[method] company legal advisers dispute insurance contract of

Analysis of the insurance contract dispute case

Cases of disputes over insurance contract refers to a contract of insurance both parties to the insurance contract and does not perform the consequences generated controversy and disputes to the courts in cases of. Cases of disputes over insurance contract directly affect the economic benefit of the insurance company, and may be normal business operations and work order impact of the insurance business, and even the whole insurance industry reputation and social image. Therefore, the insurance contract dispute case analysis, seeking to reduce or avoid the case of countermeasures, to guard against and defuse the risk of insurance law in enterprise management, has the extremely important practical significance to improve the insurance business and social benefits.
The main characteristic, insurance contract dispute cases
One is the number of cases increased year by year. In recent years, the development of China's insurance industry rapidly, and the specification of the insurer and the applicant, the insured or the beneficiary (hereinafter referred to as "Insured") between legal norms and conventions, the contract is not perfect and mature, which leads to the number of cases of disputes has not broken up the insurance contract. According to the October 8, 2007 "people's Court Daily" reported, "Jiangsu province Wuxi City Binhu District Court, district court, district court in Xishan and the Beitang District Court has carried out investigation and analysis to the insurance contract disputes, found that for four consecutive years to accept insurance disputes is increasing year by year trend, especially this year, rise more than 200% of insurance disputes, surge phenomenon". This phenomenon is universal in the country. Disputes of contract of insurance has become an important source of civil case court, become a hot topic in the judicial field, become a hot topic of public attention and media.
Two is the conflict is escalating signs. After insurance accident happens, the insured suffered casualties and property losses, such as to the insurance company for compensation or insurance payment was rejected, often emotional control and to take drastic actions, such as Barney, the normal working order, the interference of the insurance company insurance company managers to implement or the threat of violence. The court case was accepted, the possibility of reconciliation between the two parties or court mediation is smaller. Because some of the insured person to claim the standard understanding insufficiency, expectations too high, even after the court ruling, will still be around entanglement, complaint, or through the media to expand.
Three cases involved in motor vehicle insurance, accident insurance, health insurance and other insurance. Especially with the "motor vehicle traffic accident liability compulsory insurance regulations" and the implementation of individual car ownership, the number of motor vehicles insurance cases rose sharply.
Four is the number of cases of complex legal relations, new types of cases appear. As the car was the claim "depreciation fee", "fight" whether to belong to illegal operation. The development of the social situation and new cases because the law has no clear stipulation to judge the formidable.
The five is the insurance company for the majority, and the plaintiff was mostly insurance is a natural person. On the one hand, due to agree the initiative claims in the hands of the insurance company, once a dispute, "don't tell" civil litigation principles, the insurance company also often appear as the defendant's identity; on the other hand, in general, the unit for the insured by the group insurance business insurance companies as "gold customer", is the focus of competition. Once the two sides have the contract disputes, insurance company often out of competition and long-term cooperation to consider concessions, by way of reconciliation in the pre litigation to resolve through litigation, and the way to solve the low percentage of.
Six is the final mode diversification, the decision to close the case. Compared with other civil disputes, insurance contract disputes involving personal injury or damage to property, litigation is larger, the insured against serious emotional, mediation, the withdrawal rate is low, and the judgments of the effect is far better than mediation or withdraw the legal effect and social effect.
The seven is the insurance company had a high proportion of. In recent years, our country's insurance business operation is to develop in the direction of specialization, and rules of insurance regulators on the insurance business requirement changes quickly and rules is different, even contrary before or after. The vast majority of judges had no financial professional education specialized, lack of financial work experience, especially the content and the development are not familiar with the insurance regulations on insurance business, therefore resulting in the part of the insurance case in the trial process, qualitative case are not allowed, the entity judgment error. In the case of insurance of the new business, due to the negative influence judge does not understand the insurance business and relevant international practice brings to the case of insurance contract is particularly prominent. On the other hand, under normal circumstances, the legal judgment processing insurance contract dispute often need to accident responsibility book, the judicial authentication documents, intermediaries views as a basis for loss. But because of the reason as everyone knows, all kinds of institutions to make conclusive opinions fairness is hard to avoid the impact and challenge. At the same time, due to the identification of safety, cost, all appear to compulsory provisions are vague, experts in rate is low, resulting in court in the appraisal conclusion acceptance "in a dilemma". In addition, due to the lack of hierarchy in the identification of effective legal definition, different appraisal institutions on the same identification project make different conclusions, the court is often a difficult choice. In judicial practice, courts in cases of a similar verdict can be quite different. Some courts breakthrough insurance regulations in handling cases, verdict for insurance professionals feel make me on the spot.
