The violation of life insurance sales is the most prominent problem.
Insurance is divided into personal insurance and property insurance according to the subject matter of insurance. Personal insurance is specifically divided into life insurance, health insurance, children's insurance, old-age insurance, accident insurance and so on. Life insurance can be divided into term life insurance, endowment insurance and whole life insurance, while health insurance can be divided into critical illness insurance and medical insurance.
A few days ago, the China Insurance Regulatory Commission issued a circular on 20 16 insurance consumer complaints. According to the circular, there are 16039 consumer complaints involving personal insurance. Among them, the insurance company complained about contract disputes 13686, and the alleged violation of laws and regulations was 2314; There were 24 complaints about contract disputes between insurance intermediaries, including 5 complaints about alleged violations of laws and regulations/kloc-0.
According to the types of complaints, there are 565 1 piece of insurance company's contract disputes, accounting for 4 1.29%, which mainly reflects the problems of unclear terms and conditions explained by sales staff, insufficient explanation of obligations, and the other party's clear refusal to answer the phone. There were 4230 claims/compensation disputes, accounting for 30.9 1%, mainly involving liability disputes of sickness insurance, medical insurance and accidental injury insurance. Consumer dispute insurance companies refused to pay compensation on the grounds that they were out of danger during the observation period, insured with illness, did not belong to the scope of claims, and the level of illness or disability did not meet the payment conditions. There were 1943 cases of surrender disputes, accounting for 14.20%, mainly disputes over surrender conditions, procedures and surrender amount.
Among the complaints about violations of laws and regulations of life insurance companies, there are 2068 complaints about sales violations, accounting for 89.37% of the total complaints about violations of laws and regulations, of which 20 15 cases are suspected of fraud and misleading, which are mainly manifested in promising high returns or not telling the benefits truthfully, promoting the sales of insurance products in the name of other financial products such as bank wealth management, deposits and funds, and inducing the insured to tell the health status truthfully, not answering the return visit questions truthfully, signing on behalf of customers, and copying on behalf of customers.
From the perspective of sales channels, 7802 individual agents complained more, accounting for 48.64%; There are 3,389 mail channels, accounting for 2 1. 13%. In terms of insurance types, dividend insurance has the largest number of complaints, accounting for 5803, accounting for 36.18%; 4047 ordinary life insurances, accounting for 25.23%; 2389 accident insurance, accounting for 14.89%.
Property insurance claims is a difficult point in auto insurance.
Consumer complaints involving property insurance are 16403. Among them, the insurance company complained about contract disputes 15965, and complained about alleged violations of laws and regulations. There were 5 1 complaint of insurance intermediary contract disputes, and 5 complaints of suspected violation of laws and regulations.
According to the types of complaints, the contract disputes of insurance companies account for 97.33%, and most of the complaints are still claims disputes. Claims/compensation disputes 12077, accounting for 75.65% of the total contract disputes, of which auto insurance claims disputes1kloc-0/60, accounting for 84. 13% of claims disputes. Complaints mainly include: the company made a decision to refuse or give up compensation according to the terms of the contract, but the consumer did not accept it; Both parties have disputes over the maintenance plan, the price of accessories and the price of working hours; The limitation of claims is too long, the claims materials are cumbersome and the consumer experience is poor. There are 24 underwriting disputes12, accounting for 15. 1 1%, which mainly reflect disputes such as premium calculation, underwriting without consent, withholding of premium without consent, insufficient explanation of insurance liability, untimely delivery of insurance policies or invoices, and disturbing people by electricity sales.
From the perspective of sales channels, personal agent 43 13, telephone sales 2525, mainly selling traditional insurance such as auto insurance and enterprise property insurance. Online sales channels are 172 1, involving return freight insurance, flight delay insurance, travel accident insurance and various short-term new products. There is a dispute between the two sides on whether the accident belongs to insurance liability, and consumers complain that the website sales have not fully disclosed important insurance information because of refusing to pay compensation.
Can't contact the insurance salesman? Contact the insurance company directly.
Many consumers complain that when it comes to insurance claims, they can't contact the salesman who signed the insurance contract with them at the beginning, and there is no way to settle claims. Yang Wensu and Zhang Fengting of Minsheng Insurance Beijing Branch told the reporter of Beijing Evening News Financial Weekly that if you can't contact the insurance salesman, first look at the tips in the insurance contract service guide, or call the insurance company's customer service hotline directly, or know the insurance company's address from the contract and go directly to the company counter. Moreover, some life insurance companies can directly APPly for claims by providing mobile app or WeChat official account. Insurance consumers must be aware that if there are insurance-related needs, they should contact the insurance company directly.
