Recently, some consumers complained to this magazine that when collecting premiums, insurance salespeople greeted them with smiles and were always on call, even without being called. However, when it came time to settle claims, they were hard to see and their faces were ugly. It is difficult to handle; insurance salesmen also complain: it is not that it is difficult to settle claims, but that it is difficult to connect the information provided by consumers with the procedures required by insurance companies; at the same time, insurance companies also pointed out that it is difficult to conduct on-site inspections, investigate and collect evidence, control claims, and communicate with customers. …So, how difficult is it to settle insurance claims, which has been criticized by consumers and industry insiders for many years?
Personal insurance sales violations are the most prominent
Insurance is divided into personal insurance and property insurance according to the insurance subject matter. Personal insurance is specifically divided into life insurance, health insurance, children's insurance, pension insurance, and accident insurance. Insurance, etc. Life insurance can be divided into term life insurance, endowment insurance and whole life insurance. Health insurance can be divided into critical illness insurance and medical insurance.
A few days ago, the China Insurance Regulatory Commission issued a notice on insurance consumption complaints in 2016. The report shows that there are 16,039 consumer complaints involving personal insurance. Among them, there were 13,686 complaints about insurance company contract disputes and 2,314 complaints about suspected violations of laws and regulations; there were 24 complaints about insurance intermediary contract disputes and 15 complaints about suspected violations of laws and regulations.
Looking at the types of complaints, among insurance company contract disputes, there were 5,651 underwriting disputes, accounting for 41.29%. This mainly reflected that the sales staff did not explain the terms clearly, did not fulfill their obligation to inform and explain, and the other party clearly refused. Still having trouble making calls etc. There were 4,230 claims/payment disputes, accounting for 30.91%, mainly involving liability disputes for disease insurance, medical insurance and accident insurance. Consumers complained about insurance companies taking out insurance during the observation period, taking out insurance while sick, not falling within the scope of claims, and not having the disease or disability level. It is controversial to refuse compensation for reasons such as meeting the compensation conditions. There were 1,943 surrender disputes, accounting for 14.20%, mainly disputes over surrender conditions, procedures and surrender amounts.
Among the complaints about alleged violations of laws and regulations by insurance companies in personal insurance, there were 2,068 sales violations of various types, accounting for 89.37% of the total complaints about violations of laws and regulations, of which 2,015 were suspected of fraud and misleading, mainly in the promise of high returns or Failure to truthfully inform income status, promote and sell insurance products in the name of bank wealth management, deposits, funds and other financial products, induce policyholders to not truthfully inform health conditions, fail to truthfully answer follow-up questions, sign on behalf of customers, copy risk warnings on their behalf, use insurance policies as Inducing consumers to surrender existing policies and purchase new insurance on the grounds of upgrading.
Looking at sales channels, there were 7,802 complaints involving personal agents, accounting for 48.64%; and 3,389 complaints involving bank mail channels, accounting for 21.13%. In terms of insurance types, the most complaints were about participating insurance with 5,803 cases, accounting for 36.18%; ordinary life insurance with 4,047 cases, accounting for 25.23%; and accident insurance with 2,389 cases, accounting for 14.89%.
The difficulty in settling property insurance claims lies in auto insurance
There were 16,403 consumer complaints involving property insurance. Among them, there were 15,965 complaints about insurance company contract disputes and 382 complaints about suspected violations of laws and regulations; there were 51 complaints about insurance intermediary contract disputes and 5 complaints about suspected violations of laws and regulations.
In terms of the types of complaints, insurance company contract disputes accounted for 97.33% of the complaints. The most common complaints were claims disputes. There were 12,077 claims/payment disputes, accounting for 75.65% of the total contract dispute complaints. Among them, , there were 10,160 auto insurance claim disputes, accounting for 84.13% of the claim disputes. The main complaints are as follows: the company makes a decision to refuse compensation or exempt from compensation based on the terms of the contract, but the consumer does not accept it; the two parties have disputes over maintenance plans, parts prices and labor hours; the claim settlement time limit is too long, the claim settlement materials are cumbersome, and the consumer experience Bad and so on. There were 2,412 underwriting disputes, accounting for 15.11%, mainly reflecting issues such as premium calculation disputes, underwriting without consent, deduction of premiums without consent, insufficient notification of insurance liability, untimely delivery of policies or invoices, and disturbing residents through telemarketing.
Looking at sales channels, the most complaints involved 4,313 personal agents and 2,525 telephone sales, which mainly sold traditional insurances such as auto insurance and corporate property insurance. There were 1,721 cases through online sales channels, involving return freight insurance, flight delay insurance, travel accident insurance and various short-term new products. The two parties disputed whether the accident was covered by insurance liability. Consumers complained that the website sales did not fully disclose the insurance because they were denied compensation. Important information.
