两岸保险法中“意外”构成要件与举证责任分配研究

摘要

对“意外”的认定是意外伤害保险理赔的首要问题。构成“意外”应当具有外来性、突发性和非自愿性等核心要素，此外还有偶然性和非疾病性等参考因素。就“意外”对象而言，应当采用结果说。两岸均将不同构成要件的举证责任分配给双方当事人，并适当地作有利于被保险人的解释。通过对两岸法律以及司法实务进行比较，可以完善“意外”的构成要件及举证责任分配制度，以维护被保险人一方的合法利益。%The definition of accidence is the prior point in the insurance compensation, which should be external, sudden and involuntary as key factors, and probable and non-diseases as reference factors. The accident should refer to the result. In both sides of the strait, that is, in Mainland China and Taiwan, the burden of different proofs is allocated to both parties according to different components and proper interpretations are given in favor of the insurant. Through the comparison of the academic point of view and judicial practice between the two sides of the strait, the need is seen to improve “the accident” determination and the burden distribution system in the Insurance Law in Mainland China in order to protect the benefits of the insurant.