论两种以上原因造成被保险人死亡案件的处理——兼谈保险法上的近因原则及其适用

On Solution to the Case of Insured Person Death due to more than Two Causes-the Proximate Principle of the Insurance Law and Its Application

对于既有责任免除情形又有保险事故两种以上原因同时发生造成被保险人身故或高残,保险公司是否承担保险责任,是保险理赔的难点,在学术界也存在不同的认识。出现这个问题的原因在于我国《保险法》没有对近因原则作出规定,造成法院和仲裁机构在处理保险合同纠纷时无所适从。本文从一起具体的交通事故案例入手,在界定近因内涵的基础上,分析了民法上因果关系与近因原则的联系与区别,阐述了近因原则的归责机制及具体适用等问题,提出了完善我国保险立法的具体建议,旨在指导保险和司法实践活动。

There is a dilemma between whether an insurer should bear the responsibility or not to the death or serious disability caused by two or more accidents of which one falls into the exemption of insurance policy. Concerning this difficult question, different authors have different opinions. The reason is that Chinese insurance law has no stipulation on principle of proximate cause, which results in the different ways of law application by courts and arbitrators. The paper analyzes the common ground and differences between cause-result relationship in civil law and the principle of proximate cause in insurance law by making clear the interpretation, responsibility attribution rule and application of the principle of proximate cause, based on a concrete traffic accident judicial case study. At the end the paper provides some legislative advices on insurance law with an aim to guide insurance practical and judicial activities.