On strengthening the crackdown on insurance supervision

Notice on Promulgating Insurance Claims (Payment) Procedures to Further Improve Claims Service

Notice on Further Improving the Quality of Claims Service for Compulsory Traffic Insurance

Notice on Printing and Distributing the Work Plan of China Insurance Regulatory Commission on Further Standardizing the Order of Property Insurance Market

Notice of China Insurance Regulatory Commission on Further Standardizing the Order of Property Insurance Market

Notice on Strengthening the Management of Compulsory Traffic Insurance

Notice on Strengthening the Construction of Credit System. Notice on improving the quality of auto insurance claims service

Notice on publishing insurance claims (payment) procedures to further improve claims service

Insurance Regulatory Bureau [28] No.1

Insurance companies:

In order to facilitate customers to claim and apply for insurance benefits, focus on solving the problems existing in claims (payment) service and earnestly safeguard the legitimate rights and interests of insurance consumers, I will decide to establish insurance claims. The relevant issues are hereby notified as follows:

1. Each insurance company shall publish it on the company's external website, and publicize the specific process of claim (payment) service, the list of required materials, contact telephone numbers, etc. in a conspicuous position at all business outlets (including agency outlets) so as to facilitate insurance consumers to understand the relevant service standards and specific procedures.

second, when an insurance company handles the claim (application for insurance money) procedures for its customers, it should inform the customers in writing of the required materials at one time, and specify the time limit for payment according to different types of cases. If it cannot be informed at one time due to the actual situation, or it cannot be settled within the promised time limit, the insurance institution shall promptly explain and explain to the insurance consumers.

third, all insurance companies should combine the actual situation of claims (payment) services, adhere to the people-oriented principle, actively improve services on the basis of standardizing claims (payment) services, simplify claims (payment) procedures and required materials as much as possible, formulate relevant service commitments and publish them in time.

fourth, all insurance companies should publicize the complaint telephone number or contact information of claims (payment) service, analyze the complaints of insurance consumers on a regular basis, and timely improve the problems in the process of claims (payment) service to ensure that all kinds of complaints of insurance consumers are handled in a timely and proper manner.

5. All insurance companies should establish and improve the supervision and management mechanism of claim (payment) service, establish and improve the system of return visit to claim (payment) service quality, increase the assessment of claim (payment) timeliness, payment quality and complaint handling effect, and effectively improve the satisfaction of insurance consumers.

VI. All insurance companies should establish and improve the system of the person in charge of claims (payment) services. From the head office to the branches at the prefecture level, an executive should be appointed as the person in charge of claims (payment) services, and a department should be appointed as the responsible department of claims (payment) services. The main person in charge of this department is the contact person of claims (payment) services.

VII. Before December 25th, 28, each insurance company shall report to the CIRC and the Insurance Regulatory Bureau the relevant information of the person in charge of the company's claim (payment) service, the responsible department and the contact person (see Annex for the specific format); Before January 31, 29, the specific process of claim (payment) service, the list of required materials, contact numbers and complaint numbers shall be published on the company website, and reported to the China Insurance Regulatory Commission and the insurance regulatory bureaus, and the above materials shall be publicized at all business outlets (including agency outlets) before February 25, 29. If the person in charge of claims service, contact person and telephone number are changed, and the claims (payment) procedures and required materials are adjusted, all insurance institutions shall report to the China Insurance Regulatory Commission and the relevant insurance regulatory bureaus within 7 working days, and announce them to the public in time.

VIII. All insurance regulatory bureaus should strengthen supervision, take claim (payment) service as the key content of daily supervision, conduct supervision and inspection, reflect outstanding problems to insurance consumers, take regulatory measures for special treatment, and severely deal with illegal acts that harm the interests of insurance consumers according to law.

if there are any problems in the implementation of the insurance regulatory bureaus and insurance companies, please report them to our meeting in time.

