Claim settlement refers to the insurer's handling of the claim made by the insured after the insurance accident. In the project guarantee insurance, when the insured violates the contractual obligations and causes direct losses to the insured, the insured can lodge a claim with the insurer, and then the insurer will make claims accordingly. Insurance claim settlement is the concrete embodiment of the social value of insurance.
Different from the "underwriting-insurance-claim settlement" process of traditional insurance products, insurance companies introduce third-party professional risk management services into engineering guarantee insurance, participate in the risk management of engineering guarantee insurance underwriting projects throughout the process, conduct pre-underwriting risk assessment, post-underwriting risk investigation and early warning, coordinate and cooperate after insurance accidents, analyze and summarize after closing the case, and improve the risk management system.
1, whole process risk management principle
The whole process risk management of engineering guarantee insurance is a new risk management mechanism which integrates the third-party risk management technology and concept on the basis of traditional engineering management and connects the whole process supervision links before, during and after insurance.
Pre-underwriting risk assessment: In order to avoid pre-insurance risks, third-party risk management institutions will organize experts to conduct non-quantitative risk assessment in the pre-insurance audit stage, and provide insurance companies with suggestions on underwriting, cautious underwriting and refusal underwriting according to the credit rating, financial statements and historical underwriting records of the insured; And put forward corresponding evasive opinions on the possible risk factors of insured enterprises and projects, and formulate risk management plans.
Post-underwriting risk investigation: In order to find risks in insurance, third-party risk management institutions will conduct regular inspections in the post-underwriting inspection stage, and identify and control possible risks according to the information collected through inspections; On the one hand, submit the written materials with inspection conclusions to the insurance company, on the other hand, assist the insured to take emergency rescue and preventive measures to prevent disasters and losses.
Collaborative claims settlement of insurance accidents: In order to solve the risks after insurance, the third-party risk management organization will cooperate with the insurance company to follow up the accident treatment after the risk events, collect evidence, confirm rights, resolve conflicts between the insured and the insured, and intervene in advance to ensure quick claims settlement.
Insurance claims can test the quality of underwriting business, improve risk strategy, iterate risk management tools, improve the accuracy of risk assessment, and help insurance companies to further grasp the risk law and control, reduce and prevent losses caused by credit risks. As of the end of February this year, Zhejiang Baogong Construction Engineering Technology Co., Ltd., as a professional engineering guarantee insurance risk management institution, has provided full-process risk management for 1 10,000 insurance underwriting projects; Through coordinated disposal, early intervention in bid guarantee insurance and migrant workers' wage payment guarantee insurance claims can reduce the losses of insurance companies, improve the efficiency of government supervision, promote the rapid popularization and application of engineering guarantee insurance in the field of engineering construction, and reflect the economic and social value of insurance.
2. Case analysis of migrant workers' wage payment guarantee insurance claim.
In the process of insuring the wage payment guarantee insurance for migrant workers in a housing construction project in Sichuan Province, the local construction engineering guarantee insurance agency entrusted Zhejiang Baogong Construction Engineering Technology Co., Ltd. to conduct pre-insurance risk assessment and post-insurance risk investigation for the project.
When the construction unit, as the insured, insured the payment risk of migrant workers' wages in its development project with the insurance company, Zhejiang Baogong Construction Engineering Technology Co., Ltd. thought that the insured had a major risk of default after the pre-insurance risk assessment, so it issued a letter of refusal to underwrite to the insurance company; When the construction unit, as the insured, insured the payment risk of migrant workers' wages to the insurance company, Zhejiang Baogong Construction Engineering Technology Co., Ltd. thought that although the construction unit had certain ability, it could not underwrite the default risk of the construction unit, so it put forward cautious underwriting opinions and risk prevention plans to the insurance company.
During the insurance period, Zhejiang Baogong Construction Engineering Technology Co., Ltd. * * * conducted five post-insurance inspections on the insured items, and after the second inspection, it warned the insurance company and the local housing and construction bureau of the risk of unpaid wages. After the fifth inspection, it confirmed the fact that the construction unit owed 2.6 million yuan (the other three inspections were normal). Led by the Housing and Construction Bureau, with the participation of insurance companies and third-party risk management institutions, the Housing and Construction Bureau has repeatedly communicated and coordinated solutions with the construction units and policyholders. In order to protect the legitimate rights and interests of migrant workers and maintain social stability, the Housing and Construction Bureau reported the case to the insurance company and initiated the claim settlement on February 2, 202 1. In the end, the insurance company paid 6.5438+0.44 million yuan three days after receiving the report (the construction company provided a cash deposit of 360,000 yuan), and the legitimate rights and interests of migrant workers were safeguarded in time through insurance claims.
This is a typical case in which the construction company defaulted on the project payment, resulting in insufficient liquidity of the construction company, which eventually led to the construction company defaulting on the wages of migrant workers. By cooperating with third-party risk management institutions and leveraging the whole process risk management services, insurance companies have realized the functions of social security management, social risk management, social relationship management and social credit management.
3. Third-party risk management institutions can provide claims settlement services.
There are many reasons for engineering guarantee insurance claims, all of which have the transformation process of risk from quantitative change to qualitative change. Insurance institutions cooperate with third-party risk management institutions to empower claims services with full-process risk management, which not only improves the economic and social benefits of engineering guarantee insurance, but also reduces costs and increases efficiency for all participants.
On the one hand, third-party risk management institutions will help insurance companies to carry out risk management in the whole process, which is conducive to safeguarding the legitimate rights and interests of the insured. Third-party risk management institutions regularly collect written statistical data related to performance during the insurance period and inspection data of government departments, give full play to their professional ability and service advantages in risk management of engineering guarantee insurance, give full play to the function of risk early warning and fully protect the rights and interests of the insured. This is also conducive to the standardization of engineering guarantee insurance claims service: by improving case reports and claims publicity with insurance companies and improving the tracking and clearing system of outstanding claims, third-party risk management institutions can implement centralized claims operation under the premise of standardizing service rules, thus optimizing claims process, improving claims efficiency and improving service quality.
On the other hand, third-party risk management institutions will help insurance companies to carry out risk management in the whole process and reduce the pressure of government supervision: by introducing market-oriented supervision mechanism, insurance companies and specialized risk control institutions will supervise the behavior of construction enterprises, provide quality claims service for the insured, promote government supervision from direct intervention to macro-control, and help the government return to the role of macro-control. This will also accelerate credit construction: through the whole process of risk management, the "black and white list" system of construction enterprises will be introduced to transfer credit risk; According to the "black and white list" system, some construction enterprises with credit default risk will be eliminated, and the pressure of government credit supervision will be alleviated, which will promote the establishment of a new supervision mechanism with credit as the core in the field of housing construction and reconstruct the credit economy ecology in the field of housing construction.
In order to give full play to the positive significance of whole-process risk management in engineering guarantee insurance claims, Zhejiang Baogong Construction Engineering Technology Co., Ltd. and the insurance company * * * jointly discussed and formulated the SOP manual for claims, aiming at establishing a scientific claims process and a unified claims service standard, implementing the key points of each link and implementing centralized claims operation; By improving the limitation of claims, the implementation of SOP manual will also help to realize the rapid realization of project guarantee, promote the accelerated expansion of project guarantee insurance in the project guarantee market, and bring greater economic and social benefits into play.
Claims settlement is the most direct way for the insurance industry to play its economic compensation function and fulfill its insurance obligations, and it is also an important link in the risk management of insurance contracts. The introduction of whole-process risk management in engineering guarantee insurance will provide a basis for insurance companies to improve underwriting quality, claims service and risk management, and also help engineering guarantee insurance to play a greater role.