禁止反言原则的理性审思与制度重构——兼评《保险法》第16条第6款

Reflection and Reconstruction of Estoppel ——A Review of the Insurance Law Article 16,Paragraph 6

禁止反言原则以公平为核心,是最大诚信原则对保险人的要求,亦是阻断保险人不当抗辩的重要机制。从理论的维度讲,即是要厘清其适用前提,一方面要明晰其构成要件,另一方面要重申其法理基础。禁止反言的构成要件包括外观知晓和合理信赖,而无需强调在先行为的性质及损失。其存在着深刻的法理基础:是对《保险法》下保险合同格式条款规制理念的深度契合和对满足投保方合理期待意识的理性张扬,亦是对保险合同信息不对称下双方风险分配理论的适时回应。从制度设计的维度看,就是要丰富《保险法》第16条第6款的制度内涵:一是要增设复效条款同时明晰适用情形,二是要辅设监控制度从而解决举证难题,三是要将其独立成条从而更好彰显制度价值。

Estoppel is not only the requirement of the principle of utmost good faith to the insurer,but also the important mechanism of blocking the insurer s improper defense.From the perspective of theory,it is necessary to clarify its applicable premise,clarify its constitutive elements on the one hand,and reiterate its jurisprudential basis on the other hand.The constitutive elements of estoppel include apparent knowledge and reasonable trust without emphasizing the nature and loss of prior conduct.It has profound jurisprudence basis:it is the deep fit of the regulation concept of standard terms of insurance contract under the insurance law and the rational publicity of meeting the insured s reasonable expectation consciousness,and it is also the timely response to the risk distribution theory of both parties under the asymmetric information of insurance contract.From the perspective of system design,it is necessary to enrich the system connotation of article 16,paragraph 6,of the insurance law.Firstly,it is necessary to add duplicate clauses and clarify the application situation;second,it is necessary to set up a monitoring system to solve the problem of proof;third,it is necessary to make it independent so as to better demonstrate the system value.