(yi)人(ren)的，由(you)后(hou)一順(shun)(shun)序(xu)(xu)(xu)的受(shou)(shou)(shou)益(yi)(yi)(yi)(yi)人(ren)按照相(xiang)應比(bi)例享(xiang)(xiang)有(you)(you)(you)(you)。通(tong)過該(gai)規(gui)定(ding)(ding)，明確受(shou)(shou)(shou)益(yi)(yi)(yi)(yi)權(quan)的分(fen)(fen)(fen)配規(gui)則，消除保險(xian)人(ren)支(zhi)付保險(xian)金時的顧慮。

二是明確作為被(bei)(bei)(bei)(bei)保(bao)(bao)(bao)險(xian)(xian)(xian)(xian)(xian)(xian)人(ren)(ren)(ren)(ren)(ren)(ren)遺產的(de)保(bao)(bao)(bao)險(xian)(xian)(xian)(xian)(xian)(xian)金(jin)(jin)的(de)支付(fu)(fu)規則。保(bao)(bao)(bao)險(xian)(xian)(xian)(xian)(xian)(xian)法(fa)第(di)四(si)十二條(tiao)(tiao)規定，被(bei)(bei)(bei)(bei)保(bao)(bao)(bao)險(xian)(xian)(xian)(xian)(xian)(xian)人(ren)(ren)(ren)(ren)(ren)(ren)死亡時(shi)沒有受(shou)(shou)益(yi)人(ren)(ren)(ren)(ren)(ren)(ren)或(huo)者受(shou)(shou)益(yi)人(ren)(ren)(ren)(ren)(ren)(ren)放棄、喪失(shi)(shi)受(shou)(shou)益(yi)權的(de)，保(bao)(bao)(bao)險(xian)(xian)(xian)(xian)(xian)(xian)金(jin)(jin)作為被(bei)(bei)(bei)(bei)保(bao)(bao)(bao)險(xian)(xian)(xian)(xian)(xian)(xian)人(ren)(ren)(ren)(ren)(ren)(ren)的(de)遺產，由被(bei)(bei)(bei)(bei)保(bao)(bao)(bao)險(xian)(xian)(xian)(xian)(xian)(xian)人(ren)(ren)(ren)(ren)(ren)(ren)的(de)繼(ji)(ji)(ji)(ji)承(cheng)(cheng)(cheng)人(ren)(ren)(ren)(ren)(ren)(ren)享有。現實生活中，被(bei)(bei)(bei)(bei)保(bao)(bao)(bao)險(xian)(xian)(xian)(xian)(xian)(xian)人(ren)(ren)(ren)(ren)(ren)(ren)的(de)繼(ji)(ji)(ji)(ji)承(cheng)(cheng)(cheng)人(ren)(ren)(ren)(ren)(ren)(ren)可(ke)(ke)能(neng)是多(duo)人(ren)(ren)(ren)(ren)(ren)(ren)，如僅(jin)其中一個繼(ji)(ji)(ji)(ji)承(cheng)(cheng)(cheng)人(ren)(ren)(ren)(ren)(ren)(ren)持有保(bao)(bao)(bao)險(xian)(xian)(xian)(xian)(xian)(xian)單(dan)向(xiang)保(bao)(bao)(bao)險(xian)(xian)(xian)(xian)(xian)(xian)人(ren)(ren)(ren)(ren)(ren)(ren)申請理(li)賠，保(bao)(bao)(bao)險(xian)(xian)(xian)(xian)(xian)(xian)人(ren)(ren)(ren)(ren)(ren)(ren)可(ke)(ke)否直接向(xiang)該繼(ji)(ji)(ji)(ji)承(cheng)(cheng)(cheng)人(ren)(ren)(ren)(ren)(ren)(ren)給(gei)(gei)付(fu)(fu)保(bao)(bao)(bao)險(xian)(xian)(xian)(xian)(xian)(xian)金(jin)(jin)？保(bao)(bao)(bao)險(xian)(xian)(xian)(xian)(xian)(xian)人(ren)(ren)(ren)(ren)(ren)(ren)在(zai)實踐中通常擔心給(gei)(gei)付(fu)(fu)錯誤(wu)而造(zao)成損失(shi)(shi)，故在(zai)無法(fa)確認(ren)被(bei)(bei)(bei)(bei)保(bao)(bao)(bao)險(xian)(xian)(xian)(xian)(xian)(xian)人(ren)(ren)(ren)(ren)(ren)(ren)究竟(jing)有多(duo)少繼(ji)(ji)(ji)(ji)承(cheng)(cheng)(cheng)人(ren)(ren)(ren)(ren)(ren)(ren)時(shi)，拒絕給(gei)(gei)付(fu)(fu)保(bao)(bao)(bao)險(xian)(xian)(xian)(xian)(xian)(xian)金(jin)(jin)，導致被(bei)(bei)(bei)(bei)保(bao)(bao)(bao)險(xian)(xian)(xian)(xian)(xian)(xian)人(ren)(ren)(ren)(ren)(ren)(ren)的(de)繼(ji)(ji)(ji)(ji)承(cheng)(cheng)(cheng)人(ren)(ren)(ren)(ren)(ren)(ren)只能(neng)通過訴訟主張權利。鑒(jian)于(yu)此，《解釋(shi)三》第(di)十四(si)條(tiao)(tiao)規定，保(bao)(bao)(bao)險(xian)(xian)(xian)(xian)(xian)(xian)人(ren)(ren)(ren)(ren)(ren)(ren)可(ke)(ke)向(xiang)持有保(bao)(bao)(bao)單(dan)的(de)被(bei)(bei)(bei)(bei)保(bao)(bao)(bao)險(xian)(xian)(xian)(xian)(xian)(xian)人(ren)(ren)(ren)(ren)(ren)(ren)的(de)繼(ji)(ji)(ji)(ji)承(cheng)(cheng)(cheng)人(ren)(ren)(ren)(ren)(ren)(ren)給(gei)(gei)付(fu)(fu)保(bao)(bao)(bao)險(xian)(xian)(xian)(xian)(xian)(xian)金(jin)(jin)即可(ke)(ke)，提高保(bao)(bao)(bao)險(xian)(xian)(xian)(xian)(xian)(xian)金(jin)(jin)給(gei)(gei)付(fu)(fu)效率。理(li)由在(zai)于(yu)：被(bei)(bei)(bei)(bei)保(bao)(bao)(bao)險(xian)(xian)(xian)(xian)(xian)(xian)人(ren)(ren)(ren)(ren)(ren)(ren)繼(ji)(ji)(ji)(ji)承(cheng)(cheng)(cheng)人(ren)(ren)(ren)(ren)(ren)(ren)之間的(de)關(guan)系屬于(yu)繼(ji)(ji)(ji)(ji)承(cheng)(cheng)(cheng)法(fa)上的(de)問題，不(bu)屬于(yu)保(bao)(bao)(bao)險(xian)(xian)(xian)(xian)(xian)(xian)合同法(fa)律關(guan)系的(de)內容，其他繼(ji)(ji)(ji)(ji)承(cheng)(cheng)(cheng)人(ren)(ren)(ren)(ren)(ren)(ren)與(yu)取(qu)得(de)保(bao)(bao)(bao)險(xian)(xian)(xian)(xian)(xian)(xian)金(jin)(jin)繼(ji)(ji)(ji)(ji)承(cheng)(cheng)(cheng)人(ren)(ren)(ren)(ren)(ren)(ren)的(de)爭議應根據繼(ji)(ji)(ji)(ji)承(cheng)(cheng)(cheng)法(fa)相關(guan)規定處理(li)。