Contact department: Insurance Consumer Protection Division of Inspection Bureau

Contact person: Wang Zhu Zhan Liu

Tel: 1-66288669, 6628629

Notice on Further Improving the Quality of Compulsory Traffic Insurance Claims Service on November 14th, 28

Bao Jian Fa [28] No.8

. Insurance association of china:

In order to further strengthen the management of compulsory insurance business, improve the service quality of compulsory insurance, and protect the legitimate rights and interests of the insured and traffic accident victims, the relevant issues are hereby notified as follows:

1. All insurance companies engaged in compulsory insurance business (hereinafter referred to as insurance companies) must take effective measures to further simplify the procedures and procedures for claims settlement, shorten the settlement period, improve the advance payment mechanism of rescue expenses, and continuously improve the service quality of compulsory insurance claims settlement.

second, insurance companies must strictly implement the provisions of separate management and separate accounting for compulsory insurance and other insurance businesses. Cases of compulsory insurance should be filed, recorded and closed separately from other insurance businesses. Accidents within the scope of compulsory insurance liability must be paid in time within the time limit stipulated by laws and regulations. If the party (the insured) or the victim of a road traffic accident disputes the above part of the compensation for compulsory insurance, it shall not affect the compensation for compulsory insurance.

3. All insurance companies must strictly implement the Code of Practice for Compulsory Traffic Insurance Claims (28 Edition). We will implement the "advance payment mechanism for serious personal injury cases caused by traffic accidents", "compensation handling regulations for paying compensation directly to victims of traffic accidents" and "simplified handling mechanism for paying compensation for property without responsibility for traffic accidents" to shorten the claim period, solve the urgent needs of traffic accident victims and promote social harmony.

4. insurance association of china should organize all insurance companies to further unify and standardize the industry standards of claims service for compulsory insurance, and implement simplified and innovative claims settlement mechanisms such as "self-compensation for property losses caused by compulsory insurance".

5. All insurance regulatory bureaus should attach great importance to complaints about compulsory insurance claims service, solve all kinds of contradictions and disputes in a timely manner, strengthen research on the situation reflected by all sectors of society, and answer all kinds of doubts in a timely manner. Warn branches and relevant responsible persons with poor service quality and many complaints from letters and visits in time, and severely investigate and deal with illegal institutions and personnel such as malicious procrastination and reluctance to pay compensation according to law.

September 23rd, 28

Notice on Printing and Distributing the Work Plan of China Insurance Regulatory Commission on Further Standardizing the Order of Property Insurance Market

Insurance Regulatory Bureaus [28] No.7

Insurance regulatory bureaus and property insurance companies:

In order to conscientiously implement the spirit of the National Insurance Regulatory Work Conference, we will focus on standardizing the order of the property insurance market, preventing and defusing risks and effectively protecting insurance. The CIRC studied and formulated the Work Plan of China Insurance Regulatory Commission on Further Regulating the Order of Property Insurance Market. Is issued to you, please earnestly implement the units.

this notice shall be implemented as of the date of issuance.

August 29th, 28

Work Plan of China Insurance Regulatory Commission on Further Standardizing the Order of Property Insurance Market

In recent years, especially since the 16th National Congress, the national property insurance market has developed rapidly and well, its business scale has expanded rapidly, its ability to prevent risks has been gradually enhanced, its insurance coverage has been continuously expanded, and its role in serving the overall economic and social development has been well played. However, in the process of rapid development of the property insurance market, the problems of illegal operation in the market are still outstanding, which not only destroys the market order, damages the reputation and image of the industry, but also destroys insurance resources, increases the business risk of the industry, and even damages the legitimate interests of the insured. Therefore, the property insurance industry should attach great importance to the issue of standardized development, thoroughly implement the spirit of the national insurance supervision work conference, and make concerted efforts to resolve outstanding market problems.

