Abstract: At present, the insurance industry is easy to underwrite and difficult to settle claims. Can not strictly perform the insurance contract; Urgent compensation cases and urgent compensation; The agent is misleading; Dishonest behaviors such as failing to collect renewal premiums in time have become the bottleneck restricting the development of the insurance industry. Honesty is the fundamental guarantee of socialist market economy and the lifeline of insurance companies. Therefore, we should further strengthen the education of insurance integrity; Establish and improve the relevant legal system of insurance integrity; Strictly fulfill the promise; Implement insurance tips, comprehensively use various ways to promote the construction of insurance integrity, and realize the goal of making the insurance industry bigger and stronger.
[Keywords:] insurance integrity, insurance development, integrity education, system, agent, renewal premium, insurance tips, insurance contract
First, the status quo of credit construction in the insurance industry
As the cornerstone of the development of the insurance industry, credit construction has been paid more and more attention, and the insurance credit construction has been initially carried out and achieved remarkable results. However, with the rapid development of business and the rapid expansion of insurance team, many problems exposed in the construction of insurance integrity have become the bottleneck restricting the development of insurance industry.
(a) underwriting is easy, but it is difficult to claim. Those who should be compensated can't be paid as soon as possible, and those who shouldn't be compensated can't give customers a reply in a short time. According to the investigation of a company in 2005, the average time from case acceptance to payment settlement is 64 days, some companies take more than 100 days, and some cases take as long as 2 years, which leads to customer complaints.
(two) can not strictly fulfill the insurance contract. Some companies simply consider their own interests, change the contents of insurance contracts at will, and lower the compensation standard; In order to take care of "relationship" or "work convenience", some companies pay compensation in the form of "agreement" for some cases that should not be paid, encroaching on the insurance liability reserve and harming the company's interests.
(3) Cases of pressing compensation and pressing compensation. Most of this happens at the end of the year. In order to complete the assessment indicators such as profit, some companies delay the settlement of claims and postpone the compensation paid to customers to the next year. Some companies even stopped processing claims after September.
(4) The agent is misleading. Individual agents get business by hook or by crook. During the exhibition, they can't fully and accurately publicize all the contents of the insurance clauses to customers, exaggerate the insurance liability, and don't talk about or talk less about the exclusion liability. In particular, the dividend insurance business exaggerates the dividend ratio and misleads customers to insure.
(5) Failing to collect the renewal money in time. Due to the frequent flow of agents, a large number of "orphan policies" have been produced. Some companies can't inform the insured in time and collect the renewal premium, which leads to the invalidation of the policy and brings losses to customers.
(6) embezzling and misappropriating insurance premiums. Individual agents take advantage of loopholes in the company's management to keep the premiums collected for themselves or use them for other purposes. Although some agents have left their jobs, they still keep the unpaid "handling fee receipts" for themselves to collect premiums.
(7) Moral hazard. Some policyholders have incorrect insurance motives, fail to fulfill their obligation of telling the truth, take out insurance despite illness, and defraud insurance money. What's more, there is a phenomenon that agents collude with policyholders to defraud insurance companies.
Second, measures to strengthen the integrity of the insurance industry
Insurance credit construction is a systematic project, which not only depends on the situation of the whole social credit construction, but also is closely related to every unit and everyone. We should comprehensively use various methods and means to carry out construction and promotion.
(a) to further strengthen the education of insurance integrity. Strengthening the construction of insurance integrity, education is the foundation. It is necessary to educate all employees to stand on the heights of their own survival and development, the survival and development of the company, the survival and development of the entire insurance industry, national security, the rise and fall of the nation and the success or failure of modernization, and fully understand the significance of strengthening the construction of insurance integrity. It is necessary to widely carry out moral education of honesty and trustworthiness among all employees, advocate "honesty-oriented", form a good atmosphere of "being proud of trustworthiness and ashamed of breaking promises", let the concept of honesty penetrate into the hearts of all employees, let honesty become every employee's conscious action, and implement honesty in specific work. (2) Establish and improve the legal system related to insurance integrity. First, further improve the insurance law, enrich the specific good faith clauses of the parties to insurance contracts such as insurers, policyholders, insured, insurance agents, insurance brokers and insurance intermediaries, and have clear qualitative and quantitative legal provisions on the handling of offenders. Second, we will promptly formulate and promulgate administrative regulations and rules and regulations that are compatible with the Insurance Law, such as the Measures for the Administration of Insurance Credit System, the Measures for the Administration of Insurance Market, the Law against Unfair Insurance Competition, the Measures for the Punishment of Insurance Violations, the Provisions for the Administration of Insurance Information Disclosure, and the Measures for the Administration of Insurance Agents, so that the construction of insurance credit can be fully regulated by laws and regulations. The third is to improve the credit management system of insurance enterprises. First of all, establish a credit rating system for insurance companies and pass legal recognition. Secondly, establish a credit rating agency for insurance companies and regularly evaluate the credit status of insurance companies. At present, the insurance industry association can be temporarily responsible for gradually realizing socialized and professional management. Third, establish the credit files of insurers, insurance practitioners, policyholders and the insured, and establish an insurance credit information network to realize the * * * sharing of insurance institutions, regulatory agencies and social information resources. Fourth, establish credit rating standards, so that the insurance credit evaluation has a reliable basis and avoid the arbitrariness of the evaluation work. The fifth is to standardize the disclosure of insurance information, regularly publish insurance credit evaluations and "blacklists" with bad records, and accept social supervision. Sixth, strengthen social and mass supervision. Further improve the construction of customer service call center and accept customer supervision. Hire insurance supervisors to listen to the feedback and opinions from all walks of life, so as to improve the work in time. Seventh, strengthen the disciplinary mechanism of dishonesty, and effectively play the dual disciplinary role of law and market on dishonesty. It is necessary to increase the cost of breaking promises, severely punish those who break promises according to the Insurance Law and relevant laws and regulations, and safeguard the credit of the insurance industry as a whole. Eighth, establish an insurance market exit mechanism. The insurance company shall terminate the agency contract of the agent whose bad record is included in the "blacklist" and shall not re-employ other insurance companies within the prescribed time limit. Insurance companies that do not attach importance to credit, or those whose credit evaluation is unqualified for two consecutive years, should be ordered to withdraw from the insurance market to enhance the sense of crisis and responsibility of insurance business.
