Analysis And Tort Liability System Construction Of Insurer’s Undue Settlement Of Claim

As an important part of the national economy,the insurance industry plays an extremely important role in building a multi-level social security system and social governance.As the social problems of China’s aging population and declining birthrate become more severe,the Chinese government has extremely high expectations and requirements for the healthy development of the insurance industry.However,the criticized "difficulty in claims" problem in the insurance industry has seriously damaged the public’s confidence in insurance products and hindered the development of the insurance industry.Behind the problem of "difficulty in claim settlement",insurers’ improper claims settlement plays a huge role in promoting it.The insurer ’s improper claim settlement not only prevents the insured from receiving insurance benefits in time,but also places the insured in the risk of other indirect losses,even causing mental harm,which is difficult for China ’s current legal system to effectively deal with.Relief.According to the traditional insurance law theory,the insured who has encountered improper claims can only seek relief through the default liability system,but due to the scope of default liability,it cannot fully compensate the insured ’s indirect losses,and it is difficult to effectively form the insurer’s inappropriate claims.Deterrence and then containment.The solution of the insurer’s improper claims is related to the healthy development of the insurance industry and the interests of the society as a whole.For this reason,it is necessary to conduct in-depth research on its characteristics and current status and to explore effective regulatory laws based on this,and to the insurer ’s inappropriate claims.Deterrence and provide effective protection for insurance consumers.Developed countries in the insurance industry have long paid attention to this issue,and actively explored ways to regulate insurers’ improper claims,gradually forming two more perfect improper claims systems.First,the malicious tort system,represented by the United States,deters improper claims by imposing tort liability on malicious claims.Second,the typical breach of contract liability system,represented by Germany,Britain and France,is characterized by the use of punitive interest to expand the degree of relief under the traditional breach of contract liability model.Based on the analysis of the current status of Chinese insurers ’unsuitable claims and the experience of international insurers’ unsuitable claims regulations,the author proposes a method for solving the insurer’s unsuitable claims,that is,to construct an insurer’s unsuitable claims infringement liability system and learn from the malicious tort liability in the United States,To provide the insured with a tort liability relief path,and explore the specific issues of the insurer ’s infringement of improper claims into the Chinese legal system.Based on this,this article starts research on this topic,this article is roughly divided into the following five parts.The first part expounds the insurer’s improper claims from the definition and the form of expression.Regarding improper claims,there is no clear definition in law,so from the perspective of legal basis and factual basis,the author judges by examining whether the insurer ’s claims have both legal and factual legitimacy.For improper claims.On this basis,in order to further understand the characteristics of the insurer’s improper claims in practice,the author conducted a sample analysis of the referee documents on disputes over claims.Through the investigation,it was found that the insurer’s improper claims caused a large number of claims disputes.In terms of its external form,it can be classified as improper rejection,improper reduction and improper delay.The insurer ’s improper claims behavior reflects the insurer ’s indifference to the insured ’s interests and judicial litigation,and he does not hesitate to sacrifice the insured ’s interests in order to maximize his own interests.Through the analysis of litigation results,the author finds that the liability for breach of contract is difficult to provide effective protection for the insured,and exploring an effective relief system is urgent.In addition to this,judging the subjective faults of the insurer and containing them will be an urgent problem that needs to be solved to regulate the insurer’s inappropriate claims.The second part analyzes the reasons for the insurer’s inappropriate claims.First of all,the insurance contract is complex and contains a lot of professional terms and bottom-line clauses.It is difficult for the insured to accurately grasp the content of the contract.However,the insurer is familiar with the content of the contract and has the right to interpret.Secondly,the insurance contract is a collateral contract.In general,the insured cannot negotiate the format terms provided by the insurer,and can only make a decision on whether to agree or not.Under such circumstances,it is difficult to effectively stipulate how insurers perform their claims obligations.In addition,the performance of the insurance contract is sequential and the insurer’s claims obligations are conditional,the insured must first perform the main obligations of the contract,and whether the insurer needs to perform the claims obligations depends on whether the insurance accident occurs within the insurance period This makes it difficult for insurance consumers to effectively restrict the performance of insurers ’contractual obligations.The Insurance Law ’s imperfect agreement on claims settlement also gives insurers more opportunities for improper claims settlement.In addition to the objective reasons mentioned above,conflicts of interest between insurance parties are an important incentive for insurers to take inappropriate claims.The third part examines the insurer’s experience in improper claims regulation in the world.The international insurer’s improper claims system can be roughly divided into the following two models,namely the malicious infringement model and the default liability model.The malicious infringement model created by the United States has broken through the limitation of the traditional liability for breach of contract,carried out special infringement treatment on the issue of improper claims by the insurer,expanded the liability scope of the insurer’s improper claims,and effectively deterred the insurer.The malicious infringement system has become a relatively mature insurer’s improper claims system after long-term practice,which is rooted in the insurance legal systems of the United States and Canada.Most countries still adopt the default liability model,but in order to achieve effective protection of insurance consumers,some countries actively seek breakthroughs under the default liability model.For example,Germany and France expand the scope of insured relief through the flexible application of punitive interest.In recent years,the United Kingdom has also actively constructed an insurer ’s delayed compensation system,which is essentially an innovation of the default liability model.The fourth part discusses the rationality of China’s introduction of tort liability to regulate insurers’ inappropriate claims.First,the insurer’s improper claims settlement breach of contract liability to tort liability breakthrough has a sufficient theoretical basis.The special trust interests carried by insurance products and their important role in social governance have given the property of insurance quasipublic goods,and it is reasonable to impose tort liability on insurers who violate the implied obligation of honest credit and fair trading.Secondly,from the point of view,the current Chinese law is weak on the insurer ’s inappropriate claims regulation,the contract law relief path is difficult to achieve reasonable relief for the insured,and it cannot effectively deter the insurer.Will effectively change this dilemma.After the application of tort liability,the insured has the possibility of relief due to indirect losses caused by the insurer ’s improper claims,which means that the expansion of the potential consequences of the insurer ’s improper claims will form an effective deterrent to the insurer.In addition,to investigate the tort liability of the insurer for improper claims does not conflict with the current legal environment in China.The relevant provisions in the Contract Law and the Tort Liability Law have laid a good foundation for its realization.The fifth part explores the specific details of constructing the insurer’s liability system for infringement claims under the Chinese legal background.Combining with the existing laws and regulations in China,we will discuss how to effectively regulate the insurer ’s inappropriate claims while avoiding excessively increasing the liability of the insurer,and finding a reasonable balance between the interests of the insurer and the insured.Among them,the application of the insurer ’s improper claims tort liability needs to strictly meet the relevant constituent elements,especially the confirmation of the insurer ’s subjective fault,the degree of the subjective fault will directly affect the determination of the ultimate liability scope.At the same time the insured puts forward higher proof requirements while giving the insurer a flexible defense space,it not only further balances the rights of the insurer and the insured,but also avoids most unnecessary tort litigation to a certain extent,resulting in judicial burden.Finally,the process of the court’s handling of dispute settlement cases under the insurer’s improper claims system is deduced to facilitate the understanding of the insurer’s improper claims infringement litigation process.