The new Insurance Law, which came into effect on January 1, 2003, has the principle of good faith, which is the first of the four major principles of insurance, written into the law in an unmistakable manner. Among the six new provisions, three are related to good faith. "The principle of honesty and good faith shall be followed by the parties involved in insurance activities in exercising their rights and fulfilling their obligations" is included in the first chapter of the General Provisions as the purpose of insurance operation, and "the insurance company shall strengthen the training and management of insurance agents. Insurance companies shall strengthen the training and management of insurance agents, improve the professional ethics and business quality of insurance agents, and shall not instigate or mislead insurance agents to carry out activities contrary to the obligations of good faith", which is even more to the point, and "insurance companies' business reports, financial and accounting reports, actuarial reports, and other relevant statements, documents and information must be truthful records of insurance business matters, and shall not have false records, misleading statements and material omissions", also has strong practical significance and guidance. The following is the principle of good faith on the insurance company's sustained and sound development of the important role to discuss:
A, good faith on the insurance company's sustained and sound development of the important role
Integrity is to maintain the market order of the necessary conditions. Reputation, credit, trust is the cornerstone of the market economy, enterprises should be honest this is not only the requirements of society, but also the need for the development of the enterprise itself. Between the enterprise and society there is a kind of commitment rooted in the principle of good faith, do not follow this commitment to the enterprise, can be fooled for a while, but it is impossible to survive for a long time. The operating characteristics of the insurance company decided in its development, integrity is particularly important, it is the insurance company's business foundation and the basis for sustained and sound development.
(A) integrity is an important aspect of the insurance company's code of conduct. Integrity that is loyal and honest, abide by the credit is a norm of people's behavior, but also to coordinate the basic requirements of interpersonal relations. Do insurance first learn to be honest and trustworthy, so it can be said that the most important rule of conduct for insurance companies is integrity. The Insurance Law clearly stipulates that insurance activities should follow the principle of honesty and trust. The key for insurance companies to implement the principle of good faith is to use the value of good faith to unite all employees, and to use the code of good faith service to restrain all employees, so that the thinking and actions of the employees become an organic unity reflecting the values and goals of the company. The realization of collective goals from each individual
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*** with the efforts of individual rationality is a necessary condition of collective rationality, the good reputation of the insurance company must be built on the basis of honesty and trustworthiness of all employees.
(2) Honesty is the basic guideline for insurance companies to develop their business, develop their business in good faith, treat customers with sincerity, provide customers with comprehensive information and consulting services, design the most appropriate insurance program, underwriting and claims should be completed in a timely, accurate and efficient manner in accordance with the laws, regulations and the provisions of the contract terms. Therefore, in essence, the insurance company operates a relationship of trust, integrity-based is its survival and development of the inherent need to strengthen the integrity of the construction, improve the integrity of the company, to create a good atmosphere of integrity is to improve the competitiveness of insurance companies is an important task.
(3) Integrity is the basis of the insurance contract, is the basic requirements of the insurance company to maintain credibility. Insurance from its meaning is a contractual way to deal with the risk of economic compensation system, it is a contract between the insurer and the insured behavior, is a promise about the future, it is arranged for the policyholder can be rationally predicted and determine the future of the insurance contract from the parties to the contract subject to the recognition of the same value of the ****, due to the asymmetric information about the actual value of the In order to ensure that the insurance contract is effective and fair, both parties must adhere to an attitude of negotiation and cooperation based on good faith. The marketer has to explain the terms and conditions correctly to the policyholder without misleading the customer, and the customer has to inform himself truthfully of his real situation. This is the basis for ensuring that there can be successful fulfillment.
(d) Integrity is the core of brand management of insurance companies. The market is the soil on which enterprises depend for survival. Expanding market share and cultivating and developing potential future markets are inseparable from brand building. Regardless of which insurance company, in order to obtain stable and long-term development, we must treasure and maintain our own brand. After the accession to the WTO, foreign insurance companies entering the Chinese market will not only compete with domestic insurance companies for high-quality insurance sources and insurance talents, but more importantly, they will also win the trust of customers through their excellent brand names, advanced technologies and quality services. The highest level of insurance management is to establish a good brand image in the public, in order to achieve a win-win situation for its own benefits and social benefits, and the core of brand management is to adhere to the integrity of the insurance company, the only way to win the loyalty of customers is to be honest.
