《保险研究》20230509-《后民法典时代保险人不当理赔民事责任的重塑》（方乐）

［摘   要］重塑保险人民事责任是治理不当理赔乱象的至关重要一环。其原因不仅在于超额赔偿责任具有充分补偿、足够威慑的内在功效，还在于社会共治框架下的其他手段各自存在规训盲区，而超额赔偿责任是对保险合同两造失衡地位的实质矫正。为实现体系内容的融贯和法律资源的简约，后民法典时代下超额赔偿责任的引入应采用改良后的违约路径：一方面，对保险领域中可预见标准的主体、时点及范围予以调整，将精神损害、可得利益损失、律师费用支出等损失纳入《保险法》第23条的“损失”范围，但允许保险人就损害赔偿责任的成立及多少提出抗辩；另一方面，待《保险法》的新一轮修改，以“故意”和“情节严重”为要件新构惩罚性赔偿条文。其中，“故意”之主观状态可由特定客观情形直接推定,除非保险人能作出相反证明。而“情节严重”的判定需综合考虑实际损害程度、客观损害程度、非正当性程度、市场秩序的受破坏程度等四方面要素。

［关键词］民法典；不当理赔；超额赔偿责任；可预见标准；惩罚性赔偿

［作者简介］方乐，上海大学法学院讲师，法学博士，研究方向：保险法。

Reconstruction of the Civil Liability against the Bad-faith Insurer in the Post Civil Code Era

FANG Le

Abstract：Reshaping the civil liability of the insurer is a crucial part of the governance of improper claims settlement.The reason is not only that the excess compensation liability has the inherent effect of sufficient compensation and sufficient deterrent,but also that other means under the framework of social co-governance have their own blind spots,and the excess compensation liability is the substantial correction of the unbalanced status of the two parties of insurance contract.In order to achieve the integration of the legal system and the simplicity of legal resources,the introduction of excessive compensation liability in the post Civil Code era should choose the modified path of breach of contract.On the one hand,the subject,time and scope of the foreseeable standards in the field of insurance should be adjusted,including the losses such as mental damage,loss of available interests,lawyer′s expenses and others into the "loss" scope of Article 23 of the "Insurance Law",but the insurer is allowed to defend the establishment of the liability for damages.On the other hand,when the "Insurance Law" is amended in the future,the "intentional" and "serious circumstances" should be the prerequisites for the restructuring of the new punitive damages provisions.The subjective state of "intentional" can be directly inferred from specific objective circumstances unless the insurer can prove otherwise.However,the judgment of "serious circumstances" should consider the actual degree of damages,objective degree of damages,unreasonableness and damages to the market order.

Key words：Civil Code；improper claims settlement；excess compensation liability；foreseeable standard；punitive damages