First, the important role of integrity in the sustained and steady development of insurance companies
Honesty is a necessary condition for maintaining market order. Reputation, credit and honesty are the cornerstones of market economy, and honesty is not only the requirement of society, but also the need of enterprise's own development. There is a commitment between enterprises and society rooted in the principle of good faith. Enterprises that don't follow this promise can muddle along for a while, but they can't survive for a long time. The operating characteristics of insurance companies determine that honesty is of great significance in its development, which is the foundation of insurance companies' career and the basis of sustained and steady development.
(1) Integrity is an important aspect of the code of conduct of insurance companies. Honesty is loyalty and honesty. Abiding by honesty is a human code of conduct and a basic requirement for coordinating interpersonal relationships. To do insurance, we must first learn to be honest and trustworthy, so it can be said that the most important thing in the code of conduct of insurance companies is honesty. The Insurance Law clearly stipulates that engaging in insurance activities should follow the principle of good faith. The key for insurance companies to implement the principle of good faith is to unite all employees with the values of good faith, and to restrain all employees with the norms of good faith service, so that employees' thoughts and actions can become an organic unity that embodies the company's values and goals. The realization of collective goals comes from each individual's
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* * * Qi Xin works together, individual rationality is a necessary condition for collective rationality, and the good reputation of insurance companies must be based on the honesty and trustworthiness of all employees.
(2) Honesty is the basic principle of insurance companies' exhibition industry. Business development should be based on honesty, treat customers sincerely, provide customers with comprehensive information consulting services, design the most suitable insurance scheme, and complete underwriting claims in a timely, accurate and efficient manner in accordance with laws, regulations and contract terms. Therefore, the insurance company essentially operates a trust relationship, and honesty is its inherent need for survival and development. It is an important task to enhance the competitiveness of insurance companies to strengthen the integrity construction, improve the company's integrity level and create a good integrity atmosphere.
(3) Integrity is the basis of insurance contracts and the basic requirement for insurance companies to maintain their reputation. In its sense, insurance is an economic compensation system to deal with risks through contracts. It is a contractual behavior between the insurer and the insured, and a promise to the future. It arranges a future for the insured that can be rationally predicted and determined. The determination of insurance contract comes from the understanding of the same value of the subject matter of the contract by both parties. Because the information about the actual value is asymmetric, in order to ensure the validity and fairness of the insurance contract, both parties must adhere to a negotiation and cooperation attitude based on honesty. Marketers should correctly explain the terms to the insured, but they should not mislead customers, and customers should also tell their true situation. This is the basis for ensuring smooth implementation.
(D) Integrity is the core of brand management of insurance companies. Market is the soil for enterprises to survive. Expanding market share, cultivating and developing potential future markets are inseparable from brand building. No matter which insurance company wants to achieve stable and long-term development, it must cherish and maintain its own brand. After joining WTO, foreign insurance companies will not only compete with domestic insurance companies for high-quality insurance resources and insurance talents, but more importantly, win the trust of customers through their excellent brands, advanced technologies and high-quality services. The highest level of insurance management is to establish a good brand image among the public, so as to achieve a win-win situation for its own benefits and social benefits, while the core of brand management is to adhere to integrity, and insurance companies can only win the loyalty of customers with integrity.
Two, the "insurance law" on the insured against the principle of good faith.
In order to reflect the importance of the principle of good faith, the new Insurance Law not only strengthens the supervision and supervision of the insurer, but also restricts the behavior of the insured. Once the insured violates the principle of good faith, the insurance fraud will not only get the insurance money, but also be punished by law. Here are some examples to illustrate.
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The consequences and harm caused by the insured's violation of the principle of good faith in insurance fraud further illustrate the importance of the principle of good faith in insurance business activities.
