| Abstract: | 傷害保險，於我國保險法第十三條中列為人身保險之範圍，因此長久以來，傷害保險業務係由壽險業經營。惟究其險種性質，以其速決之特性分析及具損害補償之功能類別之中間性險種而言，與一般壽險不同，而反與財產保險較為接近，再加上國外其他國家（如日本、美國），或而允許在產險業經營或隸屬財產保險業務，因此屢經產險業之爭取及學者之建議，於是主管機關經過了兩次保險法之修法，分別於1997年及2001年，對於保險法第138條第一項但書予以修正，產險業得經主管機關核准經營傷害保險，是故財產保險業才得以進入傷害保險市場。近年來，傷害保險市場，由於有財產保險業的加入，財產保險業運用了彈性的產品搭配策略及靈活的行銷通路（例如以團體個人單行銷方式於銀行或相關異業聯盟通路行銷），使得原先長期由壽險業獨占的市場，在市場占有率上起了相當程度的變化。而究其原因，辜且不論財產保險業所採取之團體個人單行銷方式之適當性，最重要的因素是財產保險業所推出的傷害保險費率，遠比原由壽險業銷售之傷害保險費率來得低，傷害保險市場受此低價的衝擊，使得原先不動如山的壽險業，也紛紛檢討並調整傷害保險費率。而傷害保險費率的結構及妥適性也紛紛為業者、學者們所討論。我國傷害保險的費率基礎，長久以來均由主管機關核定，主管機關規範了意外死亡、殘廢發生率之最低標準，以為業界共同遵循。本文主要以A壽險公司實際之損失經驗為例，藉以探討壽險公司實際損失率與法定發生率間之差異，另外探討實際損失經驗與主、附約型態、職業等級、年齡、性別等之關係，以作為各業界釐訂費率時之參考。
The accident insurance lists as scope of the life insurance in the Article 13 of Taiwan Insurance Law, therefore the accident insurance business has been long-time operated by the life insurance industry. However, an insight of its product nature with some sort of pseudo-insurance property, it reveals characteristic of quick decision and the functionality of compensation to damage. It is somewhat different from the life insurance, and it inclines to be the general insurance. Additionally, some of foreign countries (for example Japan, US), either permit it to be operated by the general insurance industry or the under the realm of property insurance; Suggested by the scholar and repeatedly requested by the general insurance industry, the Insurance Bureau had two insurances law revised in 1997 and 2001. Revised the context of the first item of the article 138 of Insurance Law, the general insurance industry can operate the accident insurance business with the Insurance Bureau approval. Therefore the general insurance industry enters the accident insurance market.In recent years, because the general insurance industry joins in accident insurance market, the general insurance industry utilizes its elastic product to match its strategy and nimble marketing channel (for example: with affinity association with group for individual marketing among banks and business alliance partnership with different industries). It causes considerable changes in the market share which originally life insurance industry dominantly monopoly over for a long time. With investigation on the reasons behind this, not to mentioned the suitability of general insurance industry adopts the affinity association for individual marketing; the most important factor is: the accident insurance premium rate of the general insurance industry is far below, compared with the rate of life insurance industry uses. Impacted with the lower price, life insurance industry that originally steady as motionless mountain, examines and adjusts the accident insurance rate accordingly. Now the accident insurance rate structure, appropriateness and adequacy are widely discussed among industry and scholars.Since the accident insurance rate has been long-time formulated and promulgated by the Insurance Bureau, the Insurance Bureau establishes norms and standardizes accidental death and dismemberment minimal standard rate for the industry to use and comply. This paper mainly takes actual loss experience of “A” life insurance company as an example, to exploit the relationship of the deviation between actual loss rate in practice and legitimate incidence rate. Moreover, with the focus on the actual loss experience study, master policy, rider contract condition, the classification of avocation, age and gender relationships, as a reference for price rating to insurance industry. |
