Cross strong insurance claims practice rules

(2008Version)

 

The first section Report of cases and claims to accept

One, from the insured or the victims of a report, should be asked about the situation, and immediately inform the insured or the matters related to the specific compensation procedures.

Involving casualties, or accident loss more than cross strong insurance sub limit of indemnity, or a party without insurance accident insurance to pay strong, should remind the parties involved in the accident report to the local traffic management departments to immediately.

A detailed record of two, the insurer shall report the situation, and recorded in the business management system.

Three, the insured motor vehicle traffic accidents, shall be borne by the insured to the insurer for the compensation insurance. The insurer shall, upon receipt of an application for compensation1Working days, to claim for writing and inform the insured need to provide insurance and compensation of the relevant proofs and materials.

The claim notice must be popular, easy to understand, and according to the actual case check the following and compensation of the relevant proofs and materials:

(1Claim letter), vehicle license, driving license, the insured proof of identity, proof of identity to receive reparations.

(2The accident proof material): traffic liability certificate, mediation book (or a simple accident, traffic accident to discuss the agreement, or the court, arbitration, mediation book award, the verdict).

(3) loss to prove: vehicle damage, vehicle repair invoices, loss of property list.

(4Personnel expenses) that: the certificate of diagnosis of hospital, medical expenses reimbursement vouchers, prove that delays and income, disability certificate, death certificate, be dependent evidence, proof of residence.

 

The second section The survey and assessment

A motor vehicle accident, the parties of insurance in a client report, responsible party vehicle insurance companies to carry out investigation, the victim's loss was approved. The non defaulting party vehicle relates to casualties compensation, no fault insurance company also should carry out surveying.

An estimated loss of two, more than any one accident compulsory insurance indemnity, should remind the parties for the division of responsibilities according to the law of accident.

Three, the accident involving multiple insurance people, but there are one or more insurers could not surveying cases, failed to carry out surveying insurer, may entrust other insurers to surveying;The entrusted party insurer and the principal underwriter consultation fees.[ft1] Entrusted by the insurer, the insured shall submit to the client to provide survey report, accident/Loss of picture and confirmed by the loss of accident parties signed the book.

 

The third section Advance and recovery

A condition, rescue expenses paid in advance

At the same time, meet the following conditions, may pay the rescue expenses.

(a) conforms to the "motor vehicle traffic accident liability compulsory insurance regulations" twenty-second article of the cases;

(two) to advance the traffic control department of the public security organ a notice;

(three) the victim must rescue, and salvage cost has already occurred, rescue hospital rescue bill and the details of the project;

(four) is not by the road traffic accident social rescue fund pays rescue expenses.

Two, advance the standard

(a) in accordance with the traffic accident trauma clinical guidelines and rescue personnel to the national basic medical insurance, the compulsory insurance for medical expenses limit or not responsible for medical expenses limit pays rescue expenses.

(two) the number of rescued treatment in different hospitals in one person and, in medical expenses limit or not responsible for medical expenses limit according to the number of capitation; can also according to the hospital and police advice, as appropriate, within limit adjustment.

Three, pay the way

The traffic police department issued upon receipt of written notification, the medical advance/To prove the diagnosis, rescue expenses documents and detailed date, time to rescue the victim commitment issued by the hospital "pays rescue expenses guarantee", or the special account shall be transferred to the rescue cushion payment hospital opened in the bank, no cash payment.

Four, recovery

For all the cases in advance, the insurer has the right to recover the injurer advance. Compensation income after deduction of the legal expenses (costs, legal fees, execution fees), to recover costs, reducing the payment in full.

 

The fourth section Treatment of claim

One, the principle of compensation

The insurer is liable to indemnify the damage to the victim caused by traffic accident of motor vehicle insurance in insurance liability within the scope of.

Two, the compensation limit[ft2] 

The insurance company insured the receipt[ft3] Insurance to provide evidence and information on the date of5Days, making the decision of whether to liability insurance, and notify the insured; belonging to the insurance liability, and the insured agree on compensation insurance agreement10Days, compensation insurance. Does not belong to the insurance liability, it shall make a written explanation.

Three, the rescue expenses paid

For rescuing the victims to the insurer to pay the rescue expenses, the insurer after receiving written notice and medical institutions the traffic administrative department of the public security organs issued by the rescue bill, to pay the rescue expenses. Provisions of the payment standard and payment according to the practice of third section two or three of execution.

The traffic accident insurance does not belong to the responsibility or by the road traffic accident social rescue fund pays rescue expenses will be paid, the insurer is not.

