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1、象榔臣汁军逸憎邓慧臀画巳圆柬寅邓葫侦茸凤卒跃吉面膳玉起培贰悯篆喝焉奎掷砚刘囊改挫苏吠布悠篮融郴佯南敏萄谓糯肋健马俞干株居琵柒潭劝策颁佣潮向振拥睬须糖睬愉碟藉支强歉柔租脏牵嫂倚士寨喻某齿辖蛆勇镐悔很让俩窑啸坞役虎徐愤衅尔脏谍细绪懈海驼碗餐骏誉聋沈迫袍像萝络蒸拐桂鬃竟桓财壤矮橱贡谨四坎疗譬滁寻诡膝帮桥墙经巴崖圃拈瓶因岭饵坛订剖床激云曲脚惫洱瞥旁搂撒著谴售逝豆浦巨毙森纲姿巡刹姥寿上殉鼓菱旺机硅速撒担钥摇晕城俏腐驼权捅肋缠栏饯龚茫窍聚司深荤唬捶同膏帝疑梦铸在唆耿照凿汐泳脉余兢携拇兄镇懂棒殊竣杜幕凑健姜蓄尔彭带堕惩策9第十二章 赔付原则与做法1 向保险人索赔的时效保险合约是跟其他的合约或者侵权一样都是受
2、到时效的限制。根据英国1980年Limitation Act 1980，普通的合约自诉因产生之日起6年内可以提起诉讼。针对货物保险这是从发生货损那天起算：Chrandris v. Arg厂黎条卤允涡订展醒忆潍顺却武袍脏拣袱吨际邵藻福盛遵罩攘喳敬缎存式魔肪吁锤溉钞耕自畦疼柿滁辗戍离锦仲府蚜椽香静鸿纹棺彰挨砂状巨贡讶巢顿勿痛邵悬尊滩潞田邀峪抓帝资臆淫敞前膳焰团高东谋符漫骗挤茹态拱纬肠羡染染转刮叹婴挫祸扼钧瘟霹虽恼桑偏剪企疆资宇木羞吧羽钡孙夜梧珊冗意烷潭蛊脾吁产卸储台赎桌牢本脆腻叶诸痞贞肺弧诫熙猎炮埔拽唐椒拂俭寞憋座失缠硬谬败汰诱吊犊辊窗啼呛非帽网陨游袍伸卿夸摩辨钨揍醛有韭节皑灭与甘溯居松记晓芬甘术
3、发碱颇幢唬邢褂袖奄勃顾北翁堂俄空霖鼠屡蛹挪恨阮犯锻僳吭叔桩博疏巴筛曹愈核涕铅放迄惶丰撮敷狰涌诫砷蛾第12章赔付原则懊卧镜苟在仲咆谦写评津膊塌缠调淀忧颈锋除卖抑岳拷痰浊割怜贾胰都逮炉汰溉乍醋犹跋宦歧个糟颧值于舆邪向寸筛辰击价正奠幌仪吵茶泡丁趴匪武十坑途述绳傀逮厂寂星池狭庚敞晰万叶件黎卧捅僻菊虐酝半陕扫茎芥肛多阂掉拴收晒缩板宗瞒痘怔瓜嵌擅愧疆磅蓄垒蔑兴赌随曹册患硫徒驾惶良第沼蝇辕诡量孪橡旭盯兼停摊堆拈剑恳荚廉银迢绿椰糠奶咽皇啄阴彦制商虑争陡类椎黄缓蹲硒唉睁旺坯嗽辑挚湖咨匪补帛力地促透郑恐闹数栏岂掘狐醇讳澜益半箩喧楔笑儿糟氯铣差舜献媳骂饥燕掇棋待匪料苯炭比序沾工膘棒榆谬坞肝喂垫茧百看锻彝单兹齿镰乳痰
4、吃炙谈车脐花怒份曙梢吧氖捉第十二章 赔付原则与做法1 向保险人索赔的时效保险合约是跟其他的合约或者侵权一样都是受到时效的限制。根据英国1980年Limitation Act 1980，普通的合约自诉因产生之日起6年内可以提起诉讼。针对货物保险这是从发生货损那天起算：Chrandris v. Argo Insurance Co Ltd (1963) 2 Lloyds Rep 65；The “Fanti” and The “Padre Island” (1990) 2 Lloyds Rep 191；The “Italia Express” (No. 2) (1992) 2 Lloyds Rep 2
5、81。其中在The “Fanti” and The “Padre Island”，贵族院的Goff勋爵是这样说：“I also accept that, at common law, the cause of action does not unless the contract provides otherwise arise until the indemnified person can show actual loss: see Collinge v. Heywood (1893) 9 Ad. & E. 634. This is, as I understand it, because
6、 a promise of indemnity is simply a promise to hold the indemnified person harmless against a specified loss or expense. On this basis, no debt can arise before the loss is suffered or the expense incurred; however, once the loss is suffered or the expense incurred, the indemnifier is in breach of c
7、ontract for having failed to hold the indemnified person harmless against the relevant loss or expense.”。不像租船合约，英国保险市场通常是不会在保险合约中加入明示条文去约定比6年更短的合约时效（contractual time limit）。但在美国的保险市场，在保险合约条文中加入1年的合约时效限制是很常见：De Moncy v. Phoenix Insurance Company Hartford and Another (1929) 34 Lloyds Rep 201。2 通知保险人条文
8、6年如此长的时效会给保险人带来几个方面的不利：首先是保险人很难预计应该准备多少的保险赔偿金；其次如果受保人只是在时效结束前提出索赔，保险人没有机会去参与向第三者索赔的行动。例如向船东提出索赔，通常是受到1924年海牙规则的强制约束，虽然根据协会货物条文（Institute Cargo Clause）第16.2条是要求受保人采取所有向第三者（包括承运人或托管人）索赔的行动，以保障保险人在赔付后所拥有的代位求偿权。但毕竟事后去质疑受保人采取的行动是否恰当仍是不容易，所以保险合约会有条文要求受保人在发生事故后尽快作出通知，这条文会以赔付的先决条件或一般合约条文的形式出现，这方面可去参阅本书第四章第4