Two, the "Insurance Law" on the policyholder against the principle of good faith of the relevant provisions
The new "Insurance Law" to reflect the importance of the principle of good faith not only increased the insurer's supervision, supervision, but also on the policyholder's behavior to constrain the policyholder once the principle of good faith in violation of "fraudulent insurance", insurance fraud, not only do not get the insurance premiums, but also the insurance company will be the only way to win the loyalty of the customers. Insurance fraud, not only can not get the insurance premium, but also will be sanctioned by law, the following through a few examples to illustrate
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Policyholders against the principle of good faith insurance fraud caused by the consequences and harm, so as to further illustrate the importance of the principle of good faith in the insurance business activities.
(a) Intentional failure to inform truthfully. The Insurance Law provides that the policyholder intentionally does not fulfill the obligation of truthful information, the insurer for insurance accidents occurring before the termination of the insurance contract, the insurer does not bear the responsibility of compensation or payment of insurance premiums, and does not refund the insurance premiums. Specifically, that is, the policyholder or the insured person in the insurance before the disability, disease or discomfort symptoms or is taking medication, or it has a certain occupational category, hobbies, habits, family medical history and other important circumstances, these circumstances are to affect the insurer to decide whether to agree to underwrite the insurance or additional conditions of coverage, but the policyholder, the insured person intentionally do not inform the insurer, and the insurance agent in order to facilitate the business of the insurance agent knowingly The insurance agent, in order to promote business, does not urge the insurer to inform the insurer truthfully, but colludes with the insured, and then applies for compensation on the ground that an insurance accident occurred within the insurance period after the insurance contract has been signed for a period of time. For example, on April 5, 2002, an insurance company in Changchun received a report stating that the insured, Chen Mou, had died at home on March 29, 2002, and applied for a death benefit of 375,000 RMB. Because the case involved a large amount of money, the insurance company attached great importance to it. Claims adjusters carefully reviewed the claim materials, conducted extensive investigations, collected evidence, and asked the judicial authorities to intervene, finally making this case involving nearly 500,000 yuan of fraudulent claims with sick insurance cases solved. The insurance company's salesmen colluded with the policyholders and their relatives, intentionally falsified the insured's health and financial status, concealed the important fact that the insured was suffering from cancer, and used the method of signature and premium payment to cheat the insurance premium.
(ii) Deliberately creating insurance accidents. The Insurance Law stipulates that if the policyholder, the insured or the beneficiary intentionally creates an insurance accident, the insurer has the right to terminate the insurance contract, and does not assume the responsibility of compensating or paying the insurance premiums, and does not refund the premiums except as provided in the relevant clauses. If the insurer pays the insurance premium or incurs expenses, the premium shall be refunded or compensated. Specifically manifested as: the policyholder or the insured beneficiary against social morality for the insured to buy insurance, and then maliciously create insurance accidents, in order to fraudulent insurance benefits. Because this kind of insurance fraud is often associated with illegal and criminal, so although such cases are relatively small, but the impact and harm caused by the most serious. September 3, 1997, Liu Mou for his wife to drive a cab to an insurance company to insure a whole life repayment of the capital insurance policy, the insurance period of one year, the beneficiary of Liu Mou himself. According to the provisions of the terms, such as in the insurance period, the insured died due to an accident, the insurance company will pay 60,000 yuan of insurance premiums. the morning of December 14, 1997, Liu Mou quarrel with his wife because of trivialities, he had the idea of killing his wife, strangled his wife alive and stabbed her with scissors in the right chest, faked the scene intentionally rummage through the box, will be his wife on the body of the gold and silver jewelry to remove the hidden, and then slipped out of the house. . Originally, Liu Mou hope that the neighbors found on his behalf to the police. But he turned around outside and came back, the home is still no movement, under no circumstances, Liu Mou had to report to the police. The police after in-depth investigation and evidence collection, that Liu Mou is suspected of committing the crime. In order to further evidence, the police want to capture, intentionally will have been placed to stay 2 days of Liu Mou put back, found that Liu Mou home the first thing is to immediately
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To the insurance company to apply for the payment of 60,000 yuan of his wife's death benefit. Later, after the public security organs of the interrogation and further investigation and evidence collection, a brutal murder of his wife to cheat claims finally solved.