Yang Zhe, CEO of Elephant Insurance, said that as an Internet insurance company, the existing Internet technology is combined with the traditional insurance industry to solve the problem of not being able to contact the salesman when making insurance claims through online customer service interaction and intelligent customer service answers, simplifying, cartooning and fragmenting the professional, boring and difficult problems of traditional insurance clauses, lowering the threshold for consumers to understand insurance products and helping consumers fully understand the coverage of products. Through such guidance, users can more clearly understand the exemption and compensation exemption clauses outside the scope of protection responsibility, and will be treated more rationally when they encounter danger. In addition, as an Internet insurance company, with the development and application of mobile Internet technology, especially big data and cloud computing, it can help users submit claims materials paperless, survey and verify claims materials. And simplify the claim process.
Is compensation difficult to define or not? Fully understand the terms of the contract
When consumers complain that it is difficult to claim compensation, they often say that the insurance company talks over words and refuses to pay compensation on the grounds that the accident belongs to "subjective accident, not trauma" and "the accident caused by illness does not belong to the insurance liability of contract claims", and thinks that "this is not the insurance liability agreed in the contract".
In recent years, people's awareness of insurance has gradually increased, the proportion of insurance in financial arrangements has been increasing, and diversified insurance needs have emerged one after another. However, in the face of insurance, a multi-disciplinary consumer product such as law, medicine and advanced mathematics, some policyholders have not fully understood the terms of insurance, thinking that the insurance company will not compensate if it is out of danger, so it is difficult to claim compensation, and even think that "insurance is deceptive". In fact, insurance products, like automobiles, home appliances, mobile phones and other commodities, are subdivided according to their functions and have a wide variety, all of which are "doing their own jobs". If a person only has accident insurance, then the insurance company will not bear the medical insurance liability caused by the customer's major illness. Every insurance contract has agreed insurance liability and liability exemption.
Yang Wensu and Zhang Fengting of Minsheng Insurance Beijing Branch pointed out that it is very important to understand the "insurance liability" and "exemption" stipulated in the contract before insurance. The only effective communication platform between consumers and insurance companies is the insurance contract, which is the only basis for defining compensation and non-compensation. Therefore, the insured should evaluate their own risks before buying insurance, and the insurance consumer goods needed at different stages of life should be different. When buying insurance, don't "follow the trend", which leads to the fact that insurance protection can't completely cover the risks faced by individuals.
In addition, the formulation and implementation of terms and rates by insurance companies should be market-oriented and the terms formulated should be as easy to understand as possible. After the definition and interpretation of the claim are inconsistent, most of them can reach an understanding through repeated communication between the two parties or consulting experts on the issues involved respectively.
It is difficult for insurance companies to investigate, and the claimants are unprofessional? The regulatory authorities should "make a heavy punch"
An insurance company shall pay compensation according to the scope of claims agreed in the insurance contract, relevant certification materials and documents. If in doubt, it may be necessary to investigate, and the relevant units and organs may not cooperate, which may lead to delays; Insurance consumers will also find it difficult to settle claims if the claims personnel rush to work without strict training and assessment, or misunderstand the contents agreed in the contract.
Insurance companies and even the industry should establish a long-term mechanism for the training and appointment of claim adjusters, establish an error rate file of claim adjusters at work, and conduct continuous assessment. If the industry standards can be unified, those who fail to meet the prescribed standards will be punished accordingly, thus completely solving the problem of difficult claims.
Article 23 of the Insurance Law clearly stipulates: "After receiving the request for compensation or payment of insurance benefits from the insured or beneficiary, the insurer shall verify it in time; If the situation is complicated, it shall be approved within 30 days, unless otherwise agreed in the contract. " The eight "quantitative indicators of service evaluation" of life insurance companies formulated by the CIRC take "claim service limit" and "claim odds" as the key to assess the claim service of life insurance companies, accounting for 35% in quantification; The Beijing Insurance Association also included claims with an amount of less than 3,000 yuan in the category of simple cases, requiring that the verification be completed on the day of acceptance.
Further reading: How to buy insurance, which is good, and teach you how to avoid these "pits" of insurance.