Two main reasons, the insurance contract dispute case
(a) the external cause of the insurance contract dispute case
Deficiencies or defects, 1 insurance legal system construction. In judicial practice, because of the existing laws, regulations on the insurance sector adjustment is lagging behind, lack of complete theoretical system of support, on the cover of science and rationality, also has many problems, is a major reason for the frequent disputes and difficult to deal with. Insurance law since 1995 implementation, in 2002 only made a few modifications, the provisions are too principle, the lack of operability. The Supreme People's court "was published in 2003 8 December, social interpretation on Several Issues concerning the trial of insurance disputes (Draft)", but the judicial interpretation has not yet been issued. With the emergence of new types of insurance, the new situation of insurance disputes more and more complex, often leads to the judge to sentence under.
2, the relevant departments issued by the traffic accident report, the judicial authentication documents, damage report is not clear. Due to the frequent traffic accidents in recent years, the traffic police workload increases, so the rapid identification, rash identified phenomenon, make "accident responsibility not found" the proportion also increased substantially, and some simply do not pass directly make accident investigation. The judicial authentication activities of judicial authentication institutions and judicial appraiser is not standard. Some of the judicial authentication institutions and judicial appraiser due to profit driven and human power interference, against the independent, objective and fair principles, not in strict accordance with the operation of the judicial expertise procedure and technical specifications of the identification. Some local prices set loss center for the purpose of profit, blindly to the insured's unreasonable requests, people overestimate the amount of loss insurance.
3, the factors of the insurer. First of all, by the insurer to enhance the legal awareness and rights awareness. Be conscious of the insurer to pursue interests and initiative is strengthened day by day, so the insurance company accident processing opinion will not blindly passive obedience and satisfaction. Especially the litigation costs greatly reduced in April 1, 2007 the State Council "means to pay the cost of litigation" after the implementation of cost reduction, litigation, litigation becomes the main means to safeguard their legitimate rights and interests of the. Secondly, the insured insurance knowledge, awareness bias. China's insurance industry development time is short, the insurance knowledge popularization rate is low, professional insurance is very strong, the basic principles of insurance public do not understand the nature of insurance, understanding some deviations. Some people think that as long as the insured in the insurance, accident subject to the insurance company claims, also don't understand and the divergence of many insurance companies is reasonable and lawful practice. Some of the insured is not properly set up the insurance consumption idea and consciousness, want to pay as little as possible premium and quality insurance service. Some lack of trust in the insurance industry, prejudice and even contradictory emotions. Some mistakenly believe that, as long as the stalker to insurance company, insurance company make a claim for silence always. Some believe that the fear of litigation insurance company and the company's image and reputation, so often to sue to coerce the insurance company claims. Even some of the insured people driven by profit, after insurance accident happens at rush into danger, take a false report of loss, exaggerating the loss amount and other means, to seek illegitimate interests, if the insurance company does not meet the requirements of physiological compensation is unfair dispute.
(two) an internal cause losing of economic cases
1, the lack of insurance company service concept. The contract relationship between the insurance company and the customer is the principal of equality. But, at present, some insurance companies, its working methods and ideas are not adapting to the development of the insurance market, service consciousness and service idea is missing, not put a good service attitude. Some insurance practitioners who even residual in the past the kind of "official" habit, "bureaucratic" style, insurance claims will be superior to the customer, even against ignoring the customer's legitimate rights and interests, so that the contradiction between human intensification.
