本篇论文目录导航：
【题目】上海车险人伤理赔鉴定问题探究
【导言】
车险人伤理赔法律困境探析导言
【1.1 1.2】
上海市车险市场人伤理赔率高的原因分析
【1.3】
上海市车险人伤理赔司法鉴定中的问题及原因分析
【第二章】
司法鉴定的主观性和客观性问题分析
【第三章】
司法鉴定域外经验借鉴
【4.1 4.2】
制定统一的《司法鉴定法》，严格法律规制
【4.3 4.4】
加强行政监督管控，完善行业自律机制建设
【结语/参考文献】
车险人伤理赔鉴定制度优化研究结语与参考文献
摘要
在我国经济社会持续快速发展的大背景下，作为经济发展前沿的特大型都市之一的上海，虽然持续多年通过多种积极措施人为控制着机动车的数量，但是机动车的保有量上升势头依然难被有效遏制。机动车保有量的快速提升引发交通环境恶化，机动车相关的交通事故总量不断攀升，导致伤亡人数和伤亡赔付案件双双走高。其中，最为突出的问题是，各家保险公司中车险人伤理赔的赔款在车险理赔总赔款中的占比不断提高。因此，这些案件已成为各家保险公司中车险理赔案件业务的重点和工作难点。
车险人伤案件赔付日渐成为一个关乎民生的问题，因为赔付率高，拉高了车险费率，赔付成本随经济发展不断走高。其中，更因保险欺诈的多发造成大量不正常保险赔付，严重侵蚀了保险公司的利益，使得广大的车主不得不长期背负着高昂的保费负担，直接影响了广大车主的权益，实际上已危及了车险市场的持续稳定发展，阻碍了我国和谐社会的建设。
笔者毕业于法医学专业，曾经在保险公司从事理赔服务工作十年，对上海市车险市场人伤理赔率偏高的问题关注已久。此次，笔者通过对上海市保监会、市保险同业公会、各大财产保险公司及经纪公司等进行的大量调研所获取的“一手”数据和案例开展针对性分析，围绕上海市车险人伤理赔中司法鉴定问题及相关的法律对策展开了较为扎实、细致的研究。为此，本文拟从以下三个方面展开论述。
第一、车险人伤理赔司法鉴定中的诸问题点及原因分析
在当今市场竞争和鉴定机构的营利追求等多种因素叠加下，司法鉴定市场乱象层出、“问题鉴定”不断出现。若对其主要问题进行梳理和成因分析，大致有以下七类问题。
1.评定时间的选择对鉴定结论影响较大
我国尚无一个权威部门对鉴定的评定时机做出具体的、标准化的释义。在实际操作时，同一鉴定对象临床治疗终结的认定结论，往往因各鉴定人不同的理解、认知而出现差异。另外，因不同伤者其个体的康复时间和康复结果也存在差异性，由于时间跨度较大，重新鉴定的结论常与初次鉴定的结论不相一致。
2.伤者单方申请鉴定问题所在
依照上海市现行的道路交通事故处理流程，伤者可要求交警事故处理部门出具伤残委托书或推介书，自行选择司法鉴定机构申请进行鉴定。然而，这一自由选择的做法有多种弊端：首先，有的伤者通过对多家鉴定机构“比价”或采取贿赂鉴定人的方式，来谋取高等级的目的。其次，大多鉴定机构是自负盈亏的实体，希望“示好”申请人来扩大客源。再者，“人伤黄牛”的出现，更是追求单方委托到相熟的鉴定机构以便谋取高等级的目的。
3.鉴定人员素质参差不一带来的问题
现行司法鉴定管理规范中，对于鉴定人员的法律素养、道德操守等并无特别具体明确的要求。
例如，一些被之称为“社会机构”的鉴定部门，大多由医院或公司开设，具有挂靠或承包经营的特征，所以，日常的鉴定业务技能操作和法律素养、道德操守等只能由鉴定人自行把握，极易出现鉴定人员素质参差不齐的情况。又因为这些机构是完全靠市场吃饭，鉴定意见质量较低、“失真”率较高，是其一大特征。
4.伤残等级定级标准过于陈旧，有待优化和完善
首先，因为时过境迁和相应的标准释义不够细化等原因，我国的《道路交通事故受伤人员伤残评定》的条款内容已经不能适应当前的新情况。其次，对于伤病关系参与度的司法鉴定意见，大多是由鉴定人以其主观认知水平来决定伤病参与度的比例，其结果常常出现不同的鉴定人出具的鉴定意见相差甚远的现象。
5.主观判断与客观事实之间的差距产生的问题
伤残等级评定或鉴定是具有专业知识的人员依据相应客观材料做出的鉴别、判断的主观认知说明。仅凭鉴定人的经验、过多依赖鉴定人主观检查，结果就是每做一次鉴定都可能出现不同的结论意见，难以分清哪个鉴定人有“过失放水”或“故意放水”可能。
6.鉴定人怠于出庭，申请重新鉴定不易
按现有法律规定和司法实践，对于司法鉴定意见异议处理的司法救济手段主要有以下两种：
