《保险研究》20210206-《保险人恶意不当理赔情境下惩罚性赔偿制度的适用——基于司法判决文书的实证研究》（黄丽娟、吴剑、李臻）

［摘   要］保险人恶意不当理赔的本质是保险人的机会主义行为,属于非效率违约,司法案例的Logit回归模型结果显示,现有的制度无法对此类行为实现有效的规制。对此,惩罚性赔偿能够将保险人非效率违约造成的全部社会成本内化至损失当中,促使其选择符合社会效率的诚信履约行为,因而是一个可行的制度选择。在制度构建上,为避免对保险人的过度威慑而导致的效率减损,适用惩罚性赔偿应当从主观过错和客观行为两方面予以限制,在主观过错方面,惩罚性赔偿应限于保险人的严重恶意,主要包括故意和极为严重的重大过失；在客观行为方面,惩罚性赔偿应当遏制的是能够体现保险人严重恶意的行为,即在Logit模型中对保险人严重恶意有显著提升作用的行为。

［关键词］恶意不当理赔；惩罚性赔偿；非效率违约；社会总成本

［基金项目］本文系2015年国家社科基金一般项目“恶意理赔的侵权救济研究”(项目批准号:15BFX177)的阶段性成果。

［作者简介］黄丽娟,西南财经大学法学院副教授,硕士生导师；吴剑,通讯作者,重庆工商大学财政金融学院保险系,讲师；李臻,西南财经大学法学院硕士研究生。

The Application of Punitive Damages under the Circumstance of Insurer Bad Faith and Unfair Settlement—The Empirical Study based on Judicial Cases

HUANG Li-juan,WU Jian,LI Zhen

Abstract：Insurer′s bad faith and unfair settlement is an opportunism behavior in nature and falls under the scope of inefficient breach.The Logit regression model′s testing results on judicial cases shows that the current legal system cannot effectively regulate such behaviors.Since punitive damages can internalize the total social costs of insurer′s inefficient breaches into losses and induce insurers to behave in accordance with social efficiency with good faith,it is,therefore,a feasible policy option.On the practical policy formation,the application of the punitive damages should be restricted with differentiation in subjective fault and objective behaviors to avoid the efficiency-depletion caused by over-deterrence on insurers.As for subjective fault,the punitive damages should be limited to the insurer′s outrageous bad faith,including willful intention and gross negligence.As for objective behaviors,the punitive damages should be applied to check the misfeasance that reflects the insurer′s outrageous bad faith,the kind of misfeasance that significantly heightens insurer′s outrageous bad faith in the Logit regression model.

Key words：bad faith and unfair settlement;punitive damages;inefficient breach;total social costs