(3) Issuing false certificates or false invoices. The Insurance Law stipulates that, after the occurrence of insurance, the policyholder insured or beneficiary with forged or altered relevant certificates, information or other evidence, fabricate false causes of accidents or exaggerate the degree of loss of the insurer for its false part of the responsibility for compensation or payment of insurance premiums. If the insurer pays the insurance premium or incurs expenses, it shall return or compensate. Specifically manifested in the insured after the insurance in order to fraudulently obtain insurance benefits, some policyholders insured or beneficiaries to take various means, from the authorized departments to issue false certificates or invoices. And some authorized departments often because of a variety of social relations or accept the policyholder, insured or beneficiary of the benefits, or that "anyway, do not want me out of pocket", will disregard the principle of negligence, for insurance fraud to facilitate the door. For example, in the disability appraisal for the insured person, intentionally exaggerate the level of disability, the insured person is obviously due to suicide or disease death, but at the request of the policyholder or beneficiary to issue a certificate of accidental death. Prove that the original disability of the insured person is caused by the insurance accident, false invoicing of medical expenses, etc. There are also some policyholders, insured persons or their beneficiaries in order to obtain medical subsidies or medical expenses insurance premiums, intentionally small illnesses, stay in the hospital does not come out, or in the name of hospitalization in the name of the reality of the bed treatment, or in the name of the insurance accident, the treatment of the disease does not belong to the scope of the insurance liability, etc., and some of them simply go out of the way to create a false certificate, false invoices. Some simply take the risk of creating fake certificates, fake invoices. The following case of "insurance fraud" belongs to this type. Zhou mou, male, a state tax bureau employees, in early 2002 to participate in the urban workers large supplemental medical insurance. 2003 January 19 weeks to the county social health insurance management office to file a claim, said that in 2002 **** hospitalized 7 times, incurred costs totaling 153,146.22 yuan. According to the terms and conditions of the insurance policy and the agreement, the insurance company should pay $108,778 for major medical expenses after $21,000 was paid by the medical insurance fund. The claims manager reviewed the claim and found that there were three invoices for medical expenses in the claim materials which were hand-developed invoices, involving an amount of 140,209.8 yuan. Claims adjusters went to the hospital to investigate and confirmed that the three invoices were homemade fake invoices, as the hospital practiced electronic management and had no handwritten invoices at all.
Three, only to do a good job of effective prevention of insurance fraud in order to put the principle of good faith into practice
The reasons for the above several insurance fraud, insurance fraud case is multi-faceted, not only the policyholder, the insured and beneficiaries of the reasons, but also the insurer and the social aspects of the reasons. If China's national insurance industry is to continue to develop steadily, the principle of good faith must be implemented in every insurance business, and the whole society needs to **** the same concern. Therefore, insurance companies have to effectively prevent insurance fraud and insurance fraud while developing their business. If this phenomenon is ignored, will bring many negative impacts to the insurance company, so that consumers
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Payers of the insurance company to produce a misunderstanding of the insurance company, resulting in easy to insure, difficult to claim the view of the development of the insurance industry will be very unfavorable, so I believe that the principle of good faith will be implemented into every piece of work in the insurance business activities, but also to do a good job of effectively preventing insurance fraud, insurance fraud, The insurance industry should prevent risks from the following aspects, in order to ensure the interests of policyholders, China's national insurance industry can be bigger and stronger.
(A) from the insurance company's internal
1, to improve the insurance terms and conditions to reduce the possibility of insurance fraud. Although the insurance terms and conditions are unilaterally pre-defined by the insurer, but the insurance contract signed, the insurance terms and conditions will be transformed into the content of the insurance contract, the policyholder and the insurer are binding. Therefore, the insurer in the preparation of insurance terms, must be accurate, standardized, clear and specific description of the insurance liability and exclusion. At present, many of China's insurance terms are not clearly set out insurance fraud, insurance fraud exclusion, only in the exclusion of general provisions for the insured's intentional behavior caused by the loss of the insurer is not liable for compensation. Such provisions obviously do not contain the full content of insurance fraud. In order to better prevent the occurrence of insurance fraud, should be clear insurance terms, improve the content of the insurance contract in the exclusion of liability should be set out in the fraud liability. Only in this way can reduce the occurrence of insurance fraud.
