The hair (2012) No. 15 

Article 1 in order to safeguard the legitimate rights and interests of the insured, regulating the property insurance company (hereinafter referred to as "the company") motor vehicle insurance (hereinafter referred to as "insurance") management behavior, control business risks, enhance the level of service industry claims management, promote industry integrity construction, according to the "insurance law" of the people's Republic of China and the relevant laws and regulations to formulate "motor vehicle insurance claims management guidelines" (hereinafter referred to as the "guidelines").

 The term company second of the "guide", refers to the property insurance company in accordance with the law, the auto insurance business within the territory of the people's Republic of China, including Chinese funded insurance companies, Sino foreign joint venture insurance companies, solely foreign-funded insurance companies and the foreign insurance companies established in china.

 Article third of the "guide" in the insurance company insured refers to receive notice of loss, according to the laws and regulations and the contract of insurance, the accident loss fact investigation and verification, approved by the insurance liability and compensation insurance act, insurance performance of insurance contract.

 Article fourth insurance claims should include general acceptance, scheduling, inspection report, file, loss (estimate), personal casualty tracking (investigation), nuclear price, nuclear damage, medical examination, data collection, calculation, underwriting, node case, payment of compensation, compensation and loss goods processing, customer pay a return visit, complaint handling and special case handling links.

 Fifth the company should establish insurance organization management, a complete and unified claim case management, data management, security management system, build and business scale, risk control, customer service to adapt to claims management, process control, operation management and service system.

 Article SixthCompany insurance management and services should follow the following principles:

 (a) intensive company unified management, supervision and control;

 (two) gradually realize the whole process flow, information technology, standardization, standardization, consistency of claims management service mode;

 (three) establish a compliance management and risk prevention measures to control claims management, risk control, customer service information management system;

 (four) ensure that claims personnel agencies at all levels of the rational division of labor, clear responsibilities, clear responsibility, supervision in place, check out;

 (five) claims the allocation of resources should take into account the cost control, risk prevention, the quality and efficiency of service.

 Article seventh of the "guide" clearly the basic requirements of management and service company should achieve in the auto insurance claims in the management of. Between the company and the customer relationship of rights and obligations should be based on the "insurance law" and relevant laws and regulations and the insurance contract shall prevail.

 Article eighthChina Insurance Regulatory Committee and its dispatched institutions shall conduct supervision and inspection on the company insurance claims, on the implementation and publicly "guidelines" to the society.

 The second chapter claims management

 The first sectionOrganizational management and resource allocation

 Ninth the company shall establish and improve the insurance system of organization and management. Clear claims management architecture, management mechanism, working process and the operating norms, clear all kinds of settlement agencies and personnel responsibilities and authority, assessment indicators, standards and regulations. Clear mechanism, key management key claim settlement personnel management methods. Clear claims post relevant personnel qualifications, establish claims personnel training examination and assessment rating system, the formulation and business scale, claim management and customer service claim settlement resources allocation methods adapt etc..

 Tenth the company should be in accordance with the insurance principle of centralized management, establish a complete and reasonable insurance organization, meet the business development, claim management and customer service needs.

 (a) principle of centralized management refers to the total company claims management system, unified specification claims service procedures and standards, improve the supervision and assessment mechanisms, should implement national or regional report, and centralized management for nuclear damage, nuclear price, medical examination, underwriting, claims process key link and key data modification company.

 (two) complete and reasonable settlement organization, shall claim management functions, claim operation function and customer service functions are separated, forming effective management mechanism of mutual cooperation, mutual supervision.

 Encourage company to claim line implementation of people, money, vertical management.

 Article eleventhThe company should establish a strict control measures and IT system control means, the centralized and unified management, supervision and control to strengthen key positions and key link.

 The nuclear damage, nuclear price, medical examination, claims and other key personnel, should gradually implement the company from top to bottom vertical management, responsible for the recruitment, appointment, evaluation, send, salary, job change and settlement audit administration permissions, etc..

 The twelfth branches of the classified authorization claims management, full consideration should be given to company business scale, operational efficiency, management level, the regional condition, can choose "from the authorized" and "from the agency authorized" mode. From the institution authorized by the limited company of provincial branch of the authorization.

 "From the authorized" should be based on the Claims Officer professional skills, examination ratings granted different amount, different types of cases the audit authority; "from the agency authorized" should be based on the branches of the management level, risk control ability, operating efficiency and service demand to different claim links and content management authority.

 To encourage companies to take "from the authorization" mode, strengthening professional management.

 Article thirteenthThe company should focus on the risk characteristics of different claim settlement positions, formulate strict post cross clamping system.

 Underwriting position shall not be and nuclear damage, the price of nuclear, nuclear lost jobs concurrently. The same claim, surveying, damage and nuclear lost jobs, and between the nuclear damage claims post shall not concurrently. The authorized amount, surveying, damage and nuclear damage position, adjustment for post and core can be concurrently, but should make strict and effective during and after the event, supervision mechanism.

