Made available in DSpace on 2016-04-26T20:25:37Z (GMT). No. of bitstreams: 1 claudia.pdf: 454535 bytes, checksum: 114b3d1a5962249e005639ff644165de (MD5) Previous issue date: 2007-06-12 / The purpose of this paper is to study the group life insurance contract within the context of a consumer relationship, and, specifically, to investigate the possibility of characterizing the policyholder as a service provider (in the Brazilian Consumer Defense Code s legal definition) in his/its relationship with the insured. Divided into four parts, the paper initially addresses the general characteristics of insurance contracts. In addition, it analyses the peculiarities of group life insurance, mainly its complex contracting process. The third part is exclusively dedicated to the policyholder, the individual or legal entity that enters into a group policy in favor of a certain group of people, playing an important role in the management of the insurance. In the fourth part of the paper, the concepts of consumer, service provider and consumer relationship are reviewed, pursuant to the rules of the Brazilian Consumer Defense Code. Lastly, it is concluded in this paper that the relationship between policyholder and insured is a consumer relationship whenever the policyholder acts as an arm of the insurance company instead of representing the interests of the insured / Destina-se o presente trabalho a estudar o contrato de seguro de vida em grupo como relação de consumo e, em especial, investigar a possibilidade de caracterização do estipulante de seguros como fornecedor na relação que estabelece com o segurado. Dividido em quatro partes, o trabalho cuida, inicialmente, de abordar as características gerais do contrato de seguro. Depois, são estudadas as peculiaridades do seguro de vida em grupo, sobretudo o seu complexo processo de contratação. A terceira parte é dedicada exclusivamente à figura do estipulante, pessoa física ou jurídica que contrata a apólice coletiva em favor de determinado grupo de pessoas e que assume funções essenciais na administração do seguro. Na quarta parte do estudo são abordados os conceitos de consumidor, de fornecedor e de relação de consumo, segundo o CDC. Por fim, conclui-se pela classificação da relação entre estipulante e segurado como relação de consumo, quando o estipulante, ao invés de representar os interesses dos segurados, atua como braço da seguradora

A indústria de seguros é uma atividade econômica relativamente jovem, possuindo raízes na revolução industrial. O desenvolvimento dessa indústria ocorreu de forma bastante intensa durante o século passado, quando a atividade passou a ser inserida na área de gestão de riscos. As Companhias de Seguros que trabalham nesse ambiente de negócio fundamentam todo o processo de precificação dos seus produtos em rígidas bases técnicas e atuariais. O presente trabalho dedica-se ao estudo dessas questões, abordando especificamente os seguros de vida, com ênfase à cobertura de morte. A pesquisa tem por objetivo comparar duas modalidades distintas de seguros que são ofertadas ao mercado: o seguro de vida individual e o seguro de vida em grupo. Embora ofereçam aos consumidores coberturas bastante similares, ambas as modalidades devem obedecer a requisitos e princípios técnicos diferenciados por parte das instituições que fazem a sua gestão. / The insurance industry is a relatively young economic activity; its bases are found in the industrial revolution. The development of such industry occurred in a very intense way in the last century, when the activity started being placed in the area of management of risks. The insurance companies that work in this business environment base the whole pricing process of their products on rigid technical and actuarial bases. The present work aims at studying these questions, focusing on the life insurance, with emphasis on the death coverage. The research intends to explore and compare two distinct modalities of insurance that are offered to the market: the individual life insurance and the group life insurance. Even though they offer similar coverage, they must fulfill requirements and different technical principles ruled by the institutions which are responsible for their management.

A indústria de seguros é uma atividade econômica relativamente jovem, possuindo raízes na revolução industrial. O desenvolvimento dessa indústria ocorreu de forma bastante intensa durante o século passado, quando a atividade passou a ser inserida na área de gestão de riscos. As Companhias de Seguros que trabalham nesse ambiente de negócio fundamentam todo o processo de precificação dos seus produtos em rígidas bases técnicas e atuariais. O presente trabalho dedica-se ao estudo dessas questões, abordando especificamente os seguros de vida, com ênfase à cobertura de morte. A pesquisa tem por objetivo comparar duas modalidades distintas de seguros que são ofertadas ao mercado: o seguro de vida individual e o seguro de vida em grupo. Embora ofereçam aos consumidores coberturas bastante similares, ambas as modalidades devem obedecer a requisitos e princípios técnicos diferenciados por parte das instituições que fazem a sua gestão. / The insurance industry is a relatively young economic activity; its bases are found in the industrial revolution. The development of such industry occurred in a very intense way in the last century, when the activity started being placed in the area of management of risks. The insurance companies that work in this business environment base the whole pricing process of their products on rigid technical and actuarial bases. The present work aims at studying these questions, focusing on the life insurance, with emphasis on the death coverage. The research intends to explore and compare two distinct modalities of insurance that are offered to the market: the individual life insurance and the group life insurance. Even though they offer similar coverage, they must fulfill requirements and different technical principles ruled by the institutions which are responsible for their management.

