健康、意外保险惜赔识别
发布时间：2018-10-21 19:52
【摘要】：保险公司理赔过程中时常遭受惜赔责难,文章对2000～2011年258个健康、意外保险理赔诉讼样本进行实证分析,发现:惜赔179例,惜赔率69.38%,其中拒赔126例,拒赔率70.39%,减赔53例,减赔率29.61%;无论惜赔率还是拒赔率,均是国有控股公司低于股份制公司,省会城市公司低于中小城市公司,东部地区公司低于中西部地区公司,地市分公司低于区县支公司;拒赔组保险金额和保险费均值,均远大于减赔组,对高保险金额、高保险费拒赔概率更大,对低保险金额、低保险费减赔可能更大。
[Abstract]:Insurance companies are often reprimanded in the process of settling claims. This paper makes an empirical analysis of 258 samples of health and accident insurance litigation from 2000 to 2011. The results show that 179 cases are pity claims, 69.38 cases are rare claims, 126 cases are rejected, 70.39 cases are rejected, 53 cases are reduced. The loss rate is 29.61%, the state-owned holding company is lower than the joint-stock company, the provincial capital company is lower than the small and medium-sized city company, the eastern region company is lower than the central and western region company, the prefectural branch company is lower than the district and county branch company; The insurance amount and the average insurance premium in the rejection group are much larger than those in the loss reduction group. For the high insurance amount, the probability of refusing to pay for the high premium is greater, and for the low insurance amount, the reduction of the low insurance premium may be greater.
【作者单位】： 北京航空航天大学经济管理学院;
【基金】：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)的阶段性研究成果
【分类号】：F842.6
，
本文编号：2286191
[Abstract]:Insurance companies are often reprimanded in the process of settling claims. This paper makes an empirical analysis of 258 samples of health and accident insurance litigation from 2000 to 2011. The results show that 179 cases are pity claims, 69.38 cases are rare claims, 126 cases are rejected, 70.39 cases are rejected, 53 cases are reduced. The loss rate is 29.61%, the state-owned holding company is lower than the joint-stock company, the provincial capital company is lower than the small and medium-sized city company, the eastern region company is lower than the central and western region company, the prefectural branch company is lower than the district and county branch company; The insurance amount and the average insurance premium in the rejection group are much larger than those in the loss reduction group. For the high insurance amount, the probability of refusing to pay for the high premium is greater, and for the low insurance amount, the reduction of the low insurance premium may be greater.
【作者单位】： 北京航空航天大学经济管理学院;
【基金】：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)的阶段性研究成果
【分类号】：F842.6
，
本文编号：2286191
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