 Fourteenth the company should according to the needs of claims management, customer service and business development, fully consider the development speed and regional characteristics, business scale, to claim resource allocation scheme, explicitly claim resources and business resource ratio. Ensure claims service places, claims service tools, claims information system, claims personnel resources with adequate.

 (a) in the above marketing services business department

 1 there shall be established a fixed claims service place or set up relatively independent claims service area in the business place, accept customers surveying, claims submission materials. The number of claims service sites should be according to the scale of business, reasonable setting, the number of cases and the service radius of scientific layout. Claims service premises shall ensure convenient, eye-catching logo. The company shall announce the site address, telephone service claims.

 2 local insurance industry association should be based on the local area, natural environment, traffic conditions and other factors determine the standard basic service efficiency of each claim links, the company shall ensure that personnel, claims the post claims service tools to meet the standard requirements.

 (two) without branch area

 The company shall formulate practicable plans for claim settlement services, ensuring smooth telephone, to entrust the third party to provide timely survey, damage and rescue convenient way for customers to other services. In the underwriting, shall provide the customer specified above, and inform the service claims process.

 Do not meet the above requirements, companies should defer to the business development speed, control the scale of business.

 Article fifteenth a company shall establish the compensation responsibilities, qualification, training, assessment, rating, supervision and management system and mechanism, establish the claims officer training records and service complaint records, records of claims personnel skill level, training and service standards situation truthfully.

 Encourage insurance industry association gradually implement unified industry qualification, the Claims Officer Training and examination, assessment rating system, establish claims personnel information database.

 The sixteenth company to deal with the Claims Officer pre job, post, the promotion training and examination. To formulate detailed and feasible training plan and plan, ensure the basic training time, quality and effect.

 (a) pre job training: each post personnel shall participate in the pre job training and assessment, training time should not be less than 60 hours, after passing the examination can work;

 (two) training: the company should through the face-to-face teaching, video teaching form, training for all staff. Nuclear damage, nuclear price, medical examination, claims personnel to participate in the annual training time shall not be less than 100 hours, other staff every year to participate in training time shall not be less than 50 hours;

 (three) the promotion training: all staff promotion or non nuclear damage, nuclear price, medical examination, claims personnel to be engaged in nuclear damage, nuclear price, medical examination, nuclear lost job, should be unified training and examination, qualified after promotion.

 The second sectionClaims management

 Seventeenth the company should establish a covering the entire process of insurance management system and operating procedure. According to the principle of efficient, docking, scheduling, survey, case report, the loss (estimate), personal casualty tracking (investigation), work flow and operation methods of each link reported nuclear price, nuclear damage, medical examination, data collection, calculation, underwriting, node case, payment of compensation, compensation and loss materials processing, customers pay a return visit, complaint handling and special case processing for a unified standard, gradually realize the standardization, the consistency of the claim management and customer service.

 To prevent risks, improve work quality and efficiency, claims processing various links point to strict specifications, before and after the nodes should form a mutual supervision necessary control mechanism.

 Eighteenth the company should establish strict pending claims management system. Specification for pending claims management process, accurately grasp the outstanding claim number and processing schedule; supervision and promote claims processing time. According to the outstanding claim loss estimation and assessment of loss adjusting management rules to determine the loss amount estimated outstanding claims reserve, to ensure accurate accrued liabilities and operating results, reflect the true.

 Article nineteenthCompanies should formulate the price management system. Establish or adopt scientific and reasonable auto parts price standard, completes the spare parts price information maintenance and localization.

 Industry associations should actively promote the insurance industry and the automobile industry chain industry joint research to establish a scientific, reasonable repair parts and the time coefficient standard system.

 Twentieth the company shall establish a special case management system. On the case, the cancellation of cancellation of recovery, reopened claims, accommodation, twelve cases, claim indemnity in advance, litigation cases, within the scope of compensation claims and other special cases of the audit and the regulation of the process, and the examination and approval authority received general company.

 Twenty-first the company should establish the anti fraud management system. Company and branch offices shall establish shared anti top-down, internal and external cooperation, information fraud full-time team. In key areas and links through the establishment of fraud and suspicious claims screening function increase anti fraud prevention and efforts in claims information system. Establish a complaint, report, complaint handling mechanism and anti fraud system of rewards, published complaints telephone to the society claims.

 Conditional region should establish the local insurance industry joint anti fraud process (or information) fraud processing joint anti mechanism or the insurance industry and the local public security organs (or information) mechanism.

 Twenty-second the company should establish the different claims management system and assessment method. According to the "remote Chuxian, he claims" principle, the establishment of information management system and the network, build inter provincial authorized surveying, loss, indemnity payment platform, standard practice and the rules of operation, good inter provincial customer complaints to the management, to ensure that the national settlement service standard specification for Fan Tongyi.