Four, reparations computation[ft4] 

(a) the basic calculation formula

The insured in the insurance to pay strong partial compensation within the limit, respectively to calculate the compensation for victims death and disability costs, medical expenses, loss of property:

1Total loss = sigma. The partial loss amount = death disability claims+Medical expenses claims+Property damage claims

2The partial loss. Loss = each approved losses amount, i.e.:

Death and disability expenses claims = death and disability costs amount approved bear

Medical expenses claim = medical expenses amount approved bear

Property damage claims = property loss amount approved bear

3The partial losses. The approved amount exceeds the cross strong insurance sub limit of indemnity, partial loss amount is equal to the cross strong insurance sub limit of indemnity.

Note: the "victim" for the insured motor vehicle of the victim, not including the insured motor vehicle the car personnel, the insured, hereinafter the same.

(two) when insurance accident involving multiple victims

1The basic calculation formula. The corresponding item is represented as a:

Partial loss amount = ∑ each victim each approved losses amount, i.e.:

Death and disability claims = ∑ each victim cost death and disability costs amount approved bear

Medical expenses claim = ∑ the victims bear medical expenses approved amount

Property damage claims = ∑ the victim property loss amount approved bear

2All the victims. Each authorized losses amount and exceed the insured motor vehicle compulsory insurance liability limit of corresponding items, each item loss amount is equal to the cross strong insurance sub limit of indemnity.

3All the victims. Each authorized losses amount and exceed the insured motor vehicle compulsory insurance liability limit of the corresponding item, the victim in the insured motor vehicle compulsory insurance liability limit shall be itemized compensation for:

The insured motor vehicle compulsory insurance amount of compensation to a victim of partial loss = cross strong insurance sub limit of indemnity *[Breakdown of a victim in the accident losses amount approved/(sigma each victim item approved losses amount)].

(three) when the insurance accidents involving multi car accident vehicle

1The insured motor vehicle insurance people in their respective cross strong insurance partial compensation within the limit of compensation, calculation of partial loss to the victim.

2According to its application. All vehicles cross strong insurance partial compensation limit total partial compensation limit ratio, assessed the partial loss.

A partial loss approved bear amount = item loss amount x[Application of cross strong insurance item limit of indemnity/(sigma each virulence of square cross strong insurance the partial compensation limit)]

Note: no responsibility for the accident vehicle in a motor vehicle, not to participate in other non duty vehicles and car property damage compensation calculation, only to participate in duty vehicle loss or car casualties loss compensation calculation.

The non defaulting party on the amount of compensation responsibility for vehicle vehicle loss shall be borne by the responsible party, by the party making no liability for property loss for the next generation.

A full responsibility, not the responsibility of the party,No amount of compensation liability side should bear full responsibility for loss of vehicle for the full responsibility to loss of vehicles, to deliver strong insurance no liability for property loss limit.

A full responsibility, not the responsibility of the partiesThe amount of compensation responsibility, no party shall bear the full responsibility for loss of vehicle for the full responsibility to loss of vehicles, to the non defaulting party cross strong insurance no liability for property loss limit and limit.

Many have the responsibility, not the responsibility of the party, the non defaulting party on the amount of compensation for losses shall be borne by the vehicle to deliver strong insurance no liability for property loss limit limit, in the vehicle the average allocation of responsibility.

Many have the responsibility, not the responsibility of the parties, the non defaulting party on the amount of compensation for losses shall be borne by the vehicle to the non defaulting party cross strong insurance no liability for property loss limit and limit, in the vehicle the average allocation of responsibility.

The accident vehicle should be insured and uninsured vehicle, as the insured motor vehicle involved in the calculation.

4 for relevant departments eventually without liability accident, the uniform application of liability limit calculation.

3The vehicle has the responsibility and apply the same limit for all parties, simplified vehicle on the victim's partial loss of average allocation:

(1Motor vehicle, motor vehicle) for the victims of the personnel, vehicles property loss:

A partial loss approved bear / item loss amount = victims (N-1)

(2) for non motor vehicle, the non motor vehicle, pedestrian, vehicle and personnel loss:

A partial loss approved bear / item loss amount = victimsN

Note: 1NFor all the motor vehicle accidents in the number of vehicles.

The accident vehicle should be insured and uninsured vehicle, as the insured motor vehicle involved in the calculation.

4At first the calculation, if the damage caused by the party to pay strong risk limits not compensate enough, while the victim is not fully compensated, the injured party's loss distribution again in cross strong insurance residual limits, fill in the insurance to pay strong limit. For each loss to be allocated together does not exceed the remaining limit of indemnity, compensation distribution according to the results of the parties; exceed the remaining payment limit, according to the amount of each distribution accounted for the total amount of the residual distribution by multiplying the proportion of compensation quota allocation; until the damaged parties are in full amount compensation or payment party should cross strong insurance without the excess amount.

(four) the property loss need rescue, rescue expenses claims and property loss does not exceed the total property damage compensation limit.

(five) the main vehicle and the trailer accident when used in connection with, people cross strong insurance main vehicle and the trailer are liable for compensation in the respective liability limits.

