作者：王金玉
作者介绍：辽宁大学法学院副教授，法学博士
出版日期：2025年2月9日
内容提要 保险告知义务规则在我国司法实践中不同程度地受到近因原则的影响和制约。保险合同履行过程中，在对已经发生的保险事故进行责任界分时，为了维护自身权益的最大化，保险人往往主张投保人违反了告知义务规则，拒绝理赔或索要已经支付的保险赔偿；而投保人则会主张其违反的告知义务事项与保险标的损失没有形成因果关系，未违反近因原则，因而其有权获取保险赔付。一些司法裁判中采用近因原则来判断投保人是否违反告知义务规则，使得保险告知义务规则与近因原则之间既相互独立又相互衔接。因此，我国保险成文法应对保险业和司法界频繁使用的近因原则进行法律规制，并在未来构建新的保险告知义务规则体系中植入近因原则，将二者合理衔接并发挥各自制度优势。
关键词 保险合同 告知义务规则 近因原则 因果关系
Abstract: The rule of disclosure obligation in insurance contract is largely influenced and constrained by the principle of proximate cause in judicial practices in China. In the process of fulfilling certain insurance contracts, when dividing the liability for insurance accidents that have already occurred, in order to maintain their maximum rights and interests, the insurers would often claim that the insurance applicant has violated the disclosure obligation rule, thereby refusing their claims or claiming the insurance indemnity that has already been paid. However, the insurance applicant would claim that the violation of disclosure obligation has no causal relationship with the loss of the subject matter of insurance, which does not violate the principle of proximate cause, thus claiming that they have the right to obtain insurance claims. In some judicial rulings, the principle of proximate cause has been adopted to determine whether the insurance applicant has violated the disclosure obligation rule, which has led to the independence and connection between the insurance disclosure obligation rule and the principle of proximate cause. Therefore, the written law of insurance in China shall regulate the frequent use of the principle of proximate cause in the insurance industry and the judicial sector, and incorporate the principle of proximate cause into the construction of a new system of insurance disclosure obligation in the future, so as to reasonably connect the two and leverage their respective institutional advantages.