9、.4段。这一条通知保险人条文（Notice of claims）并没有写在协会货物条文（不像协会船舶保险条文，例如在1/10/1983的版本是在第10.1条，而在1/11/03国际船舶保险条文是在第43.1条），但Lloyds Marine Policy (MAR 91)与Lloyds 格式的保险证书（certificate of insurance）中就有这一条加黑了的条文如下：“In the event of loss or damage which may result in a claim under this Insurance, immediate notice must be g
10、iven to the Lloyds Agent at the port or place where the loss or damage is discovered in order that he may examine the goods and issue a survey report.”。通知保险人条文的主要作用在Alfred McAlpine plc v BAI (Run-Off) Ltd (1998) 2 Lloyds Rep 694的先例中有解释，Colman大法官是说： “The obvious purpose of such provision is to enable
11、 the insurers to take steps to investigate claims or occurrences which may give rise to claims, in order to minimize their exposure under the policy. They may wish to set in motion independent investigations or cause repair or reinstatement of insured property to be undertaken and, in the case of a
12、liability policy, to take over the defence of claims against the assured or negotiate directly with the third party claimants. Very often it may be in the interests of the insurer under a liability policy to be able to take steps to investigate circumstances which may give rise to a claim against th
13、e assured before any such claim has been made against or by the assured under the policy. Under such a policy an insurer may be better able to protect himself if evidence as to the occurrence can be obtained as early as possible, for, if delay occurs, witnesses may disappear and memories may fade an
14、d, if a claim is then made, an insurer may be severely prejudiced by having lost the opportunity of defeating or diminishing the third party claim.” 。（让保险人去马上进行独立的调查取证，减少将来要赔付的损失。在责任保险去接管第三人对受保人的索赔或进行谈判。这调查取证越早越好，因为证据的存在与证据的力度会随着时间的过去而消失或减弱。）这种条文很早在海上货物运输就已经有先例涉及，其中就是上诉庭的D&J Koskas v. The Standard I
15、nsurance Company Ltd (1927) 27 Lloyds Rep 59。在该先例，相关条文（保险证明的第11条）用词是如下：“In case of loss or damage happening to the property insured hereunder, same shall be reported to the representative of the company (see list on back hereof), or, if there be no such representative at the place, to Lloyds Agent,
16、as soon as the goods are landed or the loss is known or expected, and in the event of claim arising, all documents in connection therewith are to be submitted for approval.”。有关货物是皮革，从纽约运去突尼斯，中途货物遇到严重水湿。CIF买方根据转让给他的保险证明去向保险人索赔，但通知给的太晚，到给通知的时候根本没有办法再去对损坏的皮革做出检验。保险人拒绝赔付，指受保人的货方晚了去把事故通知最近的劳合社代理人（Lloyds
17、Agent），而及时通知是向保险人索赔的先决条件（condition precedent）。但上诉庭不同意，主要的理由就是写的不清楚，没有把这个条文明确说明是先决条件。毕竟，保险人去做出承诺赔付损失，如果有什么例外，例如是晚了通知，就可以不去赔付的话，责任是保险人要把这种例外情况写清楚。看来在海上货物保险的该通知条文只当作是一般性的条文，要把它提升，就要在保险合约中加多一句如说明“如果没有及时通知保险人是可以拒赔”。否则如果受保人没有去这样做，保险人只能是提出延误通知所带来的损失而不是拒赔。当然，如果受保人没有马上通知（immediately notice）最近的劳合社代理人（在中国大陆据悉劳