一是鉴定人出庭作证或“有专门知识的人”协助出庭质证。但是在司法实践中，鉴定人愿意出庭参加质证的较少，“有专门知识的人”囿于情面等因素也很少愿意出庭协助。因此，总体上而言当事人或法院更倾向于进行重新鉴定。二是重新鉴定。现行法律中对哪些情形可启动重新鉴定程序则没有明确的规范，与此相关的判断标准以及如何选择重新鉴定机构和鉴定人等均无明确的法规依据，易引发对司法鉴定意见或法院判决的公正性的质疑。
7.行政监管和自律管理的缺失
司法鉴定作为专业技术领域的活动，以行政监管手段对其进行监督确有相当的难度，监督管理往往落不到实处，难以对伤残鉴定意见的质量进行有效地监督，对鉴定机构和鉴定人的行为也难以进行实质性地监督约束。而司法鉴定协会作为行业自律机构，其制定的处罚办法之法律效力的层级较低，对专业技术领域活动中的问题管控明显不足。
第二、域外经验借鉴
1.荷兰和德国的经验
我国与荷兰和德国同属于大陆法系国家，相较而言，荷兰和德国在司法鉴定人的考核准入标准上有着较高的标准。
一是荷兰经验。首先，荷兰在司法鉴定人的准入及考核上有较高的要求，培训内容丰富、时间跨度较长。对于鉴定人除了必备的相关领域的知识以及实施鉴定执业的技能和经验外，还强调鉴定人应具有一定的相关法律知识素养。其次，资格的期限性。司法鉴定人的资格证书和注册有效期一般为 4 年，期满后需重新申请、注册，意即司法鉴定人的资格并非是终身制的。
二是德国的经验。按司法鉴定人的公信度由高到低可将鉴定人分级，等级越高对诚信程度和道德品行的要求越高。最高等级的鉴定人标准要求除严格专业技术知识和法律法规的考核外，还须考察了解申请人的过往的诚信程度和道德品行。其次，申请人上岗前还须进行公开宣誓。最后，德国诉讼法对于等级高的鉴定人优先选用也作出了具体的规定。
2.韩国经验
韩国早几年保险欺诈猖獗的情况与目前我国车险人伤理赔中发生的问题较为相似，因此了解韩国的解决对策，对我国有着现实的借鉴意义。
首先，组织架构上的保障。其成立政府联合保险犯罪专门活动对策班，集合多部门进行紧密合作。其次，构建保险诈骗认定系统。综合分析保险合同、事故及保险金支付资料等保险欺诈调查中的信息，做到动向分析和早期预警，能够有利于追索到嫌疑人之间的共谋关系。再次，建立保险犯罪检举中心。广泛呼吁一般公民提供信息、线索，当检举的内容有助于揭发保险犯罪时，各保险协会和保险公司会给予检举人奖金。
第三、实现人伤理赔司法鉴定公正的对策研究
1.制定统一的《司法鉴定法》，严格法律规制
在当前司法鉴定活动日益受到诟病的情形下，应加快制定统一的《司法鉴定法》或先行通过地方立法的形式，对于以下诸方面进行规制。
首先，应提升司法鉴定人的准入标准，强化对司法鉴定人的基本素质要求。其次，应统一司法鉴定的申请、委托、受理、实施操作标准排除人为因素对司法鉴定意见结论的干扰。再次，应构建多层次的司法鉴定体系。第一将司法鉴定人和机构分级；第二扶持权威鉴定机构，完善重新鉴定复核机制；第三树立个别“国家队”级别的鉴定机构在某些鉴定项目上权威性，在某些项目上该鉴定机构只接受重新鉴定或法院的委托。
此外，还应制定司法鉴定意见采信的标准规范，一是应制定司法鉴定意见的采信标准，并由法院与司法行政管理机构等联合制定司法鉴定人出庭质证准则；二是建立涉医专业技术官制度；三是建立专项监督管理机制。最后，应明确司法鉴定人责任制、建立错鉴追究机制。
宣誓制度作为预防鉴定人作伪证的措施，有助于鉴定人主动进行自我提醒和自我约束，有助于维护法律权威。因此，建立司法鉴定人宣誓制度是可行的措施。
2.制定《保险反欺诈法》，建立保险反欺诈体系
首先，应制定统一的《保险反欺诈法》，明确保险欺诈的概念和范围，有利于各主管部门统一认识，对保险欺诈采取有力的惩治。其次，应建立涉保的司法鉴定反欺诈工作网络平台，向相应部门双向开通信息交流的端口，做到信息共享。再者，设立涉保的司法鉴定检举中心，实现有奖举报，达到群防群治的社会效果。
3.完善司法鉴定行业的自律机制建设，加强行政监督管控机制
制定配套的行政管理办法，对司法鉴定人和机构进行鉴定前、中、后的全程监督管控，以提升司法鉴定内在的自律机制和外部的监督机制。一是加强行风的建设，倡导完善自律管理机制。二是加强联动监督管理机制，如建立“鉴定机构和鉴定人员黑名单制度”,对每一个鉴定机构和鉴定人公开进行公信度信用评级的评定 .
4.加强保险行业自身内功建设，探索争议纠纷处理新机制
建立完善的车险理赔运营体系及纠纷处理机制，配合司法系统工作，减少车险人伤理赔纠纷对司法资源的占用。
