医疗保险法律适用问题探究

The Research of Judicial Application of Medical Insurance

医疗保险法律适用问题的根源在于保险商品自由化与保险类型法定的矛盾、对保险类型法定法律效果的认知缺失以及对投保人与保险人信息偏在认知的不足。解决问题的路径有三:第一,医疗保险运营是围绕着医疗危险的转嫁进行的,根据所移转的危险属性,医疗保险具有财产性特征,从法律属性方面消除在医疗保险中适用损害填补原则的理论障碍。第二,对人身保险不适用损害填补原则的理论基础"人身无价"的理念进行调试,寻求人身保险适用损害填补原则的理论支撑。人身无价的理论只能推演出在人身保险中可以提供不受具体金额限制的保险保障,并非在人身保险中不可以将人身定价。第三,在人身保险合同的法律规定中做出医疗保险法律适用的例外规定,为医疗保险适用损害填补原则提供立法层面的支撑。

The crucial problem of the judicial application of medical insurance lies in three aspects. First, the contradiction between the insurance liberalization and the types in insurance law. Second, unawareness of the legal affection of why there are different types of insurance in the insurance legislation. Third, unawareness of the information bias between the policy holder and the insurance company. There are three ways to solve this problem ： first of all, the operation of medical insurance is passed around the medical risk. Due to the risk of property transference, medical insurance has the property characteristics. Thus, the barriers in the application of compensation principle of medical insurance could be swiped off. Second, make adjustment of the theoretical basis of ＂the body is priceless＂ and to seek the theoretical support for the application of the principle in personal injury insurance. Third, make an exception provision of the application to medical insurance from the personal insurance legislation and provide legal support in insurance law for the application of indemnity principle in medical insurance.