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    題名: 我國產險業經營傷害保險之現況與展望
    其他題名: The operation of personal accident insurance of non-life insurance industry in Taiwan : the present and future
    作者: 陳雅芬;Chen, Ya-Fen
    貢獻者: 淡江大學保險學系保險經營碩士在職專班
    胡宜仁;Hu, Yi-Jen
    關鍵詞: 傷害保險;核保作業;通報制度;accident insurance;underwriting operation;notification system
    日期: 2017
    上傳時間: 2018-08-03 14:44:47 (UTC+8)
    摘要: 產險業加入經營傷害保險業務,至今已有十餘年之久,但卻因業務過度競爭及通路成本偏高之情況下,面臨保險費對價收取不足。此外,道德風險案件及日趨嚴謹之法令規定等問題,亦造成公司經營虧損及面臨主管機關金管會裁罰與罰款。然而業者若想要永續經營傷害保險業務並從中獲取利潤,除必須在風險控管、核保理賠作業及再保安排等各方面強化外,如何防範道德風險亦是經營管理上不可忽視的重點。因此加強業務品質的篩選及強化核保作業程序對於防範道德風險,就顯得特別重要。
    本研究係透過搜集法規、書籍、期刊、學位論文及官方統計數據歸納分析;再就保費收入、理賠給付、商品內容、銷售方式等四個部份說明產、壽險業經營概況,希望最後得出研究結果及個人建議,能作為日後我國產險業者在傷害保險招攬核保作業程序及主管機關於日後修訂相關規則時之參考。
    本文研究結果如下:
    一、業務人員招攬過程的重要性:在整個傷害保險交易過程中,第一個與客戶接觸的即是業務人員,而且可能也是唯一一個可以親見保戶的人,所以業務人員可說是核保與客戶之間的溝通橋樑,因此所提供的核保訊息就非常重要,如果業務員在第一次的危險選擇做得確實,就可以使核保評估結果更準確。但由於產險在經營傷害險,大多仰賴通路行銷,所以對於通路的業務員無法直接管理,因此業務品質就不容易控管。
    二、「核保」的功能在於為公司獲取利潤,適當良好的核保政策,可使公司達到營收目標及獲取利潤,且對於防堵道德危險也是有幫助的;反之,錯誤的核保政策可在短期間內快速累積業務,但長期下來恐造成損失嚴重攀升,並造成公司虧損,因此核保政策的擬訂確實有其重要性。而執行核保政策之人員更是公司經營良窳之關鍵。
    三、傷害保險開辦以來,自2015年起保費約成長一倍,在汽車保險及火災保險保費成長有限的情況下,傷害保險仍然是未來產險業者發展的重點,但主管機關對於人身保險監理規則日趨嚴謹,所以業者應思考如何在高度監管下,讓招攬案件「質量」並重,並運用近年來主管機關所開放之網路投保與三年期傷害保險,為自己創造新契機。
    It has been more than ten years since the property insurance enterprise included the accident insurance. Because the market is so competitive and the cost of running accident insurance is high the premium of accident insurance cannot balance against the operating costs.In addition,the moral hazard cases and strict laws and regulations cause property insurance company to face financial loss and the punishment and penalty from the FSC(the Financial Supervisory Commission).If the property insurance enterprise wants to offer the accident insurance and make profits from it, the enterprise must pay special attention to risk control, underwriting, claims operations, and reinsurance arrangements. Accordingly, it is very important to take measures to prevent moral hazard by means of good quality control of the business and the strict operating procedures for protection of the underwriting.
    The approach of this project is statistical analysis and deductive reasoning via a collection of regulations, books, journals, dissertations and official statistics. This study furthermore uses four modules to examine the property insurance and life insurance businesses. They are the premium income, claim payment, the content of products, and the way of sale.It is hoped that the results of the study, along with my recommendation, will be of use to the property insurance enterprises to revise their accident insurance underwriting procedures, and to the government authorities to amend some of the insurance rules.
    The results of the thesis are as follows:
    1.The importance of the process while selling the accident insurance: During the whole transaction of the accident insurance, the first person contacting the client is the sales staff, and, moreover, he or she would be the only one that gets in touch with the insured. Therefore the sales staff plays the role of the bridge between underwriters and clients. The underwriting message, which the salesperson provides, is very important. The more correct messages the salesperson offers, the more accurate assessment the underwriter makes. However, property insurance companies sell the accident insurance through channel marketing, so it is difficult for them to manage the Channel’s sales, i.e. infeasibility of controlling the quality of the accident insurance.
    2.The purpose of "underwriting" is to help the insurance company secure its profit. The insurance company can achieve revenue target profits and help to prevent moral hazard if there is a suitable underwriting policy. If not, even a rapid development of the business in accident insurance within a very short time would result in serious losses to the insurance company under a wrong underwriting policy in the long run. Consequently, underwriting policy is very important to insurance company whose underwriting staff plays the key role in the operating of the company.
    3.Accident insurance premiums have increased about twice as big as the original since 2015, but the growths in car insurance and fire insurance premiums are lower and limited during the same time span. So, accident insurance has become one of the major products in the property insurance enterprise to develop its business in the future.However, the rules supervising personal insurance initiated by relevant government authorities will be becoming more stringent. Property insurance enterprise should take it into account how the company can take care of and improve the quality and quantity of the accident insurance under such a strict supervision.Recent official approval of the online purchase of insurance and the 3-year accident insurance opens up new opportunities for the property insurance enterprise.
    顯示於類別:[風險管理與保險學系] 學位論文

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