2, the insurance contract terms set is not tight. The clause of insurance contract terms too much content, long, obscure, the insured is difficult to fully understand. Some categories of liability insurance is not scientific, accident insurance, mutual understanding on the terms of the divisive.
3, the insurance industry show irregular. Insurance agent sales model is China insurance market especially the exhibition industry way of life insurance in the main, but some agent service quality is not high, driven by the interests, the fuzziness, fraudulent description, buy insurance to inaccurate, incomplete or false propaganda induced customers, for the insurance contract disputes.
4, the insurance company internal control mechanism is not perfect or not seriously implement. Some insurance companies for the completion of the premium, profit performance appraisal index, heavy industry, light underwriting, underwriting quality awareness is poor, or because the business pressure and human relaxed underwriting quality, there are many not standard underwriting, underwriting, underwriting the phenomenon of excess blind. At the same time the claim is not in place, the claim is not active, not timely, optional sex is strong, "wrong compensate, excessive compensation, indemnities, unreasonable exclusions" have occurred from time to time, the insurance contract disputes settlement has become the most concentrated part. There are some insurance company business development, internal management tendency, lax internal management, not through the chapter, illegal operation.
5, the legal affairs seriously insufficient, seriously restricts the legal work of legal risk prevention function. Now the insurance company branch at the provincial level are generally equipped with legal affairs staff full-time, but in the daily work of legal personnel most time and energy in dealing with the litigation. The legal departments of municipal branch is not independent, most linked in other departments, staff shortage, the independence of the legal work of the lack of security. The company is the first line in the business development, but most did not set up a legal department, with no legal personnel specialized. Law is an important but neglected embarrassment at the grass-roots company.
Lack of initiative, 6 employees of law study, legal knowledge update cannot catch up with the pace of development of law. Many people especially the grass-roots staff one-sided emphasis on internal company rules, document learning of legal learning seriously inadequate, and the personnel in the business line, so in business operations and are accustomed to subjective experience instead of law, in the traditional operation instead of law, to the subjective instead of law, legal, instead to hearsay to industry and the company's internal regulations instead of law, within the insurance industry and company rules and laws are inconsistent or even conflict situations, still machinery to act according to the internal rules, and then lead the company lawsuit.
Three, the insurance contract dispute case coping strategies
Some problems existing in the cases of disputes over insurance contract and the characteristics of the application of the law, we must respect the objective law of the development of the insurance industry, in-depth study and explore effective ways to resolve disputes, and puts forward solutions, and in between the insurer and the insured to construct a harmonious relationship, and promote the construction of harmonious society.
1, strengthen insurance legal system construction, strengthening the regulation on the insurance market and the insurance act. The amendments to the "insurance law" the relevant provisions of the amendment, supplement the supplement, the repeal of the repeal. On the explanation obligation of the insurer, the insured's obligation to inform the insurance clauses, interpretation, burden of proof and proof of insurance accident, health insurance is prohibited for repeated insurance and compensation liability as the focus, or as soon as the judicial interpretation norms, regulations or in form of law of continuous refinement further, the rights and obligations clear subject and standardize the insurance contract legal relationship, so that the law of the greatest possible maneuverability, the legal provisions and the vivid social life.
2, to further increase the insurance supervision and guidance. The insurance supervision departments should strengthen supervision of market conduct of insurance companies management and service quality, on the illegal operation, the insured, the company strongly disputes must be severely punished. The insurance industry association should cooperate with the insurance supervision departments to strengthen the insurance market orientation in education. On one hand, the insurance companies to set up correct market awareness and service concept, to provide services in strict accordance with the contract and relevant laws, regulations and industry standards. At the same time, appropriate to guide the insured to establish a correct concept of consumption to establish insurance, peer-to-peer services and perform its obligations under a contract consciousness, to reduce disputes.