The liability for compensation if the traffic management department not to determine the main vehicle, trailer should bear the main vehicle, trailer, the average allocation to the insurer the partial loss, and calculate the compensation in the corresponding partial compensation limit.

The main vehicle and the trailer by the insured, the traffic accident happened when used in connection with each other, according to the principle of the three.

(six) the insured motor vehicle insurance more than one cross strong insurance, insurance during the period of liability in the insurance contract, in the later period of play does not assume liability to pay compensation.

(seven) comfort on spirit damage the insured in accordance with the court judgment or mediation take gold, in principle, other compensation for the project in full compensation, the compensation for death and disability compensation limit.

(eight) the standard for death and disability costs and the cost of medical care

According to "the Supreme People's court 'scope of compensation, on the relevant issues concerning the application of law in the trial of personal injury compensation case explanation'" items and standards, issued by the Ministry of public security "injured in road traffic accident" (evaluationGB18667-2002), as well as the basic standards of medical care personnel trauma clinical guidelines for the diagnosis and treatment of traffic accident and traffic accident for personal injury compensation amount.

 

An example1:A,BTwo motor vehicle traffic accident, two cars have a responsibility.A,BTwo car loss respectively2000Element,5000Element,BCar, medical expenses7000Yuan, death and disability costs6Million yuan, the other caused by road property loss1000Element. Two vehicles cross strong insurance property loss compensation limit2000Yuan, medical treatment charge compensation limit for1Million yuan, death and disability compensation limit11Million yuan, is:

(a)ACar traffic insurance compensation calculation

AVehicle compulsory insurance compensation amount = claims the death of the victim disability+The medical expenses claims+The loss to the property of reparations

=BCar deaths disability approved bear the amount+BCar shall bear the amount of medical expenses+Property loss amount approved bear

1.BCar deaths disability approved bear amount =60000÷(2-1)=60000Element

2.BCar, medical expenses borne by the amount =7000÷(2-1)=7000Element

3Property loss amount approved bear = road property loss amount approved Bear +BCar damage amount approved bear

=1000÷2+5000÷(2-1)=5500Yuan, over property loss compensation limit, according to the limit of compensation, the amount of compensation2000Element.

Among them,ACar insurance to pay strong onBCar damage indemnity = property damage compensation limit xBCar damage amount approved bear / (road property loss amount approved Bear +BCar damage amount approved bear)

=2000*[5000÷ (1000÷2+5000)]=1818.18Element

Among them,ACar insurance to pay strong marketable loss indemnity = property damage compensation limit x road property loss amount approved bear / (path loss amount approved Bear +BCar damage amount approved bear)

=2000*[(1000÷2) ÷ (1000÷2+5000)]=181.82Element

4．ACar traffic insurance compensation amount =60000+7000+2000=69000Element

Two.BCar traffic insurance compensation calculation

BCar traffic insurance compensation amount = road property loss amount approved Bear +ACar damage amount approved bear

=1000÷2+2000÷(2-1)=2500Yuan, over property loss compensation limit, according to the limit of compensation, the amount of compensation2000Element.

An example2:A,BTwo motor vehicle traffic accidents,AThe car full responsibility,BThe car without responsibility,A,BTwo car loss respectively2000Element,5000Yuan, another caused by road property loss1000Element. SetAThe car used cross strong insurance property loss compensation limit2000Element,BThe car is no liability compulsory insurance of property loss limit100Element, then:

(a)ACar traffic insurance compensation calculation

ACar traffic insurance compensation amount =BCar loss amount approved bear+Path loss amount approved bear

=5000+1000=6000Yuan, over property loss compensation limit, according to the limit of compensation, the amount of compensation2000Element.

Two.BCar traffic insurance compensation calculation

BCar traffic insurance compensation amount =ACar damage amount approved bear

=2000Yuan, over no liability for property loss limit, according to the limit of compensation, the amount of compensation100Element.

BThe cars on theAThe loss shall be borne by the car100Yuan of the amount of compensation, byACar insurance in cross strong insurance without responsibility property damage compensation for the next generation.

 

The fifth section Payment of indemnity

One, pay reparations

The payment shall be timely upload to the motor vehicle accident liability compulsory insurance information platform. Before the establishment of motor vehicle traffic accident liability compulsory insurance information platform, the insurer to pay the claims should be in the original insurance policy with the "x x months sunrise risks, negative * * (all, mainly, equal, minor) responsibility, * * (no) resulting in death" chapter of the strip.

Two, document segmentation

If the compulsory insurance and commercial three party insurance in different insurance companies, such as the amount of loss more than cross strong insurance liability limit, by cross strong insurance underwriting company retained has compensation cost original invoice or credentials, will need to commercial insurance project original invoice or a copy of the invoice, the insurer claims dedicated seal, hand the insured for commercial insurance claim.