(1) deliberately not telling the truth. The Insurance Law stipulates that if the insured intentionally fails to fulfill the obligation of truthful disclosure, the insurer shall not be liable for compensation or payment of insurance premium or refund the insurance premium for the insurance accident that occurred before the termination of the insurance contract. Specifically, the insured or the insured has disability, illness or discomfort symptoms or is taking medicine before the insurance, or has certain occupational categories, hobbies, living habits, family history and other important circumstances, which affect the insurer's decision whether to agree to underwrite or attach conditions to underwrite, but the insured and the insured deliberately do not tell the insurer, and the insurance agent, in order to promote business, knowingly does not urge them to tell the truth, but colludes with the parties to sign an insurance contract. For example, on April 5, 2002, an insurance company in Changchun received a report that the insured Chen Mou died at home on March 29, 2002, and applied for death insurance money of 375,000 yuan. Because the case involves a large amount of money, the insurance company attaches great importance to it. After careful examination of the claim materials, extensive investigation, evidence collection and judicial intervention, the claim adjuster finally solved the insurance fraud case involving nearly 500,000 yuan. The salesmen of insurance companies collude with the insured and their relatives, deliberately falsify the health status and financial status of the insured, conceal the important fact that the insured suffers from cancer, and defraud insurance money by signing on behalf of the insured and paying premiums.
(2) intentionally creating an insured accident. The Insurance Law stipulates that if the applicant, the insured or the beneficiary intentionally creates an insurance accident, the insurer has the right to terminate the insurance contract, and will not be liable for compensation or payment of the insurance premium, and will not refund the insurance premium unless there are relevant regulations. If it causes the insurer to pay the insurance premium or expenses, it shall refund or compensate. Specifically, the insured or the beneficiary of the insured violates social morality to buy insurance for the insured, and then maliciously creates an insurance accident to defraud the insurance money. Because this kind of insurance fraud is often associated with illegal crimes, although there are few such cases, its influence and harm are the most serious. 1On September 3rd, 997, Liu Wei's wife, who was driving a taxi, took out a life-long principal repayment insurance in an insurance company. The insurance period is one year and the beneficiary is Liu himself. According to the terms, the insured died unexpectedly within the insurance period, and the insurance company paid 60,000 yuan. 1997 12 14 in the morning, Liu quarreled with his wife because of trivial matters. He had long wanted to kill his wife, strangled her alive, stabbed her in the right chest with scissors, deliberately rummaged through the fake scene, took down her gold and silver jewelry and hid it, and then slipped out of the house. It turned out that Liu hoped that his neighbors could find his descendants, and he reported the case to the police. However, after he came back from outside, there was still no movement at home. In desperation, Liu had to report the case himself. After in-depth and meticulous investigation and evidence collection, the police believed that Liu was suspected of committing a crime. In order to further collect evidence, the police wanted to play hard to get, and deliberately released Liu, who had been away for two days, and found that the first thing Liu did after returning home was immediately.
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Apply to the insurance company to pay 60 thousand yuan for the death insurance of his wife. After the trial by the public security organs and further investigation and evidence collection, a cruel case of killing his wife and defrauding insurance was finally solved.
