基于理赔诉讼案例的健康保险惜赔识别研究

发布时间：2018-04-17 15:19

  本文选题：拒赔金额 + 减赔金额　； 参考：《云南财经大学学报》2014年05期

【摘要】：保险理赔难已引起社会的高度关注。对2000~2012年162个健康保险理赔诉讼样本进行实证分析,发现惜赔99例,惜赔率61.1%,其中拒赔72例,拒赔占惜赔的72.7%。保险惜赔深受索赔人谈判能力、保险金额、理赔人员素质的影响。保险公司对投保人拒赔金额甚于被保险人,对职工减赔金额弱于农民。无论拒赔金额还是减赔金额,均与保险金额正相关。保险公司对重大疾病拒赔金额甚于一般疾病,对住院超过15日的减赔金额甚于住院少于15日的金额。区县支公司拒赔金额甚于地市分公司,中西部地区拒赔金额和减赔金额均甚于东部地区。
[Abstract]:The difficulty of insurance claims has aroused great concern of the society.Based on the empirical analysis of 162 cases of health insurance claims from 2000 to 2012, 99 cases of compensation were found, including 72 cases of negative compensation and 72.7% of the total of 72.7% of the total.The insurance indemnity is affected by the claimant's negotiation ability, insurance amount and the quality of the claim personnel.The insurance company claims more to the insured than the insured, and less to the workers than the farmers.No matter how much you refuse to pay or how much you reduce your claim, it is positively related to the amount of insurance.The insurance company refuses to pay more for major illness than for general illness, and for more than 15 days of hospitalization, more than 15 days of hospitalization.The district and county branch company refused to compensate more than the prefectural branch, and the central and western regions refused to pay more than the eastern region.
【作者单位】： 北京航空航天大学经济管理学院;北京大学经济学院;
【基金】：国家社会科学基金项目“基于惜赔视角的保险消费者权益保护机制设计”(13BJY181) 教育部规划基金项目“中国健康、意外保险欺诈的识别及预警研究”(11YJA790223)
【分类号】：F842.684

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中国期刊全文数据库 前1条

1 周建涛;秦炳山;迪丽;王泉涌;;健康、意外保险惜赔识别[J];新疆社会科学;2013年03期

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中国期刊全文数据库 前1条

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本文编号：1764143