3, the establishment of insurance contract dispute settlement mechanism. Negotiation, mediation, arbitration, litigation, the insurance contract dispute processing mode diversification. Insurance contract disputes occurred, take what kind of way to solve the dispute as soon as possible, to reduce the negative influence, on the insurance industry's public image and reputation. In 2007, China Insurance Regulatory Commission issued "guidance on the rapid processing of pilot work mechanism to promote insurance contract dispute" (CIRC regulations (2007) No. 427). Insurance supervision department according to the actual cases of insurance contracts in recent years increasing, an important measure of the dispute settlement mechanism as the insurance industry to strengthen the construction of credibility, establish a good image, and improve the mechanism of insurance market, promote the healthy development of the industry foundation engineering to grasp. Through the establishment of mediation mechanism in the insurance industry association, the mode of dealing with insurance contract dispute mediation or mediation and arbitration combined, so as to provide the insured convenient dispute resolution channels, timely and effectively resolve contradictions, such, can safeguard the legitimate interests of the insured, but also reduce the cost of claims or complaints. At the same time, to further strengthen and closely related to insurance disputes departments, units such as judicial and medical and health departments of communication, establish a regular consultation mechanism, in-depth study of the effective ways to solve the insurance contract dispute. As to the traffic police department objectively certificate issued by the traffic accident, and try our best to make the responsibility; suggested that the court proceedings in targeted selection of insurance experts as a jury trial, the judge make up for lack of knowledge of insurance, to the new situation, new problems, new trends in court insurance disputes they reflect the universal, puts forward suggestions to the court.
4, establish and perfect the credit mechanism. The credit system is not perfect and is one of the important causes of the credit crisis in our country's economic life. The principle of utmost good faith is the insurance industry's "imperial rule". But undeniable is, at present, China's insurance industry is facing a credit crisis. How to establish and perfect the insurance credit mechanism, has become an important topic of insurance regulatory institutions, insurance industry self-discipline organization, the insurer, insurance agencies and departments. To the credit rating system to establish a unified national insurance company as soon as possible with the personal credit joint credit rating system, insurance practitioners, formulate corresponding rewards and punishment measures, guide to the specification and claims from the interest of exhibition industry. At the same time to standardize appraiser, insurance intermediary practitioners behavior, clear responsibility for consequences, improve the identification of credibility, avoid multiple identification, repeat identification and appraisal conclusion conflict.
5, improve the management level of insurance companies. First of all, insurance enterprises to properly handle several relations in the development of good business. Properly handle the business development, business competition and legal risk prevention, the relationship of business innovation and legal risk prevention, leadership approval and legal review, respect for leadership, obey the leadership with respect to the legal relations, can not be one-sided emphasis on business development, business competition, business innovation and ignore the legal risk prevention, can not be one-sided no, the principle of respecting leadership without respect for the law, buried the hidden risks. To popular and standard implementation of the provisions of the insurance contract. The terms of the contract standard popular, customers easy to read, can fully communication and equal dialogue, insurance salesman, which helps promote the insurance product sales, can also reduce the misleading phenomenon and understand the differences on the terms, so as to reduce the incidence of disputes. Rationality is set on the insurance provisions of the full argument, the exemption clauses agreed to make more conducive to protect the insurance contract between the interests of both sides, avoid subsequent dissension. Secondly, to strengthen the supervision, examination of business operation, strictly regulate the operation behavior. Insurance companies to educate the staff, especially front-line operational staff from the importance of maintaining security of operation is highly standardized operations, to firmly establish the awareness of risk prevention. To further improve the underwriting and claim service. Perfect the policy issued procedures and sound underwriting procedures system, strict censorship policy, attach importance to protect the on-the-spot investigation and risk assessment. To the integrity of services, and thoughtful service to win the reputation and brand.Third, strengthen the legal affairs. Strengthen the construction of legal affairs and legal affairs team formation mechanism, enterprise legal adviser or lawyer team, large insurance company may set up a chief legal adviser. Enhance the independence of legal work, an important role in strengthening the legal affairs department in the insurance business, guarantee the legal department to participate in the decision-making on major issues, the company's business activities, the legal department to truly play the role of the firewall. At the same time, legal affairs to change concept, will be the focus of work in the hind dissolves steering prevention, involved in all aspects of the whole process of the company's various businesses, and effectively prevent and defuse the risks, reduce the various factors trigger disputes.