However, in the development of the insurance industry market at that time, more emphasis was placed on business expansion rather than on the improvement and improvement of insurance services. Therefore, the insurance agent system and the insurance broker system developed relatively quickly, while the insurance adjuster system developed relatively slowly. Although it was only in 1990 that the first modern adjuster in New China, the Insurance Claims Adjustment Technical Service Center, was officially established in the Inner Mongolia Autonomous Region, setting a model for the development of domestic insurance adjusters. However, since then, only sporadic areas across the country have established insurance adjuster organizations; it was not until February 2000 that the qualification examination for insurance adjusters was held in Guangzhou for the first time.
After 2000, the domestic insurance adjustment industry gradually began to be taken seriously, and the state issued relevant management regulations in a timely manner to guide and promote the development of the insurance adjustment industry. However, due to the limitations of development time and degree of development, the role, stance and functions of my country's insurance adjusters, such as the independence of the insurance adjuster's position, neutrality of stance, objectivity of conclusions, etc., are all limited. Affected by the limitations of institutional development, it has not been fully realized.
1. The role and stance that an insurance adjuster should have
An insurance adjuster is one established in accordance with the Insurance Law and other relevant laws and regulations and with the approval of the China Insurance Regulatory Commission to accept the entrustment of insurance companies, policyholders or insureds to handle the evaluation, inspection, appraisal and loss assessment of insurance subjects. , adjustment and other services, and reasonably collect fees from insurance parties accordingly.
Different from other insurance intermediary entities (insurance agents, insurance brokers), the biggest role characteristic of insurance adjusters lies in their unique role stance and role.
role stance
In the role of an insurance intermediary, the insurance agent mainly represents the interests of the insurer, and the insurance broker represents the interests of the policy holder. The insurance adjuster does not tend to the interests of any insurance party and always maintains an objective, impartial and neutral role. position.
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On the one hand, the contractual relationship signed between the insurance adjuster and the insurance parties is an entrustment relationship, which provides a guarantee for the independence and autonomy of the insurance adjuster when carrying out the adjustment work. Insurance adjusters are free from the constraints and influence of the client (insurance company and policy holder). Therefore, the adjustment results are more objective, fair and accurate.
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On the other hand, because insurance adjuster reports are of great value to insurance claims disputes and judicial trials in practice, according to the relevant provisions of the Insurance Law, an insurance adjuster intentionally or negligently causes losses to the insurer or the insured. , bear liability for compensation in accordance with the law, so the objectivity of the insurance assessment conclusion must be ensured.
role role
As an important part of the insurance intermediary market, insurance adjusters play a multifaceted role in the development of the insurance intermediary industry and the insurance industry. Based on the position of the insurance adjuster mentioned above, this article mainly analyzes its role in insurance claims settlement and industry market development.
As we all know, there is serious information asymmetry between the parties to an insurance contract. In addition, various domestic insurance market entities currently have some irregular market behaviors, such as insurance companies setting unreasonable insurance clauses and evading and rejecting claims; the insured maliciously commits fraud. , fraudulent insurance, resulting in prominent conflicts between the insurer and the insured, affecting the healthy development of the insurance industry market.
An insurance adjuster, as a third-party organization independent of the insurer and the insured, provides assessment, inspection, appraisal, loss assessment, and adjustment for both parties to the insurance contract based on an objective, impartial, and neutral role. and other insurance services. The results of the insurance adjustment report issued by it do not favor any party and can be accepted by both parties to the insurance contract. It is conducive to easing and mediating conflicts between the insurer and the insured and ensuring the objectivity, fairness and impartiality of insurance claims. , Promote the standardized and healthy development of the insurance industry market.
2. Practical development issues on the role and stance of insurance adjusters
Of course, the role positions and role functions mentioned above are more based on the theoretical perspective of the development of the insurance adjuster system. From the practical perspective of the development of the domestic insurance adjuster market, it is currently difficult for my country’s insurance adjusters to Ensure absolute third-party neutrality.
Although the number of domestic insurance adjusters has increased year by year in recent years, and the operating income of insurance adjusters has also continued to increase, there are still certain limitations in the development of their market business, and the operations of insurance adjusters have fallen into a passive state.
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First of all, domestic insurance companies have always had their own personnel for surveying, loss assessment, and loss verification, and some low-end insurance assessment services rely more on their own claims departments;
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Secondly, some high-end insurance adjustment businesses, such as aerospace, nuclear power plants, oil exploration, etc., are mostly occupied by some foreign insurance adjustment companies due to the large value of the subject matter, high professional and technical requirements, high capital investment and business risks. Insurance adjusters lack effective market competitiveness.
At present, insurance companies mainly entrust some claims cases with complicated procedures, involving relatively professional technical fields, and requiring a lot of time and effort to insurance adjusters, in order to minimize their own cost investment.
Objectively speaking, the domestic insurance adjustment business market is relatively narrow, and most of the business sources are entrusted by insurance companies. This results in the survival and development of insurance adjustment agencies being relatively dependent on insurance companies. Under such a market operating background, it is difficult for the cooperation between insurance adjustment agencies and insurance companies to ensure equal subject status, let alone the objectivity, neutrality, and impartiality of adjustment activities. Once the adjustment report issued by the insurance adjustment agency harms the interests of the insurance company during the insurance accident adjustment, it is very likely to affect its subsequent business cooperation with the latter, and thus affect the survival and development of the insurance adjustment agency. Therefore, it is difficult for insurance adjusters to maintain an absolute third-party neutral position.
3. Strengthen insurance claims management and pay attention to insurance assessment and adjustment supervision.
The problem of the role and stance of domestic insurance adjusters is caused by a variety of reasons. Changing this market status requires the joint participation of multiple market activity entities. Especially at a time when the order of the insurance adjustment market is out of balance, the insured's awareness of proactive rights protection and the strict supervision of regulatory authorities are of great significance to standardizing the order of the insurance adjustment market and reshaping the role and stance of the insurance adjustment market.
Actively protect rights - attach importance to insurance claims management
Based on the current status of the insurance adjustment business market, the insured should actively participate in and strengthen insurance claims management by establishing a special claims team and appointing dedicated personnel during the insurance claim settlement process. Management content should include: 1. Collection, review, and verification of accident materials; 2. Research on insurance contract terms; 3. Communication, negotiation, and negotiation of insurance claims (insurance companies or insurance adjusters); 4. Taking judicial means to file cases and prosecute.
Adjustment and adjustment supervision—strengthening insurance adjustment and adjustment supervision
At present, the construction of the legal and regulatory system of the domestic insurance adjuster system needs to be further improved, and the regulatory authorities' normative management and penalties for the business operations of insurance adjusters also need to be strengthened, such as establishing a clearer and stricter liability penalty system for adjusters. , to clarify the relevant illegal behaviors and violations that insurance adjusters should bear during their practice, as well as the severe legal consequences they should bear. Through strong supervision, we will standardize the market operations of insurance adjusters and reshape the role of insurance adjusters as an objective, neutral and impartial third party.
Due to its late development and incomplete development, my country's insurance adjuster system cannot guarantee absolute third-party neutrality at present. In actual insurance claims settlement, the insured should strengthen proactive rights protection and pay attention to insurance claims management; regulatory authorities should also strengthen market supervision, reshape the role and stance of insurance adjusters, and effectively play their important intermediary role.