2, improve the quality of claims personnel, the establishment of scientific claims procedures and standardize the claims system. Must be based on the principle of separation of underwriting and claims, the establishment of a specialized, high-level claims system. On-site investigation, must be strict and serious, in order to clarify the causes of insurance accidents and losses, the insurance claimant submitted by the relevant proof, to carefully examine whether complete, true. It is necessary to establish a sound system of claims verification and to supervise the settlement of claims. Specifically, claims adjusters at all levels of the insurance company must adjust claims in strict accordance with the prescribed procedures and authority. Each claim must be approved by the supervisor or the parent company, and if necessary, it should be verified by experts. Insurance companies also need to establish a standardized claims system, the implementation of the case receiver, loss adjuster, adjuster, auditor, approver separation of the system and on-site investigation of the two-person system. To do everyone to gatekeepers, each in its own way, mutual supervision, strict precautions to ensure the quality of claims. At the same time, claims should be handled strictly in accordance with the review procedures step by step, and the establishment of accident investigation report files for review and lessons learned. In the claims processing work, if found to claims for private or internal and external collusion fraud, must be seriously dealt with. Only in this way, we can handle claims well, effectively stop and eliminate the occurrence of insurance fraud.
3, improve the insurance company's internal control mechanism, strict management, to prevent oversight. Insurance companies to establish internal underwriting audit system, the risk of contracted business should be repeatedly identified in accordance with the procedures, exegesis and screening. In order to effectively control risks. Underwriting audit staff to have the appropriate qualifications, evaluation and recruitment system, only with a system of
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System of professional knowledge, a strong sense of responsibility, and rich in practical experience can act as an underwriter. In addition, it is also necessary to establish underwriting and underwriting files and audit staff's job responsibility assessment system to ensure the quality of underwriting with perfect management.
(B) from the external environment of the insurance company
1, increase the publicity of the Insurance Law. Crack down on insurance fraud. First of all, the staff of the insurance company to seriously study and publicize China's newly revised "Insurance Law" and other relevant laws, to understand the spirit of its provisions on insurance fraud, and actively publicize to all sectors of society, so that the public to participate in the insurance have a correct understanding of the public, consciously prevent the occurrence of a variety of insurance fraud. To let the public know that anti-insurance fraud will not only benefit insurance companies, the majority of insured people will also benefit from it. At the same time should establish a reporting incentive mechanism, may consider the establishment of a special reward fund, public reporting telephone number, the use of knowledge of the psychology of seeking money, access to social anti-fraud information. Practice has proved that the masses of reports on insurance fraud detection is very effective, and secondly, the insurer should fully utilize the rights granted by law to fight against insurance fraud. When insurance fraud occurs, the insurer should be actively to the relevant departments to expose, whistle-blowing, urging them to the fraudsters to be administrative or criminal penalties, and never because of the fear of losing the policyholders and tolerance, and finally, the judicial department should be strict enforcement of the law, and effectively achieve the law must be followed, and must be punished for violating the law. To properly handle each case, not only need to handle the case of the judicial personnel have solid legal skills, but also have a comprehensive knowledge of insurance, therefore, must effectively improve the quality of judicial personnel and business level, in order to facilitate the timely detection and investigation of insurance fraud, to safeguard the legitimate rights and interests of insurers.
2, drawing on the successful experience of Europe and the United States, the establishment of national or regional anti-insurance fraud organization. Europe and the United States in the insurance industry on the basis of a unified understanding of the establishment of a number of joint organizations to combat insurance fraud, to carry out effective work, can learn from. In connection with China's current situation, we can consider the policy guidance of the CIRC, led by the Insurance Industry Association, the insurance companies to participate in the public security, procuratorial organs with the liaison of the insurance intermediary organizations, *** with the funding of the establishment of a national or regional similar to the "Association for the Investigation of Insurance Fraud" organization, to develop a working constitution, stipulating that members of the rights and obligations, a unified platform for action, and the establishment of a national or regional anti-insurance fraud organization. To formulate a working constitution, stipulating the rights and obligations of the members of the unified action plan, from the three-dimensional level to carry out comprehensive governance.
3, strengthen the insurance industry and public security, procuratorial, judicial and other departments of the joint, to play their respective strengths. Under the current conditions, the way of cooperation should be multi-level, all-round, including both high-level cooperation, including mutual cooperation between the grass-roots units, can be a case-by-case cooperation, but also the establishment of the corresponding liaison organization. The content of cooperation may include, editing insurance fraud cases, exchanging and teaching insurance fraud detection methods, as well as in the case of insurance fraud, joint collaboration to solve the case, and so on.