 The third sectionData management

 Twenty-third the company should establish support auto insurance claims management, risk control and customer service the whole process of business processing and information management system. The system can be connected seamlessly, without manual intervention, real-time data processing, to avoid data loss, manual adjustment and time delay difference.

 Twenty-fourth the company should establish a data quality management system. Strengthen the claims and insurance, financial data standardization, accuracy and timeliness of the management and supervision, make the business, financial data collection, statistics caliber consistent. Regular monitoring and evaluation of quality companies to deal with data, questions on the data report.

 Twenty-fifth the company shall regulate claims nodes data management. Clear data relation, do the historical data can be traced back to the daily data, Nissin knot. Should determine the data maintenance process, the use of the nature and scope of inquiry. Should make the data standardization system. The abnormal (risk) data set based on observation, timely adjustment of observation project according to the key management control.

 Doubt data modification should be in compliance with the laws and regulations, strictly to modify the specification. Doubt that data should be timely rectification, the rectification should be considered when the rectification scheme is reasonable and whether it will lead to other data quality problems, it is strictly prohibited to modify.

 Twenty-sixth the company should establish information communication mechanisms necessary internal departments, between different regions. According to data management claims, communication and information feedback of products, underwriting, claims department and financial, actuarial, legal and customer service and other related departments.

 The establishment of an information platform area, the company shall promptly to the information platform to upload claim information, to ensure that the upload information and core business system information integrity.

 The fourth sectionOperation guarantee

 Twenty-seventh the company should establish the claim expense management system, strictly in accordance with the provisions of accounting system, regulation of direct claim expense and indirect loss adjustment expense management. The claim should be scientific, reasonable cost sharing and in conformity with the relevant provisions.

 The direct claim costs must be strictly in accordance with the paid project and original documents, materials, truthfully funds, approval should be concentrated to the institution at the provincial level or above, a certain proportion of compensation in accordance with the monitor and direct claim expense; indirect loss adjustment expense to develop indirect loss adjustment expense budget management, strict provision standard, paid project, audit and supervision of the execution of system, indirect claim expenses paid project and single large expenditure should be strictly approval process.

 The company shall be included in the cost of inspection policy claims, binding on agencies at all levels.

 The twenty-eighth company shall establish management system of reserves for outstanding claims. The accurate estimation of outstanding claims reserve according to the loss data, estimation rules established claims and actuarial, should be true, accurate, timely reflect the auto insurance business status, effective early warning management risk, guarantee the operation stability.

 Twenty-ninth the company should strengthen the management of cooperation, including cooperation repair plant, cooperative medical institutions, medical disability evaluation mechanism, assessment mechanism and other insurance agency management.

 (a) companies in the choice of partners, should guarantee the justice, fairness, openness, protect the insured, the victim and the legitimate rights and interests of the insurer, in accordance with the law, strict management, establishment of the access and exit mechanism, evaluation, supervision and.

 (two) the company shall ensure that clients to choose the right repair units, not forcibly or covertly assign vehicle repair units.

 The company choose the cooperative repair factory, and after the prescribed vehicle repair units have signed a cooperation agreement repair program. To ensure the quality of repair, repair repair time to achieve customer satisfaction, the insurance company shall assist the customer tracking quality and schedule repair.

 The association of insurance industry should actively organize company repair plant, medical institutions, medical disability evaluation mechanism, assessment institutions and other related units of communication and coordination on insurance claims service associated with the car, strengthen industrial cooperation.

 (three) strict claim rights management

 The 1 companies will be prohibited nuclear damage, nuclear price, medical examination, underwriting, claims the permissions granted to key posts cooperation unit and other kinds of organs or personnel of this company in the system of non.

 2 in principle does not allow cooperation unit on behalf of clients report, on behalf of the insurance company survey, damage (except professional assessment institutions), on behalf of the client to receive reparations.

 Thirtieth the company should establish a prevention system, including the control of risk insured, resist disasters and emergency measures, reduce the frequency of accidents and reduce accident loss of skills, enhance customer service capabilities.

 Thirty-first the company should establish customer complaint management system. For customer complaint channels, complaints, complaints, suggestions and information solutions, complaints, complaints, feedback of results results filing complaints handling supervision and assessment standard management.

 Thirty-second the company should establish a customer feedback system, customers pay a return visit, visit the amount of insurance types, the visit content, problems, solve the problem of disposal flow ratio, visit statistical analysis and feedback, return results archiving, visit quality supervision and assessment method for standardized management.

 Article thirty-thirdThe company should establish performance appraisal mechanism. Design of compensation quality index system of science, formulate measures for the management of performance appraisal.

 Compensation quality indexes include customer service satisfaction, the rate of complaints, complaints handling customer service satisfaction index, case closed time, closing rate settling efficiency indicators, assessment of loss deviation rate, time limit for rate, pending development deviation rate, quality of service, data quality management index and the rate of compensation claims, average indemnity, claim expense claims cost index. The company should strengthen the overall quality of supervision and examination shall not claim, simply check payment rate, unreasonable down the amount of compensation, damage the interests of consumers, influence of claim service quality.

