论近因原则在保险理赔中的把握和应用

The application of the proximate cause principle in insurance claim settlement

近因原则是我国保险合同法的基本原则之一,是保险理赔的难点。尤其是对于既有责任免除情形又有保险事故(如地震)两种以上原因同时发生造成保险标的的损害或者被保险人身故或高残,保险公司是否承担保险责任,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,并结合具体的案例,详细阐述了近因原则在保险理赔中的具体把握和应用,在此基础上,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。

The proximate cause principle is one of the fundamental principles in insurance contract laws. But it is also a difficult point in insurance claim settlement, especially when, while there is a exclusion provision in the contract, it comes to determine whether the insurer is liable when damages is incurred on the insurance subject matter or death or disability befalls on the insured person on occurrence of the insured event （ such as earthquake） due to more than two causes. The academic society hasn＇t reached consensus on this issue either. This is mainly due to the fact that the Insurance Law of China doesn＇ t have a provision on this question, which inevitably make the court of law and the arbitrator undecided. The paper analyzed the correlation and difference between the causal relationship and the proximate cause principle in civil laws on the basis of a deliberation on the connotation of the proximate cause principle, It availed itself of specific cases to explain how to apply this principle in claim settlement. It also proposed on amendment to the Insurance Law of China to provide a clearer guidance to insurance practices and legal disputes.