1. Work objectives

Guided by the spirit of the National Insurance Regulatory Work Conference, focusing on the management of outstanding problems in the market, and strengthening the internal control and supervision of the company as a means, through a period of rectification, a good situation of standardized and orderly operation and fair and reasonable competition in the property insurance market will be formed. Before the end of this year, we will strive to achieve a significant improvement in the order of the property insurance market:

(1) The internal control of insurance companies has been significantly improved, and the problem of untrue business financial basic data in the company's operations has been effectively curbed.

(2) Insurance companies have different terms and rates, and the behavior of changing the terms and rates without declaration or reducing the rates in disguise by various means has basically been solved.

(3) Establish and improve the standard claims service standards and claims process, and the complaints of insurance consumers about malicious procrastination, reluctance to pay, unreasonable refusal to pay and other behaviors of insurance companies have dropped significantly.

II. Highlights

At present, we should focus on the following key points to standardize the order of the property insurance market:

(1) Ensure that the basic financial data of the business operated by the company are authentic

1. Ensure that the premium income is fully recorded according to the facts. In strict accordance with the new accounting standards and the principle of premium income recognition, the premium income is fully and truthfully reflected in the premium income account. It is strictly prohibited to falsely hang the premium receivable, falsely approve the refund, tear up the bill, pay the bill in yin and yang documents, record the net premium, go out of the system, and make off-balance-sheet accounts.

2. Ensure the truth of the compensation case and compensation. It is strictly prohibited to deliberately fabricate insurance accidents that have never happened to make false claims, to deliberately expand the scope of insurance accident losses and inflated the amount of compensation, to include expenses unrelated to compensation cases in the compensation cases, and to collude with auto repair shops and other units to defraud compensation and other illegal acts. Standardize the provision, use and management of claims fees to ensure the authenticity and integrity of claims data.

3. Ensure that all operating costs of the company are charged according to the facts. Strict implementation of financial and accounting related laws and regulations, it is strictly forbidden to disburse various operating and management expenses according to the facts, and it is strictly forbidden to illegally collect funds to pay intermediary fees or use them for other purposes by reimbursing false travel expenses, vehicle and vessel use fees, conference fees, business entertainment fees, etc. Intermediary fees must be paid in full and truthfully, and no fees may be falsely listed for any reason. It is not allowed to reimburse any expenses for other units and individuals outside the unit, thus expanding operating costs.

4. Ensure that all liability reserves are accrued according to laws and regulations. Strict implementation of non-life insurance reserve management measures, accurate and true provision of various liability reserves, it is strictly prohibited to arbitrarily select development factors and the final payout ratio hypothesis and other means of illegal provision of reserves, resulting in unrealistic operating results.

the general managers or principals of companies at all levels are fully responsible for the authenticity of business and financial data of the companies under their jurisdiction.

(II) Strictly implement the clauses and rates submitted to the insurance regulatory authorities for approval or filing

Strictly implement the relevant provisions on the management of clauses and rates of property insurance, and fulfill the procedures for approval and filing of clauses and rates according to law. It is strictly forbidden for insurance institutions to report different terms and rates. Branches of companies are not allowed to expand or reduce their insurance liabilities at will for various reasons, and they are not allowed to change the terms and rates reported by the head office at will, thus engaging in vicious price competition, disrupting market order or harming the interests of the insured. If it is necessary to modify or change the terms and rates, the approval or filing procedures must be performed according to law.

(III) Solving the Problem of Difficult Claims Settlement

Insurance companies should fulfill their obligations under insurance contracts in accordance with the law, and it is strictly forbidden to maliciously delay compensation, cherish compensation, unreasonably refuse compensation and other acts that harm the legitimate rights and interests of insurance consumers. It is necessary to establish and improve the system claims service standard, standardize the claims process, improve the quality of claims service, establish a rapid claims mechanism, and effectively improve the limitation of claims.