 Thirty-fourth the company should carry out compensation quality special on-site or off-site inspections regularly or irregularly, including service claims, claims the key measures, claim quality, special case processing, compensation expenses of special inspection or evaluation. In the daily claim management, corporation shall strengthen the routine check of compensation quality branches and remote off-site supervision, when necessary, conduct a special inspection claims efficiency.

 Article thirty-fifthThe company shall strictly abide by the laws and regulations, fulfill the obligation of insurance contract. Honest, legitimate business, to prohibit the following acts:

 (a) the Claims Officer "eat, take, card, want", deliberately making things difficult for the customer, or the use of power for personal gain;

 (two) the claim case forced the insured agreed in advance;

 (three) using the insured name of making false claims;

 (four) for the case of cancellation without justifiable reasons;

(five) the wrong compensate, indemnities, drag pay, excessive;

 (six) claims personnel and customer collusion to take human losses and other illegal means to cheat the loss, damage to the interests of the company;

 Seven.Other violations of the legitimate rights and interests of clients dishonest or illegal behavior.

 The third chapter process control

  The first section claims information system

Thirty-sixth the company shall support the company claims the whole process, process standardization, standardization, operation management as the goal, unified planning, development, management and maintenance of the system and claim information.

 Article thirty-seventhThe key risk points of the claims process compliance control requirements, should be embedded within the claims information system, and realized through the information system control.

 Claim information system operation shall be consistent with the claim settlement practices, and strict norms to guide the practical operation.

 Article thirty-eighthThe company shall ensure that all claims processing through the system and claim information, realize the whole process control. No system dealing with.

 Established in the company of thirty-ninth claims information system database. Corporation shall not modify authorized provincial branch program right of revision and data. All procedures, data modification and operation record should be kept for examination and approval.

 It is strictly prohibited to claim information system database based on provincial and provincial-level branch.

 Article fortiethThe company claims information system settings should meet the control system requirements, should at least include the following contents:

 (a) and report system, insurance system, financial system, reinsurance system data to realize the integrated management system of claim information, seamless docking. Through the company's administrative examination and approval system and case information should be automatic docking to claim system, if not be automatic docking, the administrative examination and approval opinion scan and upload to claim system.

 (two) the system should achieve claims all claim information flow control, at least including a report, scheduling, survey, case, damage (estimate), personal casualty tracking (investigation), nuclear price, nuclear damage, medical examination, data collection, calculation, underwriting, node case, payment of compensation, compensation and loss goods processing, customers pay a return visit, complaint handling and special case handling and other necessary links and information management integrated. System claims information should be real-time accurately reflect the aging each claim links, posts.

 (three) the system should be able to claim information on nuclear damage, report, audit, price of nuclear medical claims, an important link of the graded authorization settings, system according to the authorization rules automatically submit audit; without the consent of the final nuclear profit audit, claim system cannot print loss confirmation. Without the consent of the person eventually underwriting, claims system shall compensate the nucleus, financial system shall pay indemnity.

 (four) the system claims information should be according to the laws and regulations and the terms of the agreement to set standards and formula calculation.

 (five) outside the system claims information may unilaterally mandatory insurance indemnity liability exemption, deduction and so on.

 (six) claim information system should ensure complete data, real and not tampered with.

 (seven) the system claims information should be set up anti fraud recognition to remind function, prompting the occurrence time and protect or termination of insurance claim, close to the annual number of abnormal situation.

 (eight) the system claims information can be collected from the customer information in each link of the amendment, to ensure customer information true, accurate, detailed.

 (nine) the system claims information should have image storage and transmission function, and gradually realize the electronic documents, implementation of paperless operation; to encourage companies to use remote video transmission system.

 (ten) the system to meet the claim information fast processing conditions claim proper simplification process.

 (eleven) claims information system monitoring should be strengthened to a person much hillock, prohibited the use of his artificial no..

 Article forty-firstThe company shall establish emergency response mechanism, ensure the system fault report claims service timely and orderly.

 The second sectionReport of cases

 Forty-second the company shall report to national or regional unified management, shall be reported to the provincial centralized or the following institutions management. All insurance claims cases must be through the system report link entry and generation number before it can continue to the next process.

 Forty-third the company should establish an effective screening mechanism through the report, report to the personnel standard operation if asked in detail about the report, after accepting the timely return method, gradually reduce the invalid.

 The forty-fourth report more than out of 48 hours, the company shall set up warning sign in system claim information, and shall record the specific reasons. Companies to report more than cases out of 15 days to establish supervision and examination mechanism.