首先，可以构建车险人伤案件专项网络数据平台，用大数据分析的方式，对司法鉴定实施前、中、后的全程覆盖监督，增进司法鉴定的透明度，以提升鉴定应有的客观公正性。其次，创设新型的保险合同纠纷快速处理机制，从时效性、公正性、权威性、合法性的多维度考量，设置涉保专业仲裁庭不失为一种好的解决途径。
本文主要采用根源分析和实证分析等方法，借鉴荷兰和德国的司法鉴定人制度、韩国的反保险欺诈举措的等经验，对于完善本市车险人伤理赔司法鉴定制度的思路和对策进行了细致地探讨和分析，从体制、制度及技术多个层面提出了相应的法律对策和建议，以期提高司法鉴定的公正性与权威性、促进车险理赔反欺诈工作的推进及车险市场的稳定发展，进一步实现司法鉴定应有的价值，维护我国司法的公平公正，有力推动我国社会的诚信建设与和谐建设。
[关键词]车险人伤理赔；司法鉴定；法律规制；机制建设
Abstract
Under the background of sustained and high-speed development of China'seconomic development, as one of the metropolitans who sits at the front line ofChina's economic development, although Shanghai has actively and intentionallytook measures to control the number of motor vehicles, the uptrend of motor vehiclesquantity seems difficult to be effectively curbed. The swift increase of motor vehiclequantity leads to a deterioration of transportation conditions, a continuous increasingof motor-related transport accidents and a continuous large number of death andpersonal injuries cases. The most prominent problem is the increasing proportionaccount by the claims for personal injuries in the total claims under motor insuranceof various insurance companies. These accidents and claims are of importance anddifficulties in motor insurance claims of various insurance companies.
The indemnity of personal injuries of motor insurance is becoming a problem ofsocial well-being. The high loss ratio in this regard has raised the premium rate ofmotor insurance. The cost of claims is growing with the economic development. Also,the frequent fraudulent claims caused a lot of undue indemnities which seriouslyinfringe the insurance company's profit and the vehicle owner's interest who shall besubject to the burden of high premium rate. This fact is actually endangering the sustainable and stable development of the motor insurance industry and thereforehampered the construction of China's harmonious society.