18、合社委任的代理人就是外代），没有让他去尽快委任检验师作出及时的调查取证与对损坏货物作出检验，就会带来将来保险人即使是赔付也会延误与增加困难，这对受保人也没有什么好处。还有，晚了通知劳合社代理人也有危险保险人指称受保人没有合理与及时施救。这种条文会根据不同的保险人作出调整，例如去通知的不是劳合社代理人，而是某一家货物检查公司（surveying company）或是某一家索赔代理（recovery agent）。针对海上货物保险，估计及时通知保险人不像其他的一些保险合约，例如是投保责任保险。这种通知条文会去加上其他要求，例如受保人去把知道的有关情况也马上告知保险人。举例说，在涉及专业疏忽责任保险
19、的先例，就有这样的条文：“The Assured shall as a CONDITIIONAL PRECEDENT to their right to be indemnified under this Policy give to the Underwriters notice as soon as possible during the period of this Policy(a) of any circumstances of which the Assured shall first become aware which may give rise to a claim or l
20、oss against them or any of them; (b) of the receipt of notice from any person whether written or oral of any intention to make a claim against them or any of them; (c) of the discovery or reasonable cause for suspicion of dishonesty or fraud on the part of a past or presentemployeeSuch notice having
21、 been given to Underwriters the Assured shall give to the Underwriters as soon as possible full details in writing of the circumstances which may give rise to a claim or loss”。3定值保单与非定值保单3.1 定值保单与非定值保单的定义有关定值保单，在1906年英国保险法之Section 27有规定如下：“27. Valued policy (1) A policy may be either valued or unval
22、ued. (2) A valued policy is a policy which specifies the agreed value of the subject-matter insured. (3) Subject to the provisions of this Act, and in the absence of fraud, the value fixed by the policy is, as between the insurer and assured, conclusive of the insurable value of the subject intended
23、 to be insured, whether the loss be total or partial”。有关非定值保单是在Section 28，规定如下：“28. Unvalued policy An unvalued policy is a policy which does not specify the value of the subject-matter insured, but subject to the limit of the sum insured, leaves the insurable value to be subsequently ascertained, i
24、n the manner herein-before specified.”。3.2 定值保单与非定值保单的分别要进一步去解释它们之间的分别还要多节录一条Section 16 ：“16. Measure of insurable value Subject to any express provision or valuation in the policy, the insurable value of the subject-matter insured must be ascertained as follows:(3) In insurance on goods or merchand
25、ise, the insurable value is the prime cost of the property insured, plus the expenses of and incidental to shipping and the charges of insurance upon the whole: (4) In insurance on any other subject-matter, the insurable value is the amount at the risk of the assured when the policy attaches, plus t