(3) strictly fulfill the promise. When customers buy insurance, they buy protection, reputation and service. What they are most concerned about is whether the insurance company can really fulfill its insurance promise.
First of all, good faith underwriting. 1. To publicize the insurance clauses accurately and comprehensively, we should not only explain the insurance liability, insurance premium rate and insurance payment to customers, but also explain the excluded liability, deductible and surrender deduction to customers. For insurance dividend products, we should objectively publicize the insurance income, and we should not exaggerate the dividend rate to induce customers to insure. The second is to standardize procedures. According to the provisions of the insurance contract, the matters and contents that should be filled in by the applicant must be truthfully filled in by the applicant himself, and the insurer (including the insurance agent) may not sign on his behalf. Avoid invalid contracts and harm the interests of customers. The third is to issue the insurance policy in time. After receiving the insurance premium, the insurance company should issue the insurance policy in time according to the contents and relevant regulations, and instruct the agent or send someone to deliver the original insurance policy and relevant insurance documents to the customer, so that the customer can rest assured of insurance.
Second, settle claims in good faith. Claims settlement is the focus of customers' concerns and complaints, and it is also the focus of the company's integrity construction. First, implement the access system for claims personnel, adhere to certificates, strengthen training, and continuously improve the quality of claims personnel. The second is to formulate a "claim settlement workflow", from filing registration and accident investigation to insurance adjustment and payment. Every step should have clear regulations and requirements. The third is to open up a green channel for claims. Immediate payment of small claims; Pay in advance for major gambling cases to reduce the burden on families and society. The fourth is to formulate the Measures for the Assessment of Claim Quality, and strengthen the assessment of the settlement rate, settlement rate, settlement speed and claim quality of insurance cases. All insurance liability cases must be investigated and paid in time, and it cannot be delayed, let alone delayed for a long time. For situations that do not belong to insurance liability, we should also explain to customers as soon as possible. Resolutely put an end to the phenomenon of arbitrary compensation and compensation for one's own interests, and fundamentally solve the problem of "easy insurance and difficult claims". The fifth is to establish a publicity system for claims cases. Regularly publicize the claims handled by the company within a certain range and accept the supervision of employees and society. The sixth is to implement the system of designated hospitals and resident representatives. Insurance companies sign cooperation agreements with hospitals to implement fixed-point treatment for insurance "patients". At the same time, the company's professionals are selected as resident representatives to provide services such as condolences, case acceptance, case investigation and assistance in claims settlement for insurance "patients".
Third, collect the renewal premium in time. In particular, the "orphan policy" should be handled by designated people so that the "orphan policy" is not "lonely". It is necessary to constantly improve the collection method of renewal insurance premiums, collect them in time through banks, establish a collection team, avoid the invalidation of policies, and earnestly safeguard the interests of customers.
Fourth, do a good job in customer return visits. Through the telephone service center and agents, we will pay a comprehensive return visit to new orders, cancellation orders, invalid and permanently invalid policies, surrender, compensation and complaints. Through the return visit, we can not only deepen the contact and communication between the company and customers, but also find and solve the problems in underwriting and compensation in time, and safeguard the interests of the company and customers.
(four) the implementation of insurance tips. Let customers clearly buy insurance and pay the premium with peace of mind. The first is the identity prompt of the salesperson. When a salesperson sells insurance or collects renewal premium, he/she shall show the insurance agent qualification certificate and exhibition certificate to the applicant, which is convenient for the applicant to check and verify. The second is to read the insurance clauses carefully. Before applying for insurance, insurance sales personnel should remind the insured to read the insurance clauses carefully, especially the insurance liability, exclusion liability, deductible, surrender deduction and other matters. The third is telling the truth and autographing tips. According to the provisions of the insurance contract, the insured's physical health and other contents and matters that should be truthfully informed must be presented and signed. The fourth is the prompt of product return rate. For investment insurance and dividend insurance, it is necessary to remind the insured that the rate of return is uncertain. It is suggested that the calculation figures in the product manual or insurance interest calculation book and the calculation of the rate of return in the publicity materials are only assumptions about the future income, and cannot guarantee the actual income in the future. The fifth is to ask for documents. After the contract is established, it is recommended that the applicant ask the salesperson or insurance company for insurance certificates such as insurance policy, insurance clauses, premium invoice or premium receipt in time. The sixth is the claim prompt. Prompt the applicant or the insured to report the case in time after the insured event, and hold the insurance policy, premium receipt, event certificate (accident certificate, disability certificate, death certificate, medical fee receipt, etc.). ) and proof of payment (household registration book, ID card, etc. ) until the insurance company applies for a claim.