试析保险人明确说明义务的判断标准——以两起相似“重大疾病”争议案相反终审判决为例

On the Standard of Insurer's Obligation of Clear Statement——Final judgment of two similar "major disease" controversial cases as an example

在保险实务中,当发生保险事故时,投保人往往因违反如实告知义务而很难得到理赔。同样,保险人未尽到对保险条款明确说明义务,往往在争议案中陷入被动境地。如何判断保险人善尽了明确说明义务,是实务中的难点。说明方式上,保险人可以针对考虑保险条款的性质与投保人的实际交易能力,对不同条款与不同的投保人采取不同的说明方式。关于说明范围,对不负赔付责任条款、限制责任条款、涉及特定效力的条款,保险人必须清楚说明。保险人的说明程度也须达到具有一般知识与智力水平的普通保险人理解的程度。

The insured is hard to get indemnity as a result of breach of obligations to truthfully inform the insurer when the insured accident occurs in insurance practice.Similarly,the insurer is always in a passive position if it fails to fulfill its obligations to clearly state the clauses.A hard problem in insurance practice is how to fulfill his obligations of clear statement.About the methods of statement,the insurer may consider the nature of the insurance terms and the actual transactions capacity of the insured,take different approaches on the different terms and the insured.On that range,the insurer must be clearly stated as to the none-paid liability provisions,the provisions related to limitation of liability and special validity,the extent that the insurer stated is required to make common insured understand with the degree of general knowledge and intelligence.