A indústria de seguros é uma atividade econômica relativamente jovem, possuindo raízes na revolução industrial. O desenvolvimento dessa indústria ocorreu de forma bastante intensa durante o século passado, quando a atividade passou a ser inserida na área de gestão de riscos. As Companhias de Seguros que trabalham nesse ambiente de negócio fundamentam todo o processo de precificação dos seus produtos em rígidas bases técnicas e atuariais. O presente trabalho dedica-se ao estudo dessas questões, abordando especificamente os seguros de vida, com ênfase à cobertura de morte. A pesquisa tem por objetivo comparar duas modalidades distintas de seguros que são ofertadas ao mercado: o seguro de vida individual e o seguro de vida em grupo. Embora ofereçam aos consumidores coberturas bastante similares, ambas as modalidades devem obedecer a requisitos e princípios técnicos diferenciados por parte das instituições que fazem a sua gestão. / The insurance industry is a relatively young economic activity; its bases are found in the industrial revolution. The development of such industry occurred in a very intense way in the last century, when the activity started being placed in the area of management of risks. The insurance companies that work in this business environment base the whole pricing process of their products on rigid technical and actuarial bases. The present work aims at studying these questions, focusing on the life insurance, with emphasis on the death coverage. The research intends to explore and compare two distinct modalities of insurance that are offered to the market: the individual life insurance and the group life insurance. Even though they offer similar coverage, they must fulfill requirements and different technical principles ruled by the institutions which are responsible for their management.

團體壽險是員工福利思潮下之產物，至今已成為分散、轉嫁企業人身及責任風險不可或缺之風險管理工具。而團體壽險以一張保險單承保多數被保險人，此項「團體」之特性使其在核保、保險費、部分有效性及契約條款之設計上，有別於一般之人壽保險。目前，各家保險公司之團體壽險保險單悉以主管機關制訂之「團體一年定期人壽保險單示範條款」為依據。此示範條款以團體為要保人、團體成員為被保險人，將團體壽險定位為由第三人訂立之人壽保險契約，使團體壽險契約受到欠缺保險利益而無效、有無保險法第一○五條之適用及指定、變更受益人之權利人為誰之質疑。其次，團體壽險契約條款中的保險契約構成部分條款、被保險人資格條款、保險契約終止條款、契約轉換權條款、免責條款及不可抗爭條款等亦存在諸多問題，實有檢討予以修正之必要。 因此，本文乃以探討示範條款所涉法律爭議問題為中心，參酌國內學說見解並比較美國判例及美國保險監理官協會所制訂之「團體壽險定義及標準條款模範法案」，對團體壽險契約條款之增訂及修正提出七項建議，包括重新定位團體壽險契約當事人、重視逆選擇防範及被保險人權益保障、明訂兩年不可抗爭期間及團體信用壽險不適用契約轉換權條款及受益人條款、修正個別被保險人保險契約終止之時點及保險人免責事由等，希冀本文之淺見能使示範條款更為完善。 / Group life insurance arises from the thought that employers have the responsibilities to take care of their employees. Until now, group life insurance has become an important part of industries’ risk management plans for distributing and transferring industries’ life and liability risk. Group life insurance insures more than five persons in one policy, and this “group” characteristic makes group life insurance different from general life insurance in many aspects: underwriting, premiums, partly effective and contract clauses. Presently, provisions of group life policies are based on“Model Provisions for Group Yearly Term life Policies”promulgated by competent authority. According to Article 2 of the model provisions, the policyholder is the “group”, and the members of the group are insureds. In other words, group life insurance is entered into by third party. This causes three problems needed to be solved: (1) If the policyholder has no insurable interest in the insured, shall group life insurance be void? (2) Is Article 105 of Insurance Act applicable to group life insurance? (3) Who has the right to designate or change the beneficiary? In addition, there are still some problems in other model provisions including the entire-contract provision, eligibility requirements provision, termination provision, conversion provision, exception clause and incontestability provision. It is necessary to review and revise the model provisions. Therefore, this study focuses on related legal issues of the model provisions. Referring to scholars’ opinions and comparing American verdicts and “Group Life Insurance Definition and Group Life Insurance Standard Provisions Model Act” issued by The National Association of Insurance Commissioners, this study concludes by providing several suggestions in revising the model provisions: (1) The policyholder and the insured should be referred to as members of the group, not “group”. (2) Emphasize on preventing adverse-selection and protecting the insured’s right. (3) Augment incontestable period of two years and a clause which provides that conversion provision and beneficiary provision are not applicable to credit group life insurance. (4) Revise the termination provision and exception clause. Hope these suggestions will make the model provisions more perfect.