Abstract] At present, there are dishonest behaviors in the insurance industry, such as easy underwriting and difficult claims; failure to strictly perform insurance contracts; pressure on claims cases and compensation; misleading agents; failure to collect renewal premiums in a timely manner, etc., which have become constraints bottleneck in the development of the insurance industry. Integrity is the fundamental guarantee of the socialist market economy and the lifeline of insurance companies. Therefore, insurance integrity education should be further strengthened; insurance integrity-related legal systems should be established and improved; commitments should be strictly fulfilled; insurance reminders should be implemented, various methods should be comprehensively used to promote the construction of insurance integrity, and achieve the goal of making the insurance industry bigger and stronger.
[Keywords] Insurance integrity, insurance development, integrity education, institutional system, agent, renewal premium, insurance tips, insurance contract
1. Current status of integrity construction in the insurance industry< /p>
As the cornerstone of the development of the insurance industry, integrity construction has received increasing attention, and the work of building integrity in insurance has been initially launched and achieved significant results. However, with the rapid development of business and the rapid expansion of the insurance team, many problems exposed in the construction of insurance integrity have become bottlenecks restricting the development of the insurance industry.
(1) It is easy to underwrite but difficult to claim. Those who should be compensated cannot be paid as soon as possible, and those who should not be compensated cannot be responded to in a short period of time. According to a 2005 survey by a company, the average time from case acceptance to settlement of payment is 64 days per case, with some companies taking more than 100 days, and the processing time of individual cases as long as 2 years, causing customer complaints.
(2) The insurance contract cannot be strictly performed. Some companies simply consider their own benefits and arbitrarily change the content of insurance contracts and lower payment standards; some companies, in order to take care of "relationships" or "work convenience", provide compensation in the form of "agreements" for some cases that should not be compensated, thereby infringing on insurance. Liability reserves harm the company's interests.
(3) Pressure on compensation cases and compensation. This happens mostly at the end of the year. In order to achieve profit and other assessment indicators, some companies suppress the compensation cases that should be handled and withhold the compensation that should be paid to customers until they are processed or paid the following year. Some companies have even stopped handling claims cases since September.
(4) The agent misleads. Individual agents do whatever they can to obtain business. When doing business, they fail to comprehensively and accurately publicize all insurance clauses to customers, exaggerate insurance responsibilities, and fail to mention or minimize exclusions. Especially for participating insurance business, the dividend ratio is exaggerated to mislead customers into purchasing insurance.
(5) Failure to collect renewal premiums in time. The frequent turnover of agents has resulted in a large number of “orphan policies”. Some companies fail to notify policyholders in time and collect renewal premiums, causing the policy to expire and causing losses to customers.
(6) Embezzlement and misappropriation of premiums. Individual agents took advantage of company management loopholes to misappropriate or misappropriate the premiums collected for other purposes. Although some agents have left the company, they still hold on to the "charge receipts" that have not been returned to collect premiums.
(7) Moral hazard. Some policyholders have incorrect motivations for taking out insurance, fail to fulfill their obligation to truthfully report, and take out insurance while sick to obtain insurance benefits. What's more, there are cases where agents and policyholders conspire to defraud insurance companies.
2. Measures to strengthen the integrity construction of the insurance industry
The construction of insurance integrity is a systematic project that not only depends on the integrity construction status of the entire society, but also is closely related to each unit and each person. Relevant, various methods and means should be comprehensively used to construct and promote.
(1) Further strengthen insurance integrity education. To strengthen the construction of insurance integrity, education is the foundation. It is necessary to educate all employees to stand at the height of their own survival and development, the height of the company's survival and development, the height of the survival and development of the entire insurance industry, and the height of matters related to national security, the rise and fall of the nation, and the success or failure of the modernization drive. Fully understand the importance of strengthening the construction of insurance integrity. It is necessary to carry out extensive moral education on honesty and trustworthiness among all employees, advocate "honesty as the basis", and form a good atmosphere of "honesty as a matter of pride and dishonesty as a shame", so that the concept of integrity can be deeply rooted in the hearts of all employees, and integrity can become a reality for every employee. Conscious actions should be taken to implement integrity into specific work (2) Establish and improve the legal system related to insurance integrity. First, further improve the "Insurance Law" and enrich the specific clauses on the good faith of all parties to insurance contracts such as insurers, policyholders, insureds, insurance agents, insurance brokers, insurance intermediaries, etc., and the handling of violators must also be clear. Qualitative and quantitative legal provisions. The second is to promptly formulate and promulgate administrative regulations and rules and regulations that are compatible with the Insurance Law, such as the "Insurance Integrity System Management Measures", "Insurance Market Management Measures", "Anti-Unfair Insurance Industry Competition Law", "Penalty for Insurance Violations" "Measures", "Insurance Information Disclosure Management Regulations" and "Insurance Agent Management Measures", etc., so that the construction of insurance integrity has a legal basis and is fully integrated into the supervision of laws and regulations. The third is to improve the credit management system of insurance companies. First, establish a credit rating system for insurance companies and obtain legal recognition. Secondly, an insurance company credit rating agency should be established to regularly evaluate the credit status of insurance companies. At present, the insurance industry association can be temporarily responsible, and socialized and professional management can be gradually realized.
