傷害保險因相對具有低保費、高保障之特色，近年來已成為國人風險移轉工具。政府自民國90年開放產險業銷售傷害險以來，傷害險保費在保險公司營收早已占舉足輕重之地位。伴隨著消費者保護意識高漲與保險商品多元化暨複雜化之影響，傷害保險之理賠糾紛亦與日俱增，類似爭議案件泰半皆透過法院訴訟程序而與保險公司對簿公堂。在眾多之傷害保險理賠紛爭，不僅造成被保險人曠日費時，同時亦不符合消費者迫切需要理賠金來保障其經濟生活安定之期待。 茲為使一般廣大消費者能保障自身權益，同時亦期能降低消費者與保險公司間之糾紛，本研究係以個人傷害保險為研究範圍，對於團體傷害保險部份則暫不列入研究範圍，採個案研究法，透過客觀個案研究分析，釐清保險案情真相，並針對雙方爭議之處，探究主要問題癥結之所在。本研究特蒐集若干具有價值之傷害險理賠案例並彙集逐案探討，盼能藉由此些代表性案例提供給一般消費者建立正確之保險概念，同時更可作為保險人針對傷害保險商品潛在瑕疵作為日後修正之參酌，俾有助於儘速解決雙方保險理賠爭議之所在。 Due to lower premium and higher security, accident insurance has been used to hedge against the risk of a contingent loss. Since Taiwan government approved accident insurance market in 2001, it has played a very important role for insurance company’s revenue. However, the rising of consciousness of protection and variety and complexity of insurance products are increasing insurance disputes. Majority of them has become a lawsuit. The duration of lawsuits delays claim payments. These delays are detrimental to confidence of insurance. For protecting individual insured privileges and decreasing insurance disputes, this thesis is only included individual accident insurance not included group accident insurance. Using objective analysis clears the truth. Also, focus on the arguments and investigate the causes. The thesis is based on several value cases. Collecting and analyzing case by case. The purpose of this research is to provide the individual the correct insurance concept. In the meantime, the research provides insurers information to correct insurance products to settle disputes in a timely manner.