(3) Issuing false certificates or false invoices. The Insurance Law stipulates that after an insured accident, if the insured or the beneficiary of the insured fabricates a false cause of the accident or exaggerates the degree of loss with forged or altered relevant certificates, materials or other evidence, the insurer shall not be liable for compensation or payment of insurance benefits for the false part. If it causes the insurer to pay the insurance premium or expenses, it shall refund or compensate. Specifically, some policyholders, insured persons or beneficiaries take various measures to issue false certificates or invoices to the competent authorities in order to defraud the insurance money after the insured is out of danger. However, some powerful departments often ignore principles, neglect their duties or accept the interests of the insured, the insured or the beneficiary because of various social relations, or think that "I don't want to pay for it anyway", thus opening the door for insurance fraud. If the insured deliberately exaggerates the level of disability during disability appraisal, the insured obviously died of suicide or illness, but at the request of the insured or beneficiary, he issued an accidental death certificate. Prove that the insured's original disability was caused by an insurance accident, falsely invoice medical expenses, and so on. There are also some insured, the insured or their beneficiaries who deliberately leave minor illnesses in hospital for treatment in order to defraud Medicaid or medical expenses insurance benefits, or hang up their beds for treatment in the name of hospitalization, or treat diseases that are not covered by insurance liability in the name of insurance accidents, and so on. Some simply take risks and make false certificates and invoices. The following "insurance fraud" cases belong to this type. Zhou, male, an employee of the State Taxation Bureau, participated in the large supplementary medical insurance for urban workers in early 2002. During the week of June 5438+1October 65438+September, 2003, he filed a claim with the county social medical insurance management office, claiming that he was hospitalized seven times in 2002, with a total cost of 153 146.22 yuan. According to the insurance clauses and agreements, after the medical insurance pooling fund pays 2 1000 yuan, the insurance company should pay a large amount of medical expenses 108778 yuan. The staff of the compensation department of the agent found that there were three invoices for medical expenses in the claim materials, involving an amount of 140209.8 yuan. The claim adjuster went to the hospital to investigate and confirmed that all three invoices were self-made fake invoices, because the hospital implemented electronic management and there were no handwritten invoices at all.
Third, only by effectively preventing insurance fraud can we implement the principle of good faith.
There are many reasons for the above-mentioned insurance fraud and insurance fraud cases, including the insured, the insured and the beneficiary, as well as the insurer and society. If China's national insurance industry wants to develop steadily, it must implement the principle of good faith in every insurance business, and the whole society should pay attention to it. Therefore, insurance companies should effectively guard against insurance fraud and insurance fraud while developing their business. If we ignore this phenomenon, it will bring many negative effects to insurance companies.
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It will be very unfavorable for the development of the insurance industry to misunderstand the insurance company and produce the view that it is easy to insure and difficult to settle claims. Therefore, I believe that to implement the principle of good faith in every work of insurance business activities, we should also do a good job in effectively preventing insurance fraud, insurance fraud and insurance risks from the following aspects to ensure the interests of the insured and make China's national insurance industry bigger and stronger.
(a) from within the insurance company.
1. We should improve the insurance clauses and reduce the possibility of insurance fraud. Although the insurance clauses are unilaterally formulated by the insurer in advance, after the insurance contract is signed, the insurance clauses are transformed into the contents of the insurance contract, which is binding on both the insured and the insurer. Therefore, when drafting insurance clauses, the insurer must use accurate, standardized and clear words to clearly define the insurance liability and exclusion liability. At present, many insurance clauses in our country do not clearly stipulate the exclusion liability of insurance fraud and insurance fraud, but only generally stipulate that the insurer is not liable for the losses caused by the intentional behavior of the insured. Such a provision obviously does not contain all the contents of insurance fraud. In order to better prevent the occurrence of insurance fraud, we should clarify the insurance clauses, improve the contents of insurance contracts, and include fraud liability in the exclusion liability. Only in this way can insurance fraud be reduced.
2 improve the quality of claims personnel, establish scientific claims procedures and standardize claims system. According to the principle of separation of underwriting and claim settlement, a special and high-level claim settlement system should be established. It is necessary to carry out on-site investigation strictly and seriously to find out the causes and losses of the insurance accident, and carefully examine the integrity and authenticity of the relevant certificates submitted by the insurance claimant. It is necessary to establish and improve the compensation system and supervise claims settlement. Specifically, the insurance company claims personnel at all levels must make claims in strict accordance with the prescribed procedures and authority. Each claim must be approved by the competent leader or the superior company, and if necessary, it must be demonstrated by experts. Insurance companies should also establish a standardized claim settlement system, and implement the separation system of loss-receiving personnel, claim settlement personnel, adjusters, auditors and approvers and the double-person system of on-site survey. Everyone should perform their duties, supervise each other and take strict precautions to ensure the quality of claims. At the same time, the claim settlement work should be carried out step by step in strict accordance with the review procedures, and an accident investigation report file should be established for review and summing up experience and lessons. In the settlement of claims, if it is found that compensation is used for personal gain or internal and external collusion fraud, it must be dealt with seriously. Only in this way can we properly settle claims and effectively stop and put an end to insurance fraud.
