新冠肺炎疫苗險保單承保範圍與可能糾紛

The scope of COVID-19 vaccine insurance coverage and possible disputes

10.6288/TJPH.202304_42(2).111070

何建志(Jen-Ji Ho)；廖昱翔(Yu-Xiang Liao)

新冠肺炎 ； 疫苗險 ； 不良事件 ； 不良反應 ； 因果關係 ； COVID-19 ； vaccine insurance ； adverse events following immunization ； adverse reaction ； causality

台灣公共衛生雜誌

42卷2期（2023 / 04 / 28）

153 - 164

繁體中文;英文

為控制新冠肺炎（COVID-19）疫情，2021年起世界各國與台灣大規模接種新冠肺炎疫苗。在台灣，新冠肺炎疫苗接種者如發生副作用傷害，可向政府申請預防接種受害救濟。因申請政府救濟金必須適用嚴格法定條件，加上程序複雜漫長且補償金額有限，接種者可另外藉由購買商業保險分攤、轉嫁接種疫苗風險。由於新冠肺炎疫苗是全新疫苗，各國醫師對疫苗副作用臨床經驗不多，而實證醫學證據也仍在發展當中，目前政府與保險公司所認定的新冠肺炎疫苗嚴重副作用相當有限。因此某些被保險人或受益人可能不易證明傷害與疫苗因果關係。本文分析台灣各家保險公司疫苗險保單承保範圍及除外不保項目，討論新冠肺炎疫苗受害人、保險受益人行使保險請求權之條件、實際困難與可能法律糾紛。最後，本文提出預防、處理疫苗險理賠法律糾紛建議方案：一、保險公司應詳細說明承保範圍，保單內容應解釋預防接種「不良事件」與「不良反應」差異。；二、政府宜積極主動更新補充新冠肺炎疫苗副作用資訊；三、法院可根據公平原則解釋疫苗險保單條款及調整舉證責任。

In response to the COVID-19 pandemic, many countries have implemented large-scale vaccination programs. In Taiwan, COVID-19 vaccine insurance is available. However, as the COVID-19 vaccine is a new vaccine, there is limited research assessing its safety, and many physicians are not fully informed about its potential risks. Additionally, there is limited recognition of the risks associated with the COVID-19 vaccine by the government and insurance companies, making it difficult for individuals to prove that an injury is a result of the vaccine. This study examined legal elements, insurance coverage, and potential disputes related to COVID-19 vaccine insurance in Taiwan. This study proposed three ways to resolve vaccine insurance disputes: 1. Insurance companies should clarify the scope of insurance policies and the difference between adverse events following vaccination and adverse reactions. 2. The government should proactively update and supplement the information available on the adverse effects of COVID-19 vaccines. 3. The courts should reduce the burden of proof for individuals with vaccine injuries by interpreting insurance contracts and evidence law.

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