Can’t contact the insurance salesperson? Contact the insurance company directly
Many consumers complain that when it comes time to settle insurance claims, they cannot contact the salesperson who originally signed the insurance contract with them, leaving them with no way to settle their claims. Yang Wensu and Zhang Fengting of Minsheng Insurance Beijing Branch told reporters from Beijing Evening News Financial Weekly that if you cannot contact the insurance salesperson, first look at the prompt claims materials in the insurance contract service guide, or directly call the insurance company’s customer service hotline, or learn from the contract For the address of the insurance company, go directly to the company counter. Moreover, some life insurance companies provide mobile APPs or WeChat official accounts, where you can apply for claims directly. Insurance consumers must be aware that if they have insurance-related needs, they should contact the insurance company directly.
Elephant Insurance CEO Yang Zhe said that as an Internet insurance company, it uses existing Internet technology to combine with the traditional insurance industry to solve insurance claims through online customer service interaction, intelligent customer service answers and other methods. The salesperson's situation can simplify, cartoonize, and fragment the professional, boring, and difficult-to-understand issues of traditional insurance clauses, lower the threshold for consumers to understand insurance products, and help them fully understand the product's coverage. Through this kind of guidance, users can more clearly understand the exemption and deductible provisions outside the scope of guarantee liability, and they will treat them more rationally when they are in danger. In addition, as an Internet insurance company, with the help of mobile Internet technology, especially the development and application of big data and cloud computing, it can assist users to complete the paperless submission of claim materials, check and verify claim materials, etc. during the insurance claim process, simplifying the claims process.
Is it difficult to define whether to compensate or not to compensate? Fully understand the terms of the contract
Consumers often complain that claims are difficult to make because insurance companies are so literal-minded and reject the claims on the grounds that the accident "is a subjective accident and not an external injury" or "accidents caused by disease are not covered by insurance liability under the contract". compensation, arguing that "this is not the insurance liability stipulated in the contract."
In recent years, people’s awareness of insurance has gradually increased, the proportion of insurance in financial arrangements has continued to increase, and insurance needs have emerged in an endless stream. However, in the face of insurance, a multi-disciplinary field that integrates law, medicine, advanced mathematics, etc. Regarding consumer goods, some policy holders do not fully understand the terms of the insurance. When the insurance company does not compensate them when they think they are in danger, they complain that "it is difficult to settle claims", or even think that "insurance is a scam." In fact, insurance products are the same as cars, household appliances, mobile phones and other products. They are subdivided by function and there are many types. They all "perform their own functions". If a person only buys accident insurance, the insurance company will not bear the customer's medical insurance liability due to critical illness. Every insurance contract has agreed upon insurance liabilities and exemptions.
Yang Wensu and Zhang Fengting of Minsheng Insurance Beijing Branch pointed out that it is crucial to understand the "insurance liability" and "exemption from liability" stipulated in the contract before purchasing insurance. The only effective communication platform between consumers and insurance companies is the insurance contract, and the contract is the only basis for defining compensation and non-compensation. Therefore, before purchasing insurance, policy holders must evaluate their own risks. Different insurance consumer products are needed at different stages of life. When purchasing insurance, be sure not to follow others' opinions, which will lead to insurance protection failing to fully cover the risks faced by individuals.
In addition, insurance companies should be market-oriented in formulating and implementing terms and rates, and make the terms as clear and understandable as possible. When there are inconsistencies in the definition and interpretation of claims, most common understandings can be reached through repeated communication between the two parties or through separate consultations with experts on the issues involved.
Is it difficult for the insurance company to investigate and the claims adjusters are unprofessional? Regulatory authorities must "punch hard"
Insurance companies must verify claims based on the scope of claims stipulated in the insurance contract, relevant supporting materials, documents, etc. If doubts arise, they may need to investigate and may encounter relevant Units and agencies fail to cooperate, leading to delays; claims adjusters are rushed into work without undergoing strict training and examinations, or have misunderstandings of the content stipulated in the contract, which can also cause insurance consumers to feel that it is difficult to settle claims.
Insurance companies and even the industry should establish a long-term mechanism for the training and onboarding of claims adjusters, establish files and continuously assess the error rate of claims adjusters, and if industry standards can be unified, those who fail to meet the required standards will be Corresponding penalties will be imposed to completely solve the problem of difficulty in settling claims.
Article 23 of the "Insurance Law" clearly stipulates: "After receiving the insured's or beneficiary's request for compensation or payment of insurance benefits, the insurer shall make a timely determination; in complex circumstances, it shall Approval shall be made within 30 days, unless otherwise agreed in the contract. "Among the eight "quantitative indicators for service evaluation" of life insurance companies formulated by the China Insurance Regulatory Commission, "claim settlement service timeliness" and "claim settlement recovery rate" are the key to assessing the claim settlement services of life insurance companies. , accounting for 35% quantitatively; the Beijing Insurance Association also includes claims with a claim amount of less than 3,000 yuan into the category of simple cases, requiring the verification to be completed on the same day of acceptance.
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