篇名

防疫保單理賠標準變變變!【醫事法學教室】   免費試閱

並列篇名

The Instability of the Criterion Settlement of Pandemic Insurance Claim

作者
中文摘要

甲於2022年2月1日以自身為要保人暨被保險人,向A產物保險公司(下稱A)投保防疫保險,系爭條款約定:「住院:係指被保險人經醫師診斷罹患法定傳染病必須入住醫院,且正式辦理住院手續並確實在醫院接受診療者,但不包含全民健康保險法第五十一條所稱之日間住院及精神衛生法第三十五條所稱之日間留院。」隨後COVID-19疫情爆發,因醫院之醫療量能有限,防疫指揮中心宣布確診者改入住防疫旅館或檢疫所,並提供醫護人員進行照護。嗣後,甲確診並安排入住防疫旅館,經醫護人員照護10日後康復,甲隨後向A請求住院醫療保險金。A則以甲僅入住防疫旅館而非正式辦理住院手續,故主張不符合理賠條件,拒絕給付。試問,A之主張有無理由?

英文摘要

X insured against epidemic with Y Property Insurance Company (as known as Y in following) with himself as the insured and the insured on February 1, 2022. The related article reads as following: “Hospitalization: The insured person is diagnosed by a physician as having a statutory infectious disease and must be admitted to a hospital, and is formally hospitalized and actually receives treatment at the hospital. The Psychiatric Day Care according to Paragraph 51 of National Health Care Act and Paragraph 35 of Mental Health Care are excluded.” Subsequently has the pandemic of Covid-19 outbroken. Due to the limited capacity of hospitals, Central Epidemic Command Center announced that the confirmed patients are to send to quarantine hotels or quarantine facilities with the care of medical staffs. After X, being sent to a quarantine hotel and cared by the medical staffs, recovered from Covid-19 in 10 days, he claimed for the insurance for the hospitalization. Y refused him the settlement, because he had been sent in the quarantine hotel instead hospitalization and the elements of the settlement are not fulfilled consequently. Ask if there is any reason for X’s claim.

起訖頁

137-142

出版單位
DOI

10.53106/241553062022060068011  複製DOI  DOI查詢

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