三是明(ming)確受益(yi)人(ren)(ren)(ren)(ren)與(yu)被保(bao)(bao)險(xian)(xian)(xian)人(ren)(ren)(ren)(ren)在同(tong)一事件中(zhong)(zhong)死亡的推定(ding)規則(ze)。存在繼(ji)承(cheng)關系的受益(yi)人(ren)(ren)(ren)(ren)與(yu)被保(bao)(bao)險(xian)(xian)(xian)人(ren)(ren)(ren)(ren)在同(tong)一事件中(zhong)(zhong)死亡且(qie)不(bu)能確定(ding)死亡先(xian)后順序(xu)，如何確定(ding)死亡順序(xu)，根(gen)據(ju)保(bao)(bao)險(xian)(xian)(xian)法(fa)第四十(shi)(shi)二條第二款(kuan)規定(ding)與(yu)《關于貫(guan)徹執行〈中(zhong)(zhong)華人(ren)(ren)(ren)(ren)民共(gong)和(he)國繼(ji)承(cheng)法(fa)〉若干(gan)問(wen)題的意見(jian)(jian)》第二條規定(ding)可(ke)能出現不(bu)同(tong)的結論(lun)。針對該問(wen)題，《解釋三》第十(shi)(shi)五條明(ming)確，確定(ding)保(bao)(bao)險(xian)(xian)(xian)金(jin)歸(gui)屬時(shi)應根(gen)據(ju)保(bao)(bao)險(xian)(xian)(xian)法(fa)第四十(shi)(shi)二條第二款(kuan)推定(ding)受益(yi)人(ren)(ren)(ren)(ren)先(xian)死亡，并(bing)根(gen)據(ju)保(bao)(bao)險(xian)(xian)(xian)法(fa)相關規定(ding)來確定(ding)其受益(yi)份(fen)額歸(gui)誰所有；在保(bao)(bao)險(xian)(xian)(xian)金(jin)作為被保(bao)(bao)險(xian)(xian)(xian)人(ren)(ren)(ren)(ren)遺產進(jin)行分配(pei)時(shi)，則(ze)根(gen)據(ju)《繼(ji)承(cheng)法(fa)意見(jian)(jian)》第二條進(jin)行推定(ding)。