3, improve the internal monitoring mechanism of insurance companies, strict management, beware of omissions. An insurance company shall establish an underwriting audit system, and repeatedly identify, evaluate and screen the risks of the business undertaken according to procedures. So as to effectively control risks. For underwriting auditors, there should be a corresponding qualification recognition and evaluation system, only with departments.
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Only people with comprehensive professional knowledge, strong sense of responsibility and rich practical experience can serve as underwriters. In addition, it is necessary to establish an evaluation system of underwriting files and auditors' post responsibilities to ensure the quality of underwriting with perfect management.
(2) The external environment from the insurance company.
1, increase the publicity of insurance law. Strictly crack down on insurance fraud. First of all, the staff of insurance companies should seriously study and publicize the newly revised Insurance Law and other relevant laws, understand the spirit of its provisions on insurance fraud, and actively publicize it to all sectors of society, so that the public can have a correct understanding of insurance participation and consciously guard against all kinds of insurance fraud. Let the public know that anti-insurance fraud is not only beneficial to insurance companies, but also beneficial to the insured. At the same time, it is necessary to establish a reward mechanism for reporting. We can consider setting up a special reward fund, publicly reporting telephone numbers, and using the psychology of insiders seeking money to obtain anti-fraud information from the society. Practice has proved that reporting by the masses is very effective in detecting insurance fraud cases. Secondly, insurers should make full use of the rights conferred by law to combat insurance fraud. When insurance fraud occurs, the insurer should actively expose, report and urge the relevant departments to impose administrative or criminal penalties on the fraudster, and must not tolerate it for fear of losing the insured. Finally, the judicial department should strictly enforce the law, and earnestly enforce the law strictly, and those who violate the law will be prosecuted. To handle every case correctly, not only the judicial personnel handling the case need to have a solid legal foundation, but also comprehensive insurance knowledge. Therefore, it is necessary to effectively improve the quality and professional level of judicial personnel, so as to facilitate the timely detection and investigation of insurance fraud and safeguard the legitimate rights and interests of insurers.
2, learn from the successful experience of European and American countries, set up a national or regional anti-insurance fraud organization. On the basis of a unified understanding, the insurance industry in Europe and the United States has set up many joint organizations against insurance fraud and carried out fruitful work, which is worth learning from. Considering the current situation in China, under the policy guidance of the CIRC, insurance industry associations will take the lead in organizing, insurance companies will participate, and public security and procuratorial organs will cooperate to contact insurance intermediary organizations. * * * A national or regional organization similar to "Insurance Fraud Investigation Association" shall be established with capital contribution, and its working regulations shall be formulated, which shall stipulate the rights and obligations of its members, adopt a unified action plan and conduct comprehensive management from a three-dimensional perspective.
3, strengthen the insurance industry and public security, procuratorial, judicial and other departments of the joint, give play to their respective advantages. Under the current conditions, the mode of cooperation should be multi-level and all-round, including both high-level cooperation and mutual cooperation between grass-roots units, which can be case cooperation or the establishment of corresponding liaison institutions. The cooperation may include editing insurance fraud cases, exchanging and teaching the detection methods of insurance fraud cases, and solving these cases together when insurance fraud cases occur.
Fourth, how to establish credit insurance.
