中国寿险“理赔难”问题浅析.doc

1、中国寿险“理赔难”问题浅析Analysis of Chinese life insurance claimsis difficult problem2012 上半年，保监会接纳人身险公司消费者投诉3923 件，同比增加 145.96%。人身险多因理赔给付胶葛和出售误导缘由投诉，其间理赔胶葛类投诉700 余件，占比28.64%。全国稳妥消费者投诉维权热线 12378 自 4 月 26 日上线注册已满一个月， 到 5 月 23 日，呼入的有用投诉 3930 个，消费者经过12378 热线反映的疑问首要会集在理赔胶葛、效劳办理和出售误导引发退保胶葛等三方面，别离占总量的33%、24%和 22%。，理

2、赔胶葛疑问仍然是投诉的要点。The first half of 2012, the China Insurance RegulatoryCommission consumer acceptance ofLife InsuranceCompany Ltd.3923 pieces of complaints, an increase of 145.96%. Personalinsurancedue topay claimsdisputesand the saleofmisleadingcause complaints,which claims disputes complaints700 piec

3、es,accountingformore than28.64%.Nationalsafe consumercomplaintshotline12378rightssinceApril26thonlineregistration has been over a month, until May 23rd, usefulincoming 3930 consumer complaintshotlinereflect,after12378questionsfirstgatheredinclaimsdisputes,servicemanagementand saleof misleadingelicit

4、sthreesurrender glueGregory,accounted for33% of the total,24%and 22%. , claimsdisputes question remains complaint.一向存在于稳妥行业的 “理赔难” 的疑问已逐步演变成我国的稳妥行业持续前行和开展的阻止，让大家对采办稳妥有些望而生畏，一起，也给许多的投保人带来了极大的担忧。究其缘由来讲，一面是投保方因为对稳妥专业知识短缺， 致使理赔时感到艰难重重。 另一方面，稳妥公司传统粗豪型的运营思路，致使对理赔环节的注重程度不行。一起，稳妥监管对市场上“理赔难”的疑问一向没有出台有用的改善办法，

5、而法制环境的不健全， 也在必定程度进步一步加剧了 “理赔难”疑问。Therehas always been to secure industryclaimsdifficultquestionshave graduallyevolvedintoour country and industrycontinued development and stop, let us together to buy somedaunting, and, for many of the insured caused great concern.Investigate its reason, one is the i

6、nsured because of soundprofessionalknowledge shortage,resultinginadjustmentsaredifficult.On the otherhand, thetraditionalideasa typesafeoperationcompany, which claims the degree of emphasis on links.Together, and regulation of the market claims to questionalways hasno usefulimprovementmeasures,andth

7、e legalenvironment is not perfect, also to a certain extent progressstep exacerbated claims difficult questions.2投保方视点剖析理赔难、 稳妥合同是格局合同， 投保方在短少法令布景及稳妥专业知识， 对格局化的稳妥条款及其内容包括的稳妥职责、职责革除等专业术语知道不精确， 致使投保人对采办的稳妥产品保证职责及职责革除不能彻底知道。 因为稳妥市场的信息不对称， 稳妥公司无法从投保问询奉告书上获悉被稳妥人的一切健康情况， 投保人能够存在不实行照实奉告责任， 稳妥事端发作后稳妥公司拒付， 逐

8、步形成了“投保简单理赔难”的误解。The insured claims difficult points, and the contract is the contract insured in pattern, lack of law knowledge and professional background and, to secure a pattern of the terms and contents include safe responsibilities, duties and otherprofessional terms to know is not accurate, t

9、he safe productson the acquisition of the insured guarantee responsibilitiesand dutiesto notto know. Because of theinformationasymmetryand market, the insurance company can notinsurethatthe bookwas informed that information from all health and human, theinsured can existwithoutthe truthfullyinformre

10、sponsibility,safe trouble after the onset of the insurance company refusedto pay,and graduallyformed a againstclaims difficultmisunderstanding.相较于投保时提交的材料， 理赔需求的索赔材料愈加繁琐。 当前，大多数公司在投保时仅需求填写投保书即可。而实务中，若客户发作3理赔，需求申请人提交的索赔单证有的多达几十页，并且材猜中许多证明需求由政府机关出具， 对客户来讲比拟艰难和繁琐。稳妥公司视点剖析理赔难，稳妥公司曩昔粗豪式运营，重保费、轻办理的表象举目皆是，

11、各家稳妥公司都或多或少存在联系单、情面单，署理人在展业过程中并不知道被稳妥人实在的健康情况，更有甚者明知投保人有病还劝其带病投保。膨润土防水毯 稳妥公司这种事务质量低下的保单，往往理赔本钱高、赔款开销大于保费收入，持久下来就会影响到稳妥公司的盈余水平。Compared to the insured submit materials, materials morecomplicated claim claim demand. At present, most companies atthe time of the applicationonlyneeds tofillintheapplicati

12、on form. In practice, if the customer attack claim,demand the applicant to submit the claim documents have up todozens of pages,and materialsthat needs many issuedbygovernment agencies, speakingtocustomers more difficultandtedious. The insurance company claims difficult points, theinsurancecompany in the pasta typeoperation,heavy premium,lightforrepresentationare finding,the insurancecompanyhasmore or less contact list, either single agent, in the courseoftheexhibitionindustryisnotknown to be healthysituationissafe,even knowing thatthe insuredhas disease also advisedthe sickinsured