 The forty-fifth report, system claims information should be automatically querying and suggest the same policy or under the same vehicle's previous report records, including the target vehicle as the third vehicle case record. Many times reported on 30 days should be set up warning signs, to prevent duplication of reporting and to reduce moral hazard.

 Forty-sixth the company shall actively guide the insured person or the driver directly report to the insurance company. The repair units and other institutions or individuals on behalf of the insured to report, companies should be required to provide the insured the real contact, and to the insured to verify. At the same time, the company shall in the subsequent claims process by checking the insured the valid identity certificate or the insured to meet to verify the case.

 Article forty-seventh the company reported case acceptance personnel should carefully and record the reporting of information, the report should be as detailed as possible, at least should include the following content: the policy information, vehicle information, insurance insured information, the informant information, driver information, loss, loss, accident treatment and rescue etc..

 Complete the report records, report to personnel or surveyor to report or the insured with clear matters relating to claims handling process and required documents etc..

 For the convenience of customers to understand the essentials of procedures and compensation claims, the company shall provide multi channels, multi way to explain to the customer.

 The third section scheduling

 Article forty-eighthThe company shall establish a sound, scientific scheduling system, the use of information means accurate scheduling, improve the efficiency of.

 Article forty-ninthThe company should control the Claims Officer, claims, claims the task by vehicle scheduling system working state.

 The fourth sectionThe survey

Article fiftiethThe company through the mobile terminal, remote control or double survey to ensure the site survey information. The major, suspicious claims, should double, many people survey.

     The publicWe should increase the intensity of complex geological problems of major cases, and no way to carry on the statistics of the site survey, prospecting field, the first scene.

 The company shall establish inspection emergency treatment mechanism, prevent and properly handle unexpected cases or cases peak possible survey resource configuration is not in place.

 The fifty-first case investigation report shall objectively reflect the real situation of the important project survey, survey report should be complete in specification. Important projects should include at least: out of vehicle information, driver information, the cause of the accident, after and properties, survey time, place, content, casualties, the accident vehicle loss position, degree, survey personnel signature.

 Scene photos should clearly reflect the panorama and the loss of the accident. The company should take technical means to prevent or recognition of digital photo modification.

 Survey information should be timely entry settlement system, exceeding the prescribed time limit, shall be submitted to senior management, assessment of survey personnel punishment.

 Article fifty-secondInvestigation personnel should be detailed records of customer information, understand the accident, investigation and evidence collection.

 Investigation personnel shall submit a written "claim notice" to the client, and the necessary explanation, suggesting that the customer timely put forward a claim. "The claim notice" shall include at least: the claim procedure guidelines, claims to provide information, claim aging commitment, claims complaints telephone, claims personnel information, claim information clients'independent search method and other matters needing attention.

 Article fifty-thirdCompany survey personnel should collect real complete customer information in the survey links, and in the subsequent link continuously perfect.

 Fifty-fourth company shall entrust the external institutions survey strict management. The company should establish qualification standards for external cooperation mechanism, and survey institutions signed a cooperation agreement with the client. Branches of external institutions commissioned survey shall be approved, authorized by the company.

 Fifty-fifth to encourage companies to printed anti false label or fragile fragile anti-counterfeiting seal (tag), add in specific parts, prevent damage to parts of malicious substitution, disposal and strengthen the fitting residual value management. Mainly used in the following aspects:

(a) the first on-site assessment of loss in accordance with the automatic nuclear price conditions, add the need for recovery of residual parts.

 (two) the first site cannot estimate the case, on the appearance of damage parts affixed, the replacement and possibly damaged parts affixed; for supervision of dismantling vehicles, the key point in dismantling affixed.

 (three) for the loss or accessories could not confirm the water damage, such as computer plate affixed.

 Fifty-sixth the company should be strictly in accordance with the "insurance law" and relevant laws and regulations and the provisions of the insurance contract, the law within the prescribed time limit, and if the accident to liability insurance. Complex, should be approved within 30 days, unless otherwise stipulated in the contract. Does not belong to the insurance liability, shall make the verification within 3 days from the date of the insured denied compensation issued notices and explain the reason, will claim document scanning deposit system, refund the relevant claim documents, and handle the formalities for signing.

 The fifth sectionLiCase

 Fifty-seventh the company should strengthen the filing process management, to ensure that the file loss amount estimated as accurately as possible. Company principle should be that case report. After receiving the report shall timely file system information processing in claims. The system should be set up for more than 3 days have not yet filed is automatic and mandatory registration function.

 Fifty-eighth the company shall promptly enough accurate input loss amount estimated for automatic registration, and through payment system to automatically estimate the assignment to the case, should be based on the sufficient principle, assignment amount reference history of similar cases in case of loss or other reasonable statistics to determine. Companies should be based on risk, there is no injury not different definite assignment rules.

 The sixth sectionLoss (estimate)

 The fifty-ninth company claims personnel should accurately record loss position and project, the repair, replacement, timely input claims information system. And please customer signature confirmation loss position and project.