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As can be seen from the above discussion, the principle of good faith is indeed very important in insurance business activities, but what should China's national insurance industry do in an invincible position in the face of the entry of "foreign insurance" after China's entry into WTO? In other words, how to build China's credit insurance! In addition to the effective prevention of insurance fraud mentioned above, I think we should also focus on the following aspects:
(1) Enhance the concept of insurance. Insurance behavior is a resource allocation mechanism with contract as the link and credit as the guarantee. On the basis of the principle of utmost good faith, the insurer should regard good faith as a kind of "capital" as important as capital and equipment, participate in the competition through the optimal allocation of the market, and establish a good relationship of mutual trust and mutual commitment with the insured.
(2) Improve the overall quality of the industry. As the insurance industry in China started late, it lacked the corresponding restraint and supervision mechanism during its development. Some agents are driven by interests and violate the principle of good faith, which directly affects the reputation of insurance companies. Therefore, when rectifying and standardizing the insurance market, all insurance companies should strengthen the training of exhibition skills, service means and moral cultivation for employees, especially those in the first-line exhibition industry. At the same time, it is necessary to strictly control the "access" of agents and brokers. Through necessary training, assessment and administrative and economic means, it has a high professional quality and moral standards. Actively perform their duties and establish a good social image of insurance companies.
(3) Improve the service level. The improvement of the service level of the insurance industry depends not only on a good working environment and advanced hardware facilities, but more importantly, it is necessary to improve the professional quality and service skills of each employee, enhance service awareness, and let the service concept penetrate into every work of the insurance business.
(4) Improve market rules. The newly revised Insurance Law puts the principle of good faith in the insurance industry in a very important position, which increases the specific requirements of good faith for insurance companies and insurance intermediaries respectively, and also increases the responsibilities and obligations of insurance companies in the insurance principal-agent relationship. At the same time, the penalties for insurance violations have been increased. These regulations have played a positive role in regulating the insurer's business behavior, making insurance companies pay more attention to the integrity education of employees.
(5) Expand the credit management system. In the process of building insurance credit brand, insurance companies should establish an internal management system with clear responsibilities. Marketing, finance and business departments are all important parts of this system. An insurance company shall conscientiously implement the provisions on insurance integrity supervision, be responsible for evaluating the insured and exhibition personnel, establish customer credit management files and integrity management systems, and formulate insurance industry integrity rules. Supervise the operation process of the business department and follow up the claims.
(six) to establish a true and complete information disclosure system. True and complete information disclosure is beneficial to insurance.
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The development of people themselves is also conducive to the effective supervision of government management departments and increase the transparency of the industry. Therefore, the insurer has the responsibility and obligation to provide true and accurate information to the higher regulatory authorities and the public, and the government regulatory authorities should classify and check these information, formulate corresponding countermeasures, and safeguard the legitimate rights and interests of the insurer.
(7) Increase the sanction function of insurance supervision. Insurance regulatory agencies should not only supervise the daily business of insurers, but also formulate a plan to supervise insurance credit. They should comprehensively evaluate the insurer's credibility through information collection, impose administrative and economic sanctions on the insurer with poor credibility, appropriately reward the insurer with good credibility, and regularly disclose the evaluation of the insurer's credibility to the public.
In short, through the above discussion and the analysis and demonstration of several cases, the importance of the principle of good faith in insurance business activities is fully explained, both for the long-term development of insurance companies and for safeguarding the vital interests of the vast number of policyholders. Therefore, the construction of good faith is the basic principle of insurance industry. As stipulated in the Insurance Law. "The parties to insurance activities should follow the principle of good faith when exercising their rights and fulfilling their obligations". Only in this way can insurance play its role as an economic booster and social stabilizer. However, if there is no trust between the insurer and the insured, the insurance industry will not grow and develop, fraudulent insurance and fraudulent insurance will be impossible to prevent, and the entire insurance industry will lose its development environment and space. The times need the rapid and healthy development of the insurance industry and strongly call for the return of integrity. Therefore, only by establishing and perfecting the insurance credit system and building the insurance credit brand can insurance companies develop steadily and continuously, and China's national insurance industry become bigger and stronger.
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Further reading: How to buy insurance, which is good, and teach you how to avoid these "pits" of insurance.