(IV) Ensure the implementation of the company's main internal control systems

Establish and improve the corporate governance structure, scientifically formulate the company's development strategy and decision-making mechanism, and improve and strictly implement the core internal control systems such as premium fund management, underwriting and compensation management, valuable document management, cost management, seal management and branch management. Strengthen centralized data management and control, the claim receiving and reporting system and the document system should be fully connected with the core business system, and the business, finance and reinsurance data should be integrated, seamlessly linked and interacted in real time. Make full use of information technology to improve internal control execution. At present, companies that have not managed data centrally by the head office must make plans, define the time limit and realize them as soon as possible.

iii. main measures

(1) resolutely intensify inspection and punishment, and severely investigate and deal with illegal acts in the market according to law.

1. If the premium income is seriously untrue by various means, administrative punishment shall be given, such as stopping accepting new business for at least 6 months, ordering the replacement of the senior executives who are directly responsible, and imposing a fine according to law. If the circumstances are serious, the insurance business license shall be revoked.

2. Whoever makes a false compensation case or intentionally expands the compensation for other purposes and is suspected of committing a crime shall be handed over to the judicial organs for handling. If it does not constitute a crime, it shall be punished according to the first paragraph above. Deliberately delaying compensation, sparing compensation and unreasonably refusing compensation shall be handled in strict accordance with the regulations.

3. Those who set up private coffers and are suspected of committing crimes shall be handed over to judicial organs for handling. If it does not constitute a crime, it shall be punished according to the act of providing false reports and statements.

4. For those who use various means to falsely list a large amount of operating and management expenses, they shall be given an administrative penalty of stopping accepting new business for at least 6 months, ordering to replace the executives who are directly responsible, and being fined according to law. If the circumstances are serious, the insurance business license shall be revoked.

5. In case of vicious price competition on the terms and rates that are not submitted for approval and filing, the senior managers who are directly responsible shall be ordered to be replaced, and the management responsibility of the higher level and even the head office shall be investigated.

6. Those who fail to draw various liability reserves according to regulations shall be given administrative penalties such as fines, limiting business scope, stopping accepting new business, and ordering to replace the executives who are directly responsible. If the circumstances are serious, the insurance business license shall be revoked.

7. those who violate the relevant laws and regulations on compulsory insurance by operating compulsory insurance companies will be severely punished according to law.

(2) intensify information disclosure. It is necessary to disclose the company's violation of laws and regulations by administrative punishment to the public in a timely manner, and strengthen social supervision and restraint.

(3) Strengthen solvency supervision. For companies whose solvency adequacy ratio is not up to standard, the CIRC should take measures such as limiting the establishment of branches, business scope, executive compensation, dividend distribution to shareholders, increasing reinsurance and increasing registered capital, and urge the company to reduce the speed and scale of business development, improve business quality and efficiency, and enhance its risk prevention ability. For companies whose solvency adequacy ratio is at the critical point, China Insurance Regulatory Commission should make timely risk warning through dynamic supervision.

(4) establish inquiry and supervision over the head office. If the development strategy of the head office is inconsistent with the company's strength, the company's market development incentive mechanism is inconsistent with the market, the company's core internal control management is weak, the control means are weak, and the management is extensive, the Property & Casualty Department of the China Insurance Regulatory Commission will send supervision tips to the head office, conduct supervision talks with the main responsible persons of the head office, list the company as a key supervision company, and take corresponding supervision measures.

(5) establish a notification system with the company's major shareholders, independent directors and supervisors. The CIRC will inform the company's major shareholders, independent directors and supervisors about the company's violations of laws and regulations and penalties every quarter, and give full play to the due supervision and restraint role of shareholders, independent directors and supervisors.

(6) Establish a mechanism to share bad record information of insurance institutions and employees. Establish archives of bad records of senior executives, legal persons, actuarial persons and other important personnel in the national property insurance industry, timely publish information of institutions and personnel who have been punished in violation of laws and regulations, and strictly prohibit personnel with bad records from serving in different places.

IV. Working principles < p