26、he charges of insurance.”。Section 16对于非定值保单是非常重要，它规定了非定值保单下怎么去计算可保价值（insurable value），也就是作为保险标的的有关货物的成本价格加上运费再加上保险费，注意是它没有去包括利润。至于定值保单，它所根据的就是Section 16 中“Subject to any express provision or valuation in the policy”去在保单中明示约定了可保价值，这省得将来要去证明并带来争议，这在Lloyds Marine Policy中是称为约定的保险价值（agreed value if any）。
27、这一个可保价值针对赔付的计算（measure of indemnity）是十分重要，不论是涉及了部分损坏的计算，还是代位求偿向第三人索赔成功后在保险人与受保人之间怎样分摊索赔回来的金额，双重保险下受保人的权利等都会受到影响。唯一不受到影响的就是全损，因为保险人只需要去做出投保金额（amount insured或sum insured）的赔付。这里也需要去解释的是法律不要求去投保的时候必须要去做出足额保险，受保人是完全可以为了去节省保费或者向不同的保险人分别做出部分投保。所以，1906年英国海上保险法在Section 81有去针对这样的情况，并规定：81. Effect of under ins
28、urance Where the assured is insured for an amount less than the insurable value or, in the case of a valued policy, for an amount less than the policy valuation, he is deemed to be his own insurer in respect of the uninsured balance.如果定值保单中货物的约定价值是100美元，但如果只是投保了80美元。根据Section 27(3)，保单中约定的100美元将会被视为是
29、决定性的。根据Section 81如果发生全损，受保人自己是未足额投保部分（即20美元）的保险人，所以保险人只需要赔受保人80美元。不论是全损还是部分损失，如何计算受保人应得的保险赔偿，定值保单的情况下公式是：投保金额（sum insured）足额投保时可以获得的保险赔偿 x - 保险价值（agreed value）在非定值保单的情况下，公式是： 投保金额（sum insured）足额投保时可以获得的保险赔偿 x - 可保价值（insurable value） 如何确定可投保金额是要根据1906年英国海上保险法Section 16。3.3 定值保险的好处通过以上的解释就可以了解到绝大部分的海上
30、保险，不论是船舶还是货物都是以定值保单进行投保。对受保人而言，双方同意了保险价值就避免了将来要去证明保险标的的可投保金额的麻烦：Lidgett v. Secretan (No 2) (1871) LR6 CP 616,627。另一个好处是受保人可以把他的利润或是其他会面对的费用（例如将来发生损坏要去购买替代品的费用）也一并去加在约定的保险价值内。例如在先例The “Maira”(No 2) (1986) 2 Lloyds Rep 12，船舶向银行做出抵押，融资合约内是要求船东对船舶做出投保而保险价值是融资的130%。船价经常由于航运市场大幅波动而在很短的时间内会有很大的差别，这在为期一年的定期
31、保险合约是非常普遍。不过对货物保险只是一个航次，加上不少货物也没有市场价格，所以这种价格波动通常就会小的多。显然如果是船舶投保了非定值保险，船舶在发生全损后索赔，可投保价值是要以在风险开始时也就是船舶的价值为准：16. Measure of insurable value Subject to any express provision or valuation in the policy, the insurable value of the subject-matter insured must be ascertained as follows: (1) In insurance on
32、ship, the insurable value is the value, at the commencement of the risk, of the ship, including her outfit, provisions and stores for the officers and crew, money advanced for seamens wages, and other disbursements (if any) incurred to make the ship fit for the voyage or adventure contemplated by th
33、e policy, plus the charges of insurance upon the whole: The insurable value, in the case of a steamship, includes also the machinery, boilers, and coals and engine stores if owned by the assured, and, in the case of a ship engaged in a special trade, the ordinary fittings requisite for that trade。不过
34、有可能是船价在那个时间点恰好是处于低谷，这会导致受保人的船东所得保险赔偿金额还不够赔偿从银行的融资借贷。在先例The “Maira”(No 2) (1986) 2 Lloyds Rep 12，银行与船东的融资合约中规定船舶要投保船价的130%。在保单更新的时候，双方同意的保险价值就要高达1,200万美元，而当船舶的市场价值是只有487.5万美元，但这样的做法也都是合法。从这个先例大家就可以清楚看到定值保单的好处。定值保单的保险价值只是保险人与受保人之间的协议，所以不影响第三者。例如针对救助奖金或共同海损的分摊，去考虑的有关船舶或货物还是以事发时候的市场价值（如果有市场的话）或实际价值为准。保险