Four, how to build the integrity of insurance
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From the above discussion, we can see that the principle of good faith in the insurance business is indeed very important, but in the face of the WTO accession after the "foreign insurance" into the Chinese national insurance industry should do in order to be invincible? That is to say, how to build China's integrity of insurance! In addition to the effective prevention of insurance fraud mentioned above, I think we should focus on the following aspects:
(a) Enhance the concept of insurance. Insurance behavior is a contract as a link to the credit as a guarantee of resource allocation mechanism, the insurer should be based on the principle of utmost good faith, integrity as a kind of funds, equipment and equally important "capital", through the market optimization to participate in the competition, and the insured to establish a good relationship of mutual trust, *** to keep their promises.
(ii) Improve the overall quality of the industry. Due to the late start of China's insurance industry, in the development of the lack of appropriate constraints and standardization mechanism, some agents are driven by the interests, made against the principle of good faith behavior, which directly affects the reputation of the insurance company. Therefore, in rectifying and standardizing the insurance market, insurance companies should strengthen the training of practitioners, especially the front-line exhibition staff, in the areas of exhibition skills, service means and moral cultivation, etc. At the same time, agents and brokers should be strictly trained. At the same time, agents and brokers should be subject to strict "entry" requirements. Through the necessary training, assessment and administrative and economic means, make them have high business quality and moral standard. Actively fulfill their duties, for the insurance company to establish a good social image.
(3) Improvement of service level. Improvement of the service level of the insurance industry, not only depends on a good working environment and advanced hardware facilities, more importantly, to improve the business quality and service skills of each practitioner, enhance the service consciousness, so that the concept of service penetrates into the insurance business in each of the work.
(iv) Improvement of market rules. The newly revised Insurance Law has brought the principle of good faith in the insurance industry to a very important position, adding specific requirements in terms of good faith for insurance companies and insurance intermediaries respectively, as well as increasing the responsibilities and obligations of insurance companies in the insurance principal-agent relationship. Penalties for insurance violations have also been increased. These provisions have played a positive role in regulating the business behavior of insurers, making it necessary for insurance companies to pay more attention to the education of their employees on integrity.
(E) Extending the integrity management system. Insurers, in the process of building an insurance integrity brand, should establish an internal management system with clear responsibilities. Marketing and sales, finance, and business departments are all important parts of this system. Insurers should conscientiously implement the provisions of insurance integrity supervision, be responsible for evaluating policyholders and exhibition personnel to establish a customer credit management file and integrity management system, and formulate integrity rules for the insurance industry. Supervise the operation process of the business department and follow up the claims cases with return visits.
(vi) Establishment of a true and complete information disclosure system. Truthful and complete information disclosure is not only conducive to the insurance
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insurer's own development and growth, but also to the implementation of effective supervision by the governmental administration and the increase of transparency in the industry. Therefore, insurers have the responsibility and obligation to provide truthful and informative information to the higher supervisory authorities and the public, while the governmental supervisory authorities have to categorize the information and formulate corresponding countermeasures to safeguard the legitimate rights and interests of insurers.
(vii) Increase the sanction function of insurance supervision. Insurance regulators should not only carry out daily business supervision of insurers, but also develop a set of insurance credit supervision program, through the collection of information, the credibility of the insurer's comprehensive assessment of the poor credit insurer to administrative and economic sanctions, the better credit insurer will be appropriate incentives, and regular disclosure to the public of the assessment of the credibility of the insurer
In summary Through the above discussion and analysis of several cases, it is fully explained that the principle of good faith in the insurance business activities, whether it is for the long-term development of insurance companies, or to safeguard the interests of policyholders are quite important. Therefore, integrity building is the basic principle of the insurance industry. As stipulated in the Insurance Law. "the parties involved in insurance activities should follow the principle of honesty and credit in exercising their rights and fulfilling their obligations", only in this way can we give full play to the role of insurance as an economic booster and social stabilizer. However, if there is no trust between the insurer and the policyholder, the insurance industry will not develop and grow, fraudulent insurance, fraudulent insurance will not be able to prevent, the whole insurance industry will lose the development of the environment, the existence of space. And the times need the rapid and healthy development of the insurance industry, a strong call for the return of integrity. Therefore, only to establish and improve the insurance integrity system, to build the integrity of the insurance industry brand, insurance companies can continue to develop steadily, China's national insurance industry can be bigger and stronger.
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