【作者】 李军；

【导师】 徐民；

【作者基本信息】 海南大学 ， 民商法学， 2013， 硕士

【摘要】 损失补偿原则作为保险法最为重要的基本原则之一,其宗旨是对被保险人的损失进行补偿且只进行补偿,其包含了填补被保险人损失和禁止被保险人不当得利两个方面,而禁止得利又是该原则的核心。损失补偿原则适用于财产保险已经获得了广泛的认同,鉴于人身损害的不可补偿性,大多数人身保险也无适用损失补偿原则的必要。但是对于既属于人身保险又具有财产属性医疗费用保险是否应该适用损失补偿原则,对于这个问题理论界之间以及实物部门之间存在较大的观点差异。对于医疗费用保险这类新型的保险类型是否应该适用损失补偿原则这一问题,只有抓住医疗费用保险的实质特点——填补具体损失的保险并结合损失补偿原则的实质适用范围——补偿性质的保险,才可以对此问题作出合理的解答。文章共分为四个部分,第一部分论述了损失补偿原则适用于医疗费用保险中的理论依据。首先,通过损失补偿原则的起源、意义为着眼点,分析了损失补偿原则的适用范围是补偿性质的保险。其次,通过对医疗费用保险的内涵及外延的界定,得出医疗费用保险属于财产损害补偿性质的保险。所以损失补偿原则应该适用于医疗费用保险。第二部分,论述了重复保险制度在医疗费用保险中的适用问题。鉴于我国《保险法》中只对财产保险规定了重复保险制度,对于属于人身保险的医疗费用是否适用、如何适用重复保险制度提出了观点：重复保险的适用范围应为填补具体损害的损害保险,医疗费用保险属于填补具体损失的损害保险理应适用重复保险规则；考虑积极保险与消极保险的差异,对于医疗费用保险这类消极保险在构成重复保险的要件中不再以“保险金额总计超过保险价值”为要件。第三部分,论述了保险竞合制度在医疗费用保险中适用问题。鉴于医疗费用保险的补偿性质、社会保险与商业保险的区别,在社会保险与商业保险相竞合时,应该赋予社会保险居次赔付的特权,在当前立法不健全的状态下,可以通过社会保险的代位权来对居次赔偿权救济。第四部分,论述了代位权制度在医疗费用保险中的适用问题。针对商业保险人是否享有代为权以及行使代为权的条件的问题,作出了以下解答：保险提供的是一种损失赔偿的承诺而不是必然,而且保险的机制是将少数人的风险在集合体内进行分散,保险人的代位权可以实现上述功能；保险人代位权的行使并不以合同中代位权条款的约定为条件,只要具有标的一致性即可。更多还原

【Abstract】 Loss compensation principle as one of the most important basic principle of insurance law, the aim is to compensation for the loss of the insurant compensate, and only it contains filling the insured losses and forbid unjust enrichment by the insured, and banned benefit is the core of the principle. Loss compensation principle apply to property insurance has gained widespread recognition, in view of personal injury is compensatory, most insurance nor for loss compensation principle is necessary. But has property attribute for both belong to the personal insurance and medical expense insurance should apply the principle of damage compensation, the theoretical circle to the problem, and between physical objects larger view differences between departments. For medical expenses insurance of this kind of new type the question of whether should apply the principle of damage compensation, only grasp the essence of the medical expense insurance characteristics-fill the specific loss insurance and loss compensation scope, compensation principle is the essence of the nature of insurance, can make a reasonable answer on this question.The article is divided into four parts, the first part discusses the damage compensation principle is suitable for the theoretical basis of medical expenses insurance. First of all, through loss compensation principle’s origin, significance as the starting point, analyzes the scope of damage compensation principle is the nature of the compensation of insurance. Secondly, based on the connotation and denotation of the definition of medical expenses insurance, concluded that medical expense insurance belongs to the nature of the property damage compensation insurance. So the loss compensation principle should be applied to medical expenses insurance.The second part, discusses the system of double insurance on health insurance cost of application problems. Given only to the property insurance in our country "insurance law" regulation, repeated insurance system for medical costs belong to personal insurance if applicable, double insurance system is put forward how to apply point of view:scope of application of double insurance should fill the concrete damage damage insurance, medical expenses insurance belongs to fill a specific loss of damage should apply double insurance rules; Consider insurance of insurance of positive and negative differences, for medical expenses insurance such negative in the elements that make up the double insurance is no longer with "insurance amount totaled more than the insured value" for the requirements.The third part, discusses the system of insurance concurrence in medical expense insurance problem. Given the nature of medical expense insurance compensation, social insurance and commercial insurance, the difference between the concurrence of social insurance and commercial insurance, should be endowed with the privilege of pay society insurance in time, under the current state of the imperfect legislation, can through the social insurance subrogation to the second purchasing benefits.The fourth part, discusses the system of subrogation in the applicable problem in medical expenses insurance. Aimed at business whether the insurer has the right of and on behalf of the right to conditions of problems, made the following answer:the insurance provided by promises but not necessarily is a kind of damages, and the insurance mechanism is scatter risks in the collection of a few people, the insurer’s subrogation can realize the function; Insurer subrogation exercising is not for subrogation clause in the contract conditions, as long as have the underlying consistency.更多还原