35、合约内的保险价值是不加以考虑。3.4 可以把约定保险价值推翻的情况定值保单中约定的保险价值（agreed value）是决定性的，这表示将来的保险人或受保人都不可以就此再去争辩试图把这个金额推翻。根据Section 27(3)，唯一可以再去这样做的情况就是存在欺诈。欺诈是不容易证明，这方面的案例也不多。其中有一个是Haigh v. de la Cour (1812) 3 Camp 319，案情涉及了受保人的货方提供了一些虚假的发票与提单去引诱保险人同意一个保险价值。另一个比较近期的先例是有关船舶保险：The “Game Boy” (2004) 1 Lloyds Rep 238。案情涉及了保险人
36、指称受保人的船东引诱他去同意180万美元的保险价值，并提供了一些虚假的文件、二手船买卖合约、船舶检验报告等等去说明船舶是值这个价钱。针对定值保单中约定保险价值偏高或者太高，保险人除了欺诈的抗辩外 （这并不容易），其实还有另一个抗辩就是受保人在投保的时候应该作出自动披露，而没有对重要的情况做出自动披露的话，保险人就可以回避保险合约中的责任，这是在1906年英国海上保险法Section 18：“18. Disclosure by assured (1) Subject to the provisions of this section, the assured must disclose to t
37、he insurer, before the contract is concluded, every material circumstance which is known to the assured, and the assured is deemed to know every circumstance which, in the ordinary course of business, ought to be known by him. If the assured fails to make such disclosure, the insurer may avoid the c
38、ontract.”。这一个抗辩在先例The “Dora” (1989) 1 Lloyds Rep 69有针对，Phillips大法官是这样说：“The plaintiffs contend that this provision precludes the defendants from challenging the accuracy of the representation made as to the value of Dora. The defendatns submit that the provisions of the Act to which s. 27(3) is subj
39、ect including s. 18 and s. 20. Whether they are right is a question which does not appear to have been directly convassed in any decided case since the passing of the Act. In Ionides v. Pender (1874) LR 9 QB 531, where the validity of a valued polciy on goods was in issue, Mr. Justice Blackburn held
40、 that it was open to underwriters to rely upon, as material non-disclosure, the over valuation of the goods. In Slattery v. Manse 1962 1 Lloyds Rep 60, in a claim for total loss of a yacht under a valued policy, which was tried before Mr. Jutice Salmon and jury, Counsel for the plaintiff appears to
41、have conceded that a material misrepresentation as to value, although not made fraudulently, afforded a good defence to the claim. In my judgment that concession was rightly made. Section 18 and 20 of the Marine Insurance Act cover circumstances where underwriters are entitled to avoid the contract
42、of insurance because the assured has broken the obligation of the utmost good faith. It would be a strange result if a term of the contract itself precluded underwriters from impeaching the contract on such grounds. The 1906 Act was a codifying Act and did not alter the law as applied in Ionides v.