The author is graduated in the major of forensic medicine and has ten yearsclaims service work experiences in insurance company circle, and has focused on therelatively high loss ratio of Shanghai motor insurance personal injuries claim in a longterm manner. Through analyzing abundant “first-hand” data and precedents whichcollected from CIRC Shanghai, Shanghai Insurance Association, property andcasualty insurance companies and brokers, together with the author's personalpractical experiences, the author has carried out a relatively solid and meticulousresearch for judicial identification of personal injury and related legalcountermeasures about the indemnity of personal injuries of motor insurance.Therefore this paper intends to start from the following three aspects.
Section one, analyze the problems and reasons of the judicial identification of themotor insurance claims.
Current market competition and identification of institutions who pursuit theprofit and other factors leads to the judicial identification of market chaos layer andthe problem identification continues to appear. To analysis the main reasons, there arethe following seven aspects.
1.the choice of assessment time has a greater impact on the identificationconclusions.
There is no authoritative department in our country to make a specific,standardized interpretation of the evaluation time. In actual operation, theidentification of the end of clinical treatment for the same object was always differentconclusion by expert witness' different understanding and cognition. In addition, thedifferences of the rehabilitation time and rehabilitation results of different patientswere also different, and due to the large time span, the conclusion of the re appraisalis not consistent with the conclusion of the initial identification.
2. unilateral application by the injured person.
In accordance with the existing road traffic accident process in Shanghai, theinjured could require traffic accident treatment department to issue a disability letter of authorization or recommendation and he can choose the judicial identificationinstitution by himself. However, this free choice of practice has many drawbacks.Firstly, some injured compare the number of identification institutions conclusion, ortake a bride to the expert witness to get the higher grade identification. Secondly,most of the identification institutions are self financing entries and they would like toshow good to the application to get more clients. Thirdly, “personal injury scalpers”will pursue the familiar judicial identification to see for higher grade identification.
3.the problem of different the expert witness' qualities.
In the current judicial appraisal management standard, there is no specificrequirement for the expert witness' legal literacy and ethics of the personnel.
For example, for some identification institution which usually is called as socialinstitution, mostly they are operated by hospitals or companies with the characteristicsof anchored or contracted operation. So the daily identification skills and legalliteracy and ethics are controlled by the expert witness himself, and this is easy toappear different expert witness' qualities situation. In addition, these institutionscompletely rely on the market, they usually provide the lower identification and withhigh rate of distortion.
4. the evaluation criteria of degree of disability are too old to be optimized andimproved.
Firstly, because of the passage of time and the corresponding interpretationstandard are not detailed enough and other reasons, the content of assessment ofdisability for road traffic accidents in our country could not be adapted to the currentsituation. Secondly, for the judicial expertise opinion about the injury mostly will bedecided by the expert witness' subjective cognitive level for the injury participationrate. The result is often quite different from the different expert witness' judicialexpertise opinion.
5. the problem of the difference between subjective judgment and objectivefacts.
The disability degree assessment or identification is a professional knowledgeof personnel based on the corresponding objective material to make the identification, the subjective cognitive explanation. Only by the experience of the expert, too muchdependence on the identification of the subjective examination, the result is that eachof the identification of a different conclusions. It is hard to find if the expert witnessnegligence or intentional concession.
6. the expert witness disdains to appear in court, it is not easy to apply for there-identification.
According to the existing legal provisions and judicial practice, the judicialrelief measures for the judicial identification of the views are mainly the followingtwo:
The first one is the confrontation of the expert witness appearing in court orwith the assistant of the professional expert. But in the judicial practice, the expertwitness seldom appears in court, and the professional expert wouldn't like to appearin court either. So in generally, the parties or the courts are more inclined tore-identify. The other one is about re-identification. In current law, there are no clearrules about what kind of situations can be re-start the process of identification, and noclear legal basis about the related judging standard and how to choose theidentification institution and expert. This is easy to bring the doubt for the judicialidentification opinion and the justice of court decision.
7.the absence of administrative supervision and self-discipline management.
As a professional technical field of activity, it is quite difficult for judicialexpertise to supervise the administrative supervision. Supervision and managementare often not implemented. It is difficult to effectively monitor the quality of thedisability appraisal. It is also difficult to carry out substantive supervision andrestraint to the identification of institutions and the identification of human behavior.And the judicial authentication Association, as the industry self regulatory body, thelegal effect of the punishment circular is lower, and the problem of the professionaltechnical field is obviously insufficient.