 Sixtieth therefore the personnel should be timely to the customer loss, and loss project, repair, repair parts type, amount of patience to explain to the customer. Nuclear damage through loss after confirmation, shall be borne by the customer signature confirmation. The client shall bear the losses, should be clear to the customer and make explanation.

 The loss of items and amounts of the needed adjustment, therefore the personnel should be agreed and signed by the customer.

 Article sixty-firstCompany shall entrust the external mechanism of damage control.

 The seventh sectionNewspaper prices

 Article sixty-secondThe company should establish professional newspaper price team, set the newspaper price module in the system and claim information, and gradually realize the common parts automated quotation.

 Article sixty-thirdThe company shall maintain and update spare parts price information, price information to ensure the implementation of localization, matching with the regional market price information.

 The company shall use the relevant state departments approved and accredited accessories production, conform to the technical specifications and performance standards, the original factory parts have legitimate trademark, quality inspection of parts. 　　

The eighth sectionNuclearLoss

Article sixty-fourthThe company should attach great importance to the management of nuclear damage link, to strengthen the nuclear damage team construction, improve the professional skills of personnel for nuclear damage.

 Article sixty-fifth the nuclear damage personnel shall carefully check the scene of the accident investigation, the loss of personnel to submit the survey, with customers in the accident is consistent, determine the authenticity and whether to belong to the insurance liability accident.

 To encourage companies to nuclear damage personnel to be provided to the customer "claims to" the contents of the audit, to ensure that the required claim that accurate material.

 Article sixty-sixth the nuclear damage staff to deal with the loss of personnel to submit the loss of the subject matter, repair projects, assessment of loss amount, according to the parts price information price links provided by remote online audit or audit, and the audit opinion.

 Article sixty-seventhThe system should be in accordance with the nuclear damage compensation information automatically by numerical adjustment loss amount. For the outstanding loss amount of volatile, should remind the flag is set in the system.

   The Ninth SectionInjured tracking and medical examination

 Sixty-eighth company shall establish personal injury cases (hereinafter referred to as the "injured") audit professional management team, the provincial and the following claims department set up full-time injured tracking (investigation) and medical audit team or job, participate in the injured accident survey, damage survey, process tracking, assist the solution, participation procedure, data collection, document review and approval work cost. The company should establish a wounded tracking, audit practice, should be early intervention, process tracking, full assistance, strengthen the control goals.

 Company principle should be set on the phone line, arrange the wounded personnel, the insured or the victims injured handler consulting services.

 The company shall investigate and adult wound strength, making people injury investigation requirements, specific content and investigation of aging.

 Injured audit staff should actively participate in between the insured and the accident victim's compensation system to work, both sides reached a satisfactory solution results.

 Disputes occurred between the insured and the victim, the company shall actively assist the insured do case work.

 The sixty-ninth company in the injured in the tracking process, should be timely treatment, medication issues standards, the follow-up treatment costs, disability apparatus used to medical units, the insured or the victim of understanding, and timely amendment to pending claim loss amount estimated.

 Article seventiethThe company shall, in accordance with relevant laws and regulations and the contract of insurance, in accordance with the principle of people-oriented and beneficial to timely treatment, were injured in audit fees and payment.

 The seventy-first company of disability identification for injured cases, should give priority to recommend and guide the injured to disability appraisal mechanism of local higher credibility assessment, ensure fair, objective evaluation of residual. Companies should be tracking disability evaluation process and the identification results, found should be timely to the appraisal agency feedback or review the doubt.

 The company will be "low residual high rating," doubt "disabled" record, feedback to the relevant departments in charge.

 The tenth sectionData collection

 The seventy-second company to receive, record customer service claims data, should be in accordance with the "notice on the spot check claims" claims data are complete, timely receive receipt. A receipt shall be marked on the recipient, receiving company time and corporate advisory telephone.

 Article seventy-thirdThe company believes that the relevant certificates and materials incomplete, it shall timely notify the applicant once, the insured or the beneficiary to provide supplementary.

The eleventh sectionScienceCount

Article seventy-fourthCompany to claim full data, without objection cases, should be timely adjustment work.

     The twelfth sectionNuclearCompensate

 Article seventy-fifthProvisions of the companies claim aging standards shall not be less than the laws and regulations and industry about the claim limitation.

 The company within 60 days from receiving the claim and relevant evidence, to date, the amount of compensation cannot be determined, shall be determined by the evidence and material amount to pay in advance. Ultimately determine the amount of compensation, payment of the corresponding difference.

 The seventy-sixth company to deal with difficult cases consultation, in full respect facts, apply the law correctly, comprehensive evaluation of the interests of all parties, and effectively communicate with customers, make the final conclusion, and the results will be timely feedback.

 The thirteenth sectionNode a

 Article seventy-seventhThe company shall in all loss standard claims by automatic or manual closing. After the case reopened claim rights should be based on the total company to claim information.