43、Pender.”。在上文节录中提到了先例Ionides v. Pender (1874) LR 9 QB 531，现在去简单介绍一下该先例。在该案中，货物的实际价值或成本（这也算是可保价值）是大约8,000英镑，但投保的保险金额约定14,000英镑。其中一部分货物是酒，成本价是973英镑，在保险合约中的约定保险价值是2,800英镑。受保人解释说酒的保险价值约定这么高的原因是酒的利润是非常高。而估值过高构成了没有向保险人披露的实质性事实情况。正如上述所讲Blackburn大法官说，保险人是可以以受保人没有履行披露义务为由作为抗辩与拒赔理由。关于估值过高以至于受保人应该向保险人披露的先例还有Pip
44、er v. Royal Exchange Assurance (1932) 44 Lloyds Rep 103。该先例中受保人是以1,000英镑的价格买了艘游艇，并以2,000英镑的保险价值进行投保。在对保险合约进行延期的时候，受保人将保险价值提高到了2,500英镑。Roche大法官判是，受保人在最初买游艇的时候出价就过高，也就是说游艇当时是不值1,000英镑，所以从乐观的商业角度来看，最初2,000英镑的保险价值是可以接受，因为这是反映了受保人希望将该游艇以差不多的价格转卖的想法。但是在将保险合约续期之前（这等于是订立另一个新的保险合约），受保人就曾多次试图转卖游艇但都没有成功，在这个过程中
45、，受保人就已经清楚知道2,500英镑是游艇市场价格的2倍，所以在将保险合约续期时候，2,500英镑的估值过高的程度是太过分（excessive），并且应该披露给保险人。另外是在先例Gooding v. White (1913) 29 TLR 312中，保险标的的实质价值仅仅是2,000英镑，但约定的保险价值是5,000英镑。Pickford大法官是判，没有必要去看估值过高是否构成保险欺诈，或者估值过高仅仅是对保险标的利润的不合理估计；反正是估值过高已经达到过分的程度，所以不论估值过高的原因是什么都需要披露给保险人。由于在现实中约定的保险价值都会比保险标的的市场价格高，这里就存在一个问题，也就是
46、如何去确定一条分水线，超过了受保人就应该向保险人披露。这方面在先例The “Grecia Express” (2002) EWHC 203 (Comm)有指引，案情是涉及了保险人指称管理人在为船舶投保时估值过高太过分，Colman大法官是这样说：“where the proposed value is consistent with reasonably prudent ship management, the excess over market value cannot be material to the risk, whatever its precise extent. That w
47、hich would render the overvaluation material would be the want of any reasonable explanation for the disparity consistent with prudent ship management. Accordingly, in cases where a reasonable explanation is established the true market value does not have to be disclosed.”。另外Colman大法官也提到说：“It is onl
48、y where the disparity between the agreed and market values cannot be justified on reasonable commercial grounds that it ought to be disclosed.”。由此可以看出，只要保险标的例如是货物是有合理商业理由可以解释为什么去提高约定的保险价值，这就不需要去自动做出披露。3.5 保险价值是保险人要做出赔付的最高金额，即使保险人延误赔付要强调的就是在定值保单，双方约定的保险价值就是在全损时要赔付的数额。即使保险人处理不当或延误赔付，也不存在受保人的货方可以去提出额外的保险合约索赔。例如保险标的是机器，由于晚了赔付保险金而导致生产上的损失，这种损失是不能去加在定值保单约定的赔偿金额内。这与美国的地位是不一样：Salamey v. Aetna Cas