| Abstract: | 保險商品為射倖契約、承諾兌現時間長、招攬業務員的專業及職業道德等，造就保險商品或服務無可避免的爭議。筆者服務於公務機關，必須處理民眾保險申訴案件，因此對於我國訴訟外保險爭議制度，以及主管機關以保險業者申訴處理績效為差異化監理指標等，衍生進一步研究的動機，並期藉由此研究，能進一步提供更符合我國國情之訴訟外保險爭議處理建議及差異化監理措施之運作機制。
本研究主係採文獻分析法、比較研究法等，部分章節再輔以專家訪談方式進行。文獻回顧中，除探究我國訴訟外保險爭議處理機制之沿革外，並列舉英國、新加坡及日本等國家之相關制度文獻，以為比較。研究過程中，介紹我國金融消費者保護法立法沿革、訴訟外保險爭議處理制度、金融消費爭議處理機構(財團法人金融消費評議中心，簡稱評議中心)運作情形及其績效，並兼論主管機關以保險公司處理申訴之績效(以評議案件數為基礎所計算之保險業申訴綜合評分值)作為業務上及財務上差異化管理手段之探討，同時分析其優劣。
最後提出相關結論與建議：在爭議處理機構方面，如何再強化其教育宣導功能之廣度與深度、進一步促進保險業者與消費者自主協商和解機制之運作、評議決定援引公平合理原則應再行制度化與規範化，並著手為鉅量資料作準備；主管機關方面，建議先立於消費者保護立場，再行強化監理指標之差異化管理措施，促使業者全面提升對保險爭議處理績效之重視，以期保險市場更行穩定發展。
Attributing to such features as aleatory contract, a long term agreement to fulfill a promise and representing the broker’s major and professional ethics, there are inevitable disputes on insurance products or services. The author works in the government and has to deal with public insurance appeal cases, which motivates him/her to do a study on Alternative Dispute Resolution of Insurance Consumers and how the competent authority takes the performance to resolve appeal cases of the insurer as differentiating management indicators. Based on this study, suggestions to Alternative Dispute Resolution of Insurance Consumers and operation mechanisms of differentiating supervision measures are put forward, which is sure to be much more suitable for the situation of R.O.C.
This study adopts literature review and comparison method, accompanied by expert interview method in some chapters and section. In this literature review, the author not only explores the history of Alternative Dispute Resolution of Insurance Consumers, but also lists literatures of related systems in the UK, Singapore, Japan, etc. During the study, it introduces the history of financial consumer protection legislation, Alternative Dispute Resolution of Insurance Consumers and the operation and performance of financial consumer dispute authority (Financial Ombudsman Institution, hereinafter referred to as the Institution). Moreover, it discusses how the competent authority takes the aforesaid performance to appeal cases of the insurance company as the differentiating management methods on business and finance, and also analyzes the advantages and disadvantages. The above-mentioned performance refers to the comprehensive scores for calculating insurance appeal, based on quantities of reviewed cases.
In the end, this study puts forward the relevant conclusions and suggestions: For the aspect of disputes resolving authority, it proposes ways on how to intensify the breadth and depth of its educating and publicizing functions, to further promote the operation of autonomic negotiation mechanism from insurers and consumers, to carry out the institutionalization and standardization when citing the Fair and Reasonable principles into resolutions, and start to prepare for such big data; For the aspect of the competent authority, this study suggests, out of the position of protecting consumers, to further strengthen the differentiating management measures of supervision indicators in order to encourage the insurer to fully emphasize insurance dispute resolution performance and make more stable development in the insurance market. |