 Article Seventy-eighthThe company shall clearly stipulate the claim cancellation, zero closing and exclusions conditions, strict case cancellation, zero closing and rejecting claims management.

 Cancellation of recovery case processing permissions should claim information gathered through the system to the company.

 The fourteenth sectionCompensation payments

 Seventy-ninth the company shall pay to reach a compensation agreement with the customer within 10 days after the. The company shall promptly notify the customer to receive insurance compensation, regular cleaning has never paid the claim. Not through prepaid indemnity payment agreement has been reached.

 To encourage companies to establish a rapid settlement mechanism.

 Article eightiethThe company name, account should be set in the system loss payee claim information and bank name, abide by the relevant provisions on anti money laundering shall indemnity payments.

 In the claims of success after payment, the company shall inform the customer via phone, SMS or written form.

 Encourage company policy, actively guide customers agreed compensation payment, payment of compensation object, clear account bank account information, etc..

 Article eighty-first of the insured person, the company should actively guide the insured by bank transfer to receive insurance indemnity. The insurance indemnity amount exceeds a certain amount, pay by non cash payment, and payment to the insured, the traffic accident victim, comply with laws and regulations of the people's bank account is consistent with the name.

 Each area, the company can according to the actual situation, formulate the maximum limit cash.

 Article eighty-second the insured units, the company shall strictly in accordance with the provisions of the relevant payment, to pay the non cash payment of insurance indemnity of 1000 yuan of above, and pay to the insured, the traffic accident victim, comply with laws and regulations of the people's bank account is consistent with the name.

 Each area, the company can according to the actual situation, further defined to remittance, online banking without endorsement transfer payment function.

 Encourage companies to adopt non cash payment to pay reparations.

 Article eighty-thirdCompany shall strictly control on behalf of insurance risk.

 (a) the strict "direct compensation" repair factory management

 Repair units for DPCA "direct compensation" agreement (hereinafter referred to as the "direct compensation factory"), must be in strict management and supervision.

 1 may not report generation generation, survey the permissions granted to direct compensation factory.

 2 straight for plant in the generation customer claims, shall provide repair, repair list and invoice issued by the original, the insured's authorization identity materials.

 3 the company shall be transferred to the insurance indemnity repair accident vehicle repair units into account bank account through a bank with no endorsement function of transfer payment, and by telephone or in writing inform the insured.

 4 for not providing the insured the real contact, the authorization of the repair unit, the company should not signed or renewed "direct compensation agreement".

 (two) the strict control of other units or individuals to collect the insurance indemnity

 For direct compensation factory outside of the other units or individuals on behalf of the insured or the traffic accident victim to receive insurance indemnity, must provide the insured or the traffic accident victim valid identity certificate, authorization certificate and lead the claims were the original proof of identity.

 Claim payment in accordance with the provisions of article eighty-first and article eighty-second executive.

 Article eighty-fourth the insured caused harm to the third party liability insurance, is to be determined by third, according to the request of the insured, the company shall directly to the third party compensation insurance. The insured fails to request, third have the right to request compensation should be compensation directly to the company, the company shall accept the.

 The fifteenth sectionCompensation and loss goods processing

 Article eighty-fifthThe company should strengthen the subrogation case management, and business process, financial regulations and formulate recovery case.

 Article eighty-sixthThe company shall establish loss goods management approach. Loss goods discount to the insured, the insured shall be agreed with, to ensure the fair and reasonable.

 Company for the recovery of loss goods, should be in the system of claims information accurate input loss goods management information and the disposal of the case, the statistical loss goods disposal amount. Process payments should be offset compensation.

 For the loss treatment pilfer to recover the vehicle, constructive total loss of the vehicle, shall receive institutions at the provincial level or above unity.

 The fourth chapterClaims service

 The first sectionService standards

 Article eighty-seventhSettlement service should be carried out to claim the entire process, including risk management, customer complaint handling, etc..

 Article eighty-eighthThe company should establish a claim service standards, to ensure that the link flow control procedure is simple, clear claims prescription services, service standards.

 Article eighty-ninthThe company should establish "Shouwenfuze system, ensure the smooth process flow, not mutually making excuses.

 The first to accept customer consultation, complaints of staff as the first person of responsibility, responsible for handling or urge the relevant departments to solve all kinds of problems raised by customers, and to solve the problem of tracking.

 Ninetieth the company shall establish a unified national service phone number, and social publicity, 24 hours by 365 days to accept the report and consulting. The company shall ensure that telephone is smooth, the rate of not less than 85%.

 The company shall provide 24 hours by 365 days surveying services.

 All the insurance industry association should be based on the actual situation of local regulations, the Claims Officer arrived at the time the scene of the accident, and to the public.

 Ninety-first the company should establish claims service index system. Claims service indicators should include at least: telephone connection rate, arrived at the scene, the average closed cycle long, small claim lawsuit cycle time, payment, customer complaint rate.

