Study Of Theoretical Issues Of Medical Expenses Insurance Claims Mechanism

China's newly revised"Insurance Law"still insist on the Marxist law that"one divides into two"represented by"property insurance"and"personal insurance".This classification neglects the specificity of health insurance and accident insurance,which is that they have both the nature of fixed sum insurance and indemnity insurance.They constitute a special type of insurance.Especially for the medical expense insurance which is belongs to this type of insurance, although it is a kind of the personal insurance,it has the nature of property insurance,just because it underwrite the specific medical expense. China's insurance law does not see the special nature of such insurance.In the article 2 of"Insurance Law","payment of indemnities"is corresponded to"property losses",and"payment of insurance benefits"is corresponded to"the death,injury,disability or illness of the insured,or conditions such as age and term specified in the contract",which essentially sets up the claim adjustment mechanism of"compensation rules applicated to property insurance and payment rules applicated to personal insurance". For the medical expenses insurance on behalf of such health insurance and accident insurance,whether they are compensatory?whether we should use suborgation and the rules of double insurance?what claim adjustment mechanism should we choose? Academics and practitioners on these issues is quite controversial. Insurers and the insured also hold different views on this problem,which has caused many problems in the judicial practice and the insurance practice.If we don't make these problems clear, it is harmful to the development of China's insurance industry and it is not conducive to the insured, the beneficiary of the protection of legitimate rights and interests, as well as the maintenance of China's judicial seriousness.Besides the preface and conclusion,there are four parts in this paper.The first part tries to define the connotation and extension of"medical expenses insurance",and clarifies the status of the claim adjustment mechanism and the significance of the study of this mechanism above.The second part is about the scope of application of the indemnity principle.The third part mainly talks about the scope of application of double insurance and the subrogation.In the last part, a concept - the "third area" insurance is introduced,which is closely related to the study of medical expenses insurance claims mechanism . The study of the "third area" insurance can help us to make clear the nature,characteristic,and the coverage of health insurance and accident insurance.Finally,a feasible solution for the problems mentioned is given to.