問：醫療費用是(shi)否能夠雙倍賠償是(shi)當(dang)前理論界與實務界爭(zheng)議(yi)較大的問題，不知《解釋三》對此有無規定？

答：醫療費(fei)用(yong)(yong)(yong)保(bao)(bao)險(xian)在(zai)理論(lun)上(shang)屬于(yu)(yu)定(ding)(ding)額(e)給(gei)(gei)付保(bao)(bao)險(xian)，適(shi)用(yong)(yong)(yong)損(sun)害(hai)(hai)填(tian)補原則(ze)(ze)(ze)，被保(bao)(bao)險(xian)人或受益(yi)人不(bu)能就醫療費(fei)用(yong)(yong)(yong)獲得雙倍賠償(chang)。但我(wo)國保(bao)(bao)險(xian)法(fa)的(de)立法(fa)體系上(shang)并(bing)不(bu)是(shi)(shi)(shi)采區分定(ding)(ding)額(e)給(gei)(gei)付保(bao)(bao)險(xian)和損(sun)害(hai)(hai)填(tian)補保(bao)(bao)險(xian)的(de)立法(fa)模式，而是(shi)(shi)(shi)區分財產保(bao)(bao)險(xian)與(yu)人身保(bao)(bao)險(xian)，并(bing)分別進行(xing)規定(ding)(ding)，財產保(bao)(bao)險(xian)適(shi)用(yong)(yong)(yong)損(sun)害(hai)(hai)填(tian)補原則(ze)(ze)(ze)，而人身保(bao)(bao)險(xian)不(bu)適(shi)用(yong)(yong)(yong)損(sun)害(hai)(hai)填(tian)補原則(ze)(ze)(ze)，且(qie)人身保(bao)(bao)險(xian)的(de)保(bao)(bao)險(xian)人給(gei)(gei)付保(bao)(bao)險(xian)金后不(bu)享有(you)對(dui)第三人的(de)保(bao)(bao)險(xian)代(dai)位(wei)求償(chang)權(quan)。這種(zhong)立法(fa)模式導致醫療費(fei)用(yong)(yong)(yong)保(bao)(bao)險(xian)在(zai)實踐中(zhong)定(ding)(ding)位(wei)不(bu)清，是(shi)(shi)(shi)否適(shi)用(yong)(yong)(yong)損(sun)害(hai)(hai)填(tian)補原則(ze)(ze)(ze)存在(zai)爭議(yi)。《解(jie)釋三》起草過程(cheng)中(zhong)，曾擬(ni)對(dui)醫療費(fei)用(yong)(yong)(yong)保(bao)(bao)險(xian)相關問題進行(xing)規定(ding)(ding)，但受制于(yu)(yu)理論(lun)界通說與(yu)保(bao)(bao)險(xian)法(fa)第四十(shi)六條之間的(de)矛盾，沒能形成最終條文。

日期：2015-11-27 9:11:05 | 關閉 |  分享到：