Section two, foreign experience for reference.
1.the experience in Holland and Germany.
China is a country of continental legal system which is the same with Hollandand Germany, compared the judicial identification of people's assessment of accessstandards, Holland and Germany have a higher standard.
The first one is Holland experience. Firstly, in Holland, the judicialidentification of the access and assessment has the higher requirements, the richertraining content and longer time span. Beside the necessary areas of knowledge andexperience in the implementation of the identification of the practice, the expertwitness is also required a certain knowledge of the relevant laws. Secondly, it isqualification period. Generally, the judicial expert witness qualification certificate andregistration is valid for 4 years, after the expiration, they need to re apply forregistration. This means that qualification is not is for life.
The second one is Germany experience. The judicial expert witness should bedivided into different levels according to public trust from high to low, the higher thelevel, the higher the requirement on integrity and moral conduct to the expert witness.For the highest level expert witness, who is not only strictly required the professionaltechnical knowledge and legal regulations of the assessment, but also investigated theintegrity of the applicant's past and moral conduct. Secondly, the applicant must makea public oath before the applicant. Finally, the German litigation law also gives thespecific provisions of the priority to choose the high level expert witness.
2.the experience in South Korea.
In the early years, the situation of insurance fraud in South Korea is similarwith our current situation. Therefore, it is realistic significance to understand thesolution of South Korea.
Firstly, it is organizational structure security. They establish the department ofthe special event of joint insurance policy, different departments cooperate together.
Secondly, they establish the insurance fraud identification system to analyze theinvestigation information for insurance fraud comprehensively, such as insurancecontract, accident and insurance payment. It can realize trending analysis and earlywarning, and search for the collusion between the suspects. Furthermore, theyestablish the insurance crime reporting center. General publish is widely appeal to provide information and clues, if the information is helpful to expose the suspects, allof insurance association and companies will provide reward.
Section third, realize the countermeasures research for the judicial identificationof the claims.
1.the unified Judicial Identification Law should be formulated to realize strictlegal regulation.
In the case of the current judicial appraisal activities, we should speed up theestablishment of a unified Judicial Identification Law or approve the local legislationin advance, and the following aspects of regulation,
Firstly, we should improve the judicial identification of the access standards,and strengthen the judicial identification of people's basic quality requirements.Secondly, we should unify the application of forensic identification, commissioning,acceptance, the implementation of the standard of operation to exclude theinterference of human factors on the judicial appraisal conclusion. Thirdly, we shouldconstruct multi levels of judicial appraisal system: （1） to classify the judicial expertiseand institution; （2） To support the authority of the identification of institutions,improve the mechanism of re appraisal review; （3） To establish the authority of theindividual “national team” rating agencies in certain appraisal projects, in someprojects, the identification of the institution is only accepted by the re appraisal or thecourt's commission.
In addition, we should also develop a standard specification for collectingopinions for judicial identification. （1） We should make the collecting opinionstandard for judicial identification and also make the expert witness appearing in courtrules by the courts and judicial administrative agencies together. （2） We shouldestablishment of medical professional and technical officer system. （3） We shouldestablish special supervision and management mechanism. （4） We should establish aclear judicial expert responsibility system, and the wrong identification and correctionmechanism.
The oath method is helpful to remind and bind the expert and is able to upholdthe law's authority. Therefore, it is feasible to build an oath measure for judicialexpert.
2.make Anti Insurance Fraud Laws, and establish anti insurance fraud system.
First of all, we should formulate a unified Anti Insurance Fraud Laws, clear theconcept and scope of the insurance fraud, which is good for the competent departmentunified understanding of the insurance fraud and take effectively action. Secondly, weshould establish a network platform for the anti fraud work of the judicialidentification, and shear the exchange information to the corresponding department.Thirdly, establish the reporting center of the judicial identification to realize prizereport to achieve the social effects of prevention and treatment.
3.improve the self regulatory mechanism of the judicial identification industryand strengthen the administrative supervision and control mechanism.
To develop a complete set of administrative measures to improve thesupervision and control of the whole course of the judicial expert witness and theinstitution, in order to improve the internal self-discipline mechanism and externalsupervision mechanism: （1） To strengthen the construction of morals, advocatingperfect self-discipline management mechanism. （2） To strengthen the linkagesupervision and management mechanism, such as the establishment for theidentification system and the identification of the black list system to assess eachidentification mechanism and expert witness publicly.