 All insurance industry associations should according to the local actual situation, formulate the reference standard claims service index, announce to the society.

 Ninety-second the company shall unified surveying officer clothing style, unified production and hanging badges, surveying vehicle appearance spraying and numbered according to the unified visual identification, convenient management claims service work supervision, enhance the service claims image.

 Ninety-third the company should formulate claim Standard Terminology Standard, covering the whole process of claims. The Claims Officer should embody the good occupation morality and spirit of insurance in the service process, take the initiative to provide quality services to customers quickly and accurately.

 Article ninety-fourthThe different claims service, commissioned by the external claims service shall not be less than the service claims, claims the standard provisions of aging.

 The second sectionService content

 Article ninety-fifthThe company should pay more attention to insurance claims service work, to further strengthen the service consciousness, strengthen claims claims service ability, improve the claims service quality.

 The company shall actively assist the insured liability (liability to the other party refers to the accident to the insured person liable for the claim); when the insured person directly to the insurance claim with the insurance company, and the responsibility to each other the right to claim for transfer to the insurance company, the insurance company should conscientiously perform their payment obligation.

 Companies should further strengthen communication and coordination. For many insurance company claims, each company should participate actively in the process, not prevarication.

In order to improve the efficiency of the industry, the provincial association should rely on industry insurance information platform as soon as possible to achieve the data timely delivery and sharing, should organize the insurance company gradually established industry standard, loss compensation standards and compensation standards of practice, to solve the problem of insurance services, improve customer satisfaction.

 Article ninety-sixthThe company should be based on the type of claim, customer classification and compensation data to establish differential settlement service mechanism.

 The company should establish small claims processing mechanism case claims, improve the small case claims the timeliness and quality of service. Small Peian standard and payment time limit determined by each industry association at the provincial level according to the situation.

 Article ninety-seventhThe company can provide vehicle rescue, risk management and other value-added services to customers at a reasonable cost range.

 Ninety-eighth the company shall claim information feedback service provides multiple channels. The company shall, in accordance with the relevant provisions, provide claims self-service information query service. The company should be in place of business or service establishments and claims related, posting guidelines or claim flowchart claim unified printing, express service calls in the certificate of insurance and the insurance propaganda material, formulate and publish claims service commitment.

 The company should be carried out step by step telephone, SMS notification, the network platform to upload data services.

 The third sectionService guarantee

 Ninety-ninth the company should establish a return visit system, shall set full-time staff return visit to customers in the indemnity payment within 15 working days, the company shall ensure that a certain proportion of the case according to the amount of return.

 Establish customer account or retained return telephone recording, shall at least include: the case of authenticity, claims, claims for service quality. Review records shall be properly kept, counted from the date of termination of the contract, keeping period shall not be less than 5 years.

 Article 100thThe company should establish complaint petition processing mechanism, set up customer service department or advisory complaints Post published telephone complaints, claims to the public, accept social supervision.

 (a) the company shall set full-time staff responsible for accepting the customer claims complaints. Establish customer complaint registration account, account shall at least include: serial number, date of complaint complaint, the complainant and contact way, the respondent, relates to the policy or claim, cause of complaints, complaints, the specific content, answer customer date.

 (two) to the insurance supervision departments in accordance with the provisions to do involve petitions claims service, not prevarication, perfunctory, procrastination, resort to deceit, the company is in charge of the leadership responsibility and asked to report in accordance with the regulatory authorities and the management of the.

 (three) the door customers with complaints, a person responsible for the reception, make the greatest efforts to resolve immediately. Unable to resolve immediately, clear answer time. Other forms (such as telephone, fax, letters and e-mails) general complaints, the undertaking department shall reply within 3 working days; major, difficult complaint, should reply within 5 working days.

 Regular analysis of complaint letters and visits, and take measures for improvement.

Article 101stThe company shall establish and improve the emergency mechanism of major emergencies, groups of complaints and the media exposure event.

Article 102ndThe company should establish the service claims internal auditing and checking mechanism.

 The company shall be by way of customer service, customer satisfaction survey system, make unannounced visits to a variety of claims service quality supervision and inspection, to ensure that the claims service level.

 The 103rd company in strengthening claims management at the same time, it should continue to enhance the service level of the claims, claims service commitment, not to fight against insurance fraud and other various reasons as, reduce the insurance service quality.

Article 104thAuto electric pin special products business claims and subsequent management principle in insurance mark is located, and execute apanage management.

 Article 105thCross strong insurance case settlement, shall be strictly in accordance with the relevant provisions of regulatory authorities and industry associations executive.

 The 106th company in the establishment of business relations of cooperation and insurance assessment institutions, should be clearly defined the related services provided insurance assessment institutions of not less than the management and service quality of the "guidelines" requirements of the two sides signed the cooperation agreement.

 Article 107thThe "guidelines" issued since the date of implementation.