Study On The "Non-medicare Drug Deductible" Clauses

With the continuous development of insurance industry,various new insurance disputes emerge as the times require.The nature and validity of the clause "non-medical insurance drugs do not compensate" has been debated in theory and practice.People's courts deal with such disputes,because of differences of opinion,often lack a unified basis for hearing.The definition of liability of non-medical insurance is helpful to the application of the exemption clause and form clause in the Insurance Law and the Contract Law in the insurance contract,and it can also deepen the understanding of the principle of unity of rights and obligations and the principle of fairness.The first part of the article first introduced the "non-medical insurance non-compensation" clause background,and then from the concept,introduced the connotation and extension of the clause,and made clear the difference and connection between the clause and its similar concept.Then,after comparing the nature of the three types of clauses in the insurance clause with the clause,we make a comprehensive judgment and qualitative analysis according to the different viewpoints of the academic circles,and think that the clause is not an exemption clause,and should be a special "format clause ",which accords with the nature of the general insurance contract clause.The second part puts forward the dilemma of "non-medical insurance drugs do not compensate" clause,through the analysis of the statistical results of traffic accident liability disputes,because of the large proportion of disputes arising from this clause,it is urgent to solve.Then we use three cases to show the phenomenon of different cases in practice,analyze the cases,and summarize the problems in practice,such as the differences in the validity of the provisions,excessive medical treatment,the difficulties in the identification of drugs.And the existing law on the dispute liability is not clear,so there are differences of judicial opinion.Sum up all the problems are the core of the "non-medical insurance drugs do not compensate" the rationality of the determination.The third part is the rationality analysis of "non-medical insurance drugs do not compensate ",first analysis of the nature of vehicle liability insurance,is a regulation class on behalf of the social and public interests of insurance,and empirically demonstrated that this clause fits the insurance risk allocation and loss compensationfunction,reflecting the rights and obligations of the insurer and the insured.Then from the point of view of social public interest,it is beneficial to promote traffic safety,and concludes that the relationship between the interests of the insured and the insurance premium rate is in a dynamic balance,and the reduction of the insurance rate is conducive to the maintenance of the interests of other insured people,thus promoting the stable development of the insurance industry and society.The fourth part is "non-medical insurance drugs do not compensate" dispute resolution countermeasures.First of all,from the legislative point of view,put forward judicial interpretation to aggravate the burden of proof of the insurer,think that the burden of proof should be reasonably distributed,and put forward supplementary suggestions to the law,then from the perspective of the insured described the necessity and rationality of the establishment of additional insurance,and put forward a relatively specific opinion on the conditions of additional insurance set,and finally through the necessity of restraining excessive medical treatment analysis,and put forward the idea of establishing the prevention and control mechanism of excessive medical treatment in hospitals.