4.strengthen the internal construction of the insurance industry and explore newmechanisms for dealing with disputes.
Establish a complete insurance claims operation system and dispute settlementmechanism, and cooperate with the judicial system to reduce the judicial resourcesoccupation from motor insurance claims.
Firstly, we can build a special network data platform for motor insurance injurycases, with the way of big data analysis, supervise the whole judicial process, toenhance the transparency of judicial identification and improve the objective justice.Secondly, we can establish a new type of quick handing mechanism for insurance contract disputes, and considering from the timeliness, impartiality, authority,legitimacy of the multi dimension considerations, it is a good way to set up a specialarbitration court.
This paper mainly focus on the detailed discussion and analysis of improvingthe thinking and strategies of judicial identification of personal injuries claims undermotor insurance by using the methods of original analysis and empirical analysis,learning from the judicial identification systems of Holland and Germany, the Koreaninsurance anti-fraud measures. This paper also provides relevant legal strategies andsuggestions from multiple aspects of system, policies and techniques to the aforesaidissues to improve the jurisprudence and authority of judicial identification andpromote the advancement of anti-fraud business in motor insurance claims and thesteady growth of motor insurance for further realization of the value of judicialidentification, the maintenance of China's justice and the construction of a trusty andharmonious society.
[Keywords]Personal Injuries claims of Motor Insurance;JudicialIdentification of Personal Injury; Supervision and Regulation;Construction of Mechanism
目 录
导 言
一、问题的提出
二、研究价值及意义
三、文献综述
四、主要研究方法
五、论文结构
六、论文的主要创新及不足
第一章 上海市车险人伤理赔现状分析
第一节上海市车险人伤理赔现状
一、机动车保有量急增、车险人伤事故骤升
二、人伤事故赔款占比畸高
第二节上海市车险市场人伤理赔率高的原因分析
一、保险产品费率设置不合理，无法遏制高赔付率
二、保险人对伤者、肇事方（投保方）的控制力较弱
三、立法和司法过于保护伤者
四、人伤理赔赔偿标准升幅快
五、伤残等级评定或鉴定虚高
第三节上海市车险人伤理赔司法鉴定中的问题及原因分析
一、评定时机对鉴定意见结论影响较大
二、伤者单方申请鉴定问题所在
三、鉴定人员素质参差不一
四、伤残等级定级标准有待优化和完善
五、鉴定人的主观判断与客观事实之间的差距
六、鉴定人怠于出庭，申请重新鉴定困难重重
七、行政监管和自律管理的缺失
第二章 司法鉴定的主观性和客观性问题分析
一、司法鉴定的主观性
二、司法鉴定的客观性
三、司法鉴定主观性与客观性统一的目标与方法
第三章 域外经验借鉴
第一节荷兰和德国的经验
一、荷兰的经验
二、德国的经验
第二节韩国经验
一、组织架构上的保障
二、构建保险诈骗认定系统
三、建立保险犯罪检举中心
第三节台湾地区经验
一、设立中立、独立的争议纠纷处理机构
二、争议纠纷处理的法定效力
第四章 实现上海市人伤理赔司法鉴定公正的对策研究
第一节制定统一的《司法鉴定法》，严格法律规制
一、提升司法鉴定人的准入标准
二、统一司法鉴定的申请、委托、受理、操作标准
三、构建多层次的司法鉴定体系
四、制定司法鉴定意见采信的标准规范
五、明确司法鉴定人责任制，建立错鉴追究机制
六、建立司法鉴定人宣誓制度
第二节制定统一的《保险欺诈法》，健全保险反欺诈体系
一、明确保险欺诈的概念和范围
二、建立涉保的司法鉴定反欺诈工作网络平台
三、设立涉保的司法鉴定检举中心
第三节加强行政监督管控，完善行业自律机制建设
一、加强行风的建设，倡导完善自律管理机制
二、加强联动监督管理机制
第四节加强保险行业“自身内功”建设，探索争议纠纷处理新机制
一、构建车险人伤案件专项网络数据平台
二、创设新型的保险合同纠纷快速处理机制
结 语
参考文献
