打击保险人机会主义的追求:打击索赔过程中不当行为的比较分析

Gabriella Gropper
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摘要

本文将通过比较分析英格兰、威尔士和美利坚合众国(US)的司法管辖区来评估如何打击索赔过程中的承保人不当行为。在英格兰和威尔士,被保险人此前被禁止就保险赔偿之外的额外损失获得赔偿。此后,《2015年保险法》第13A条在保险合同中引入了一个隐含条款,即保险公司必须在合理的时间内支付索赔,如果违反该条款,则相当于赔偿损失。然而,本文将质疑改革和当前的监管实践是否为保证提供了充分的保护。在这样做的过程中,它将确认有必要阻止保险公司利用保险合同中固有的对他们有利的不平衡。与此相反,美国保险法的运作明显更有利于保障。具体而言,允许对违约、诚信和法规采取法律行动和补救措施,以令人满意地维护被保险人的利益。这包括在保险公司明显不当行为的情况下追回惩罚性损害赔偿的争议性能力。最后,本文将建议英国法律借鉴美国法律的特定要素,加强对保险业的监管,打击保险人机会主义。
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The Pursuit to Defeat Underwriter Opportunism: A Comparative Analysis of Combating Misconduct in the Claims Process
This dissertation will assess how underwriter misconduct in the claims process is combated by comparatively analyzing the jurisdictions of England and Wales and the United States of America (US). In England and Wales, assureds were previously barred from recovering damages for additional losses separate from the insurance indemnity. Section 13A of the Insurance Act 2015 has since introduced an implied term into the insurance contract that the insurer must pay claims within a reasonable time which, if breached, can amount to recovery of damages. However, this thesis will challenge whether the reforms and current regulatory practices provide adequate protection of assureds. In doing so, it will affirm the need to disincentivise the insurer from exploiting the imbalances inherent to the insurance contract that lie in their favor. Conversely, operation of American insurance law is significantly more assured- friendly. Specifically, legal actions and remedies for breach of contract, good faith, and statute are permitted, argued to satisfactorily safeguard the assured’s interests. This includes the controversial ability to recover punitive damages in cases of flagrant insurer misconduct. Ultimately, this thesis will suggest English law borrow specified elements of American law to strengthen regulation of the insurance industry and defeat underwriter opportunism.
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