|其他題名: ||A study of claim disputation in Taiwan life insurance industry|
|作者: ||許妙菁;Hsu, Miao-ching|
郝充仁;Hao, Chung-jen;李雅婷;Lee, Ya-ting
|關鍵詞: ||理賠爭議;保險申訴;申訴案例;claim disputation;the complaint cases of insurance|
|上傳時間: ||2010-01-11 02:04:16 (UTC+8)|
Nowadays, in view of the enhancement of the consumer consciousness, the claim disputations are getting more and more. Pursuant to the life insurance complaint statistics done by the Controlling Organization, the number of the complaint cases of life insurance was 474 in 1996 and, right after ten years, it had risen to 1,644 in 2006, a rapid growth of approximate 3.5 times.
Although some of the claim disputations of life insurance result from the malicious behaviors of the applicants and the insureds, the majority are owing to the insureds’ insufficient or misleading comprehensions, such as the insureds cannot correctly fill in application; the life solicitors convey wrong message; the applicants or the insureds do not have adequate insurance concepts, different understandings about the interpretations of the accidental injury and the misunderstandings about the clause wordings. Furthermore, the life insurers confine the insurance coverage, and do not present detailed evidences to the exclusion liability, and exclude the medical reimbursements due to the boasting applications by the applicants/the insureds as well as do not thoroughly underwrite the insureds’ past medical records, which are also the reasons to cause the claim disputations.
The insureds usually judge or inspect the quality of the insurance company by means of the quantity and the frequency of complaint cases raised. At the same time, a detailed analysis of the complaint cases of life insurance enables people to fully understand whether the settlement is proper, the reasons of the complaints, the allegation difference between the insurers and the insureds, the design problems of the clauses and the potentially claim disputations in future etc.
Through the research of the complaint cases of the life insurance, the study analyzes the causes of the claim disputations and other relevant problems. In the meantime, it also proposes the analysis results and practical suggestions, which should be helpful references to the Controlling Organization, the life insurers, the life solicitors and the consumers.