Third, establish credit files of insurers, insurance practitioners, policyholders and insureds, establish an insurance credit information network, and realize the full sharing of information resources by insurance institutions, regulatory agencies and society. Fourth, formulate credit rating standards to provide a reliable basis for insurance credit assessment and avoid arbitrariness in assessment work. Fifth, standardize insurance information disclosure, regularly publish insurance credit evaluations and "blacklists" of bad records to the public, and accept social supervision. Sixth, strengthen social and mass supervision. Further improve the construction of the customer service call center and accept supervision from customers. Hire insurance supervisors and listen extensively to feedback and opinions from all aspects of society in order to improve work in a timely manner. Seventh, strengthen the punishment mechanism for dishonesty and effectively bring into play the dual punishment functions of law and market on dishonesty. It is necessary to increase the cost of dishonesty and severely punish dishonest persons in accordance with the Insurance Law and relevant laws and regulations to maintain the overall industry credit of the insurance industry. Eighth, establish an insurance market exit mechanism. For agents who have bad records and are included in the "blacklist", insurance companies should terminate their agency contracts, and other insurance companies cannot hire them again within the specified period of time. Insurance companies that are not trustworthy, or insurance companies that have failed credit evaluations for two consecutive years, should be ordered to withdraw from the insurance market to enhance the sense of crisis and responsibility in insurance operations.
(3) Strictly fulfill commitments. When customers buy insurance, they buy protection, they buy reputation, and they buy services. What they care most about is whether the insurance company can truly fulfill its insurance promise.
First, integrity underwriting. The first is to accurately and comprehensively publicize insurance terms, not only to clearly explain insurance liabilities, insurance rates and insurance benefits to customers, but also to explain exclusions, deductibles and surrender deductions to customers. For insurance dividend products, the insurance benefits must be objectively promoted, and the dividend rate must not be exaggerated to induce customers to buy insurance. 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 policy holder must be filled in truthfully by the policy holder himself, and the insurer (including insurance agent) is not allowed to sign on his behalf. Avoid invalid contracts and damage to customer interests. The third is to issue insurance policies in a timely manner. After receiving the insurance premium, the insurance company must issue the insurance policy in a timely manner in accordance with the content of the insurance policy and relevant regulations, and instruct the agent or send a designated person to deliver the original insurance policy and relevant insurance documents to the customer, so that the customer can purchase insurance with confidence.
Second, settle claims with integrity. Claims settlement is a hot topic of customer concern, the focus of complaints, and the focus of the company's integrity building. First, implement the access system for personnel in claims positions, insist on holding certificates to work, strengthen training, and continuously improve the quality of claims personnel. The second is to formulate a "Claims Settlement Work Process". From case registration, accident investigation to insurance adjustment, payment, etc., every step must have clear regulations and requirements. The third is to open up a green channel for claims settlement. Immediate payments will be made for small-sum compensation cases; a compensation prepayment system will be implemented for major gambling cases to reduce the burden on families and society. The fourth is to formulate the "Measures for the Assessment of Claims Quality" to increase the assessment of indicators such as insurance case investigation rate, case settlement rate, case settlement speed and claim settlement quality. All cases involving insurance liability must be investigated, studied and paid in a timely manner. There should be no delay, let alone lingering on for a long time. For cases that are not covered by insurance, explanations should be provided to customers as soon as possible, and we should resolutely put an end to the phenomenon of arbitrarily suppressing compensation cases and suppressing compensation for our own interests, and fundamentally solve the problem. The problem of "it is easy to obtain insurance but difficult to claim". The fifth is to establish a system for publicizing claims handled by the company within a certain range and accept the supervision of employees and the society. The sixth is to implement a system of designated hospitals and resident representatives. The insurance company signs a cooperation agreement with the hospital to provide targeted treatment to the 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 claim assistance. < /p>
Third, it is necessary to designate a dedicated person to collect renewal premiums in a timely manner, so that the "orphan policies" are not "alone" and the renewal premium collection method must be continuously improved and collected through banks. , establish a team of collectors and other channels to collect renewal premiums in a timely manner to avoid policy lapse and effectively safeguard the interests of customers.
Fourth, make return visits to customers through the telephone service center and agents. Conduct comprehensive return visits on orders, cancellations, expired and permanently expired policies, surrenders, benefits, complaints, etc. Through return visits, we can not only deepen the contact and communication between the company and customers, but also timely discover and solve problems in underwriting, benefits, etc. existing problems and protect the interests of the company and customers.
(4) Implement insurance reminders. Let customers buy insurance with confidence and pay premiums with confidence. First, the sales staff come to sell insurance. When collecting renewal premiums, the "Insurance Agent Qualification Certificate" and "Business Exhibition Certificate" should be presented to the policy holder to facilitate the policy holder's inquiry and verification. Second, the insurance salesperson should carefully read the insurance terms and tips before applying for insurance. Please read the insurance terms carefully, especially the insurance liability, exclusions, deductibles, surrender deductions and other matters. The insurer must inform the policy holder truthfully and sign the health status. Fourth, the product return rate reminder. For insured investments and dividend insurance, the policy holder must be reminded that the rate of return is uncertain, and the product brochure or insurance benefit calculation sheet must be prompted. The estimated figures in the figures and the calculation of the rate of return in the promotional materials are only assumptions about future returns and cannot guarantee actual future returns.
The fifth is to ask for documentation reminders. After the contract is established, the policy holder is reminded to promptly request the insurance policy, insurance clauses, premium invoice or premium receipt and other insurance certificates from the salesperson or insurance company. Sixth, claim reminder. The policy holder or the insured is reminded that after an insurance event occurs, he or she must report it promptly and hold the insurance policy, premium receipt, event certificate (accident certificate, disability certificate, death certificate, medical expense receipt, etc.), collection certificate (household register, ID card, etc.) until the insurance company applies for a claim.