Salary survey plays an important role in salary processing and has a decisive influence on the result of salary processing. Investigation is a process of verifying objective facts, and the following aspects should be paid attention to when investigating compensation: investigation must be based on the principle of seeking truth from facts; The investigation should be prompt, accurate, timely and comprehensive; It is forbidden for investigators to make any form of commitment to claims during the investigation; The investigation should follow the principle of avoidance; After the investigation, an investigation report should be written in time to truly and objectively reflect the investigation.

(5) Approval

Verification here means the process of paying, refusing to pay, exempting from handling claims and calculating the amount of compensation. Before adjusting the case file, the adjuster should check whether the information attached to the case file is enough to make correct payment and refusal to pay. If the information is incomplete, it shall notify the relevant information in time; When the information is still in doubt, it is necessary to inform the investigators for further investigation and verification. According to the insurance contract and claim classification, the claim adjuster makes a claim calculation sheet and a claim processing submission sheet. Specifically, the approved contents include:

1. Calculation of payment claim. For the settlement of normal claims, the amount of compensation should be calculated according to the contents of the insurance contract, the types of insurance, the liability for compensation, the insured amount and the insurance situation. For example, the death insurance premium is calculated according to the death liability in the contract; According to the degree of disability and appraisal results, the disability insurance premium is calculated according to the prescribed proportion; The medical insurance premium is calculated according to the medical expenses paid by customers.

2. Refuse to pay. In case of refusal to pay, the claimant will confirm the refusal and record the opinions and reasons for the refusal. For the insurance contract terminated from this, it shall be indicated in the handling opinions, and the value of the premium or cash to be refunded, as well as the amount and amount of supplementary deduction shall be calculated according to the terms; For the insurance contract that continues to be valid, it shall be indicated in the handling opinions, and the contract shall be placed in the state of continuing validity.

3. Exempt from calculating insurance premium. For cases that should be exempted from paying insurance premiums, the claims adjuster should confirm the exemption and put the contract in the state of exemption from paying insurance premiums.

4. Matters needing attention in claim calculation. The result of claim calculation is directly related to the economic interests of customers, so it is necessary to ensure the accuracy of claim insurance amount calculation; At the same time, the items involved in the claim calculation should be calculated together. The items that should be deducted when calculating claims include: if you are in danger within the grace period, you should deduct the unpaid insurance premium; If the customer has loans and interest receivable, the loans and interest shall be deducted; If there is prepayment, the prepayment amount shall be deducted; Other items that should be deducted. Items to be supplemented include: prepaid insurance premium; Failing to receive the due insurance money; Dividends, spreads and other items payable are not received.

(6) Review and approval

Audit is the key link of salary business processing. Through the audit, find the negligence and mistakes in business processing and correct them in time; At the same time, the review also has the function of supervising and restraining the indemnity personnel, preventing the personal factors of the indemnity personnel from affecting the indemnity results, and ensuring the objectivity and fairness of the indemnity processing, which is also an important link in the internal risk prevention of the indemnity department. The contents and main points of the review are as follows: (1) Confirm the insurer; Confirmation of insurance period; Confirmation of the cause and nature of the accident; Confirmation of insurance liability; Confirmation of the completeness and validity of the certification materials; Confirm the accuracy and completeness of claim calculation.

Examination and approval is the step of reporting the examined cases step by step according to the nature of the case, the amount of compensation, the right of compensation and the examination and approval system, and the supervisor with corresponding examination and approval authority will examine and approve them. For what? Some major, special and difficult cases need to be tried collectively by a compensation case review committee. According to the examination and approval results, give corresponding treatment. In case of recalculation, it shall be returned to the claim calculator for re-adjustment; If further investigation is approved, the investigator shall be notified to continue the investigation; If the case is approved, it will be handed over to the next closing process.

(seven) closing and filing.

First of all, according to the settlement results, the closing personnel prepare the Notice of Payment (Refusal to Pay) or the Notice of Insurance Exemption and send it to the insured. Refusal to pay compensation shall indicate the reasons for refusing compensation and the reasons for the termination of the effectiveness of the insurance contract. If there is a refund, it should be reflected in the notice at the same time, and the amount and payee should be indicated to remind you to collect the money. The payment letter shall indicate the payment amount and the name of the beneficiary, and remind the beneficiary to come to the payment formalities with relevant documents. The payee goes through the payment formalities with the notice of refusal to pay compensation and relevant documents, and the insurance company confirms the identity of the payee to ensure that the insurance money is correctly paid to the beneficiary stipulated in the contract. The payee can receive the due amount by cash, cash check, bank transfer or other permitted means, and the financial department of the insurance company will pay the corresponding amount according to the regulations. Secondly, the closing personnel modify the status of the insurance contract according to whether the validity of the insurance contract is terminated or not, and make a closing mark. Finally, the closing personnel will discharge all the materials of the closed claims in the prescribed order and file them according to the requirements of business file management for future reference.

Fourth, non-life insurance claims process

The procedure of non-life insurance claims mainly includes the steps of accepting loss notice, auditing insurance liability, conducting loss investigation, compensating insurance money, handling losses and subrogation.

(1) loss notice

It refers to the link that the insured or beneficiary should inform the insurer of the time, place, reason and other relevant information of the accident as soon as possible after the insurance accident happens, and file a claim. Giving notice of loss reporting is also an obligation that non-life insurance policyholders must fulfill.

1. Time requirement for loss reporting notice. Depending on the type of insurance, sometimes it takes time to report the loss. For example, the insured shall notify the insurer within 24 hours after the insured property suffers the stolen loss within the scope of insurance liability, otherwise the insurer has the right not to compensate. In addition, some types of insurance have no clear time limit, and only require the insured to inform the insurer of the accident loss as soon as possible. If the insured fails to notify the insurer within the time limit prescribed by law or agreed in the contract, it may be regarded as giving up the right to claim compensation. Article 26 of the Insurance Law of People's Republic of China (PRC) stipulates that the insured or beneficiary of insurance other than personal insurance shall be extinguished if he knows or should know that he has not exercised his right to claim compensation or pay insurance money from the insurer for two years from the date of the insured accident. ?

2. Report the loss. The insured may send a notice of loss orally or in other forms, such as letters and telegrams. However, a formal written notice shall be reissued in time and all necessary claim documents shall be provided. Such as insurance policies, account books, invoices, proof of danger, loss identification, loss list, inspection report, etc. If the loss involves the responsibility of a third party, the insured must also issue a letter of transfer of rights and interests to the insurer, who will exercise the rights and interests recovered from the third party on his behalf.

3. Insurance company accepts. Accepting the loss notice means that the insurer accepts the case. The insurer shall immediately check the insurance policy with claims in detail, report to the competent department in time, arrange on-site investigation and other matters, then register the acceptance case number and formally file a case.

(2) Review the insurance liability.

After receiving the notice of loss, the insurer shall immediately examine whether the claim is the insurer's responsibility, and the contents of the examination may include the following aspects:

1. Is the insurance policy still valid? For example, the basic insurance clauses of China's property insurance stipulate that the insured shall fulfill the obligation of telling the truth, otherwise, the insurer has the right to refuse compensation or terminate the insurance contract after a certain number of days after the notice of termination is served.

2. Whether the loss is caused by the insurance risk. The loss claim put forward by the insured is not necessarily caused by the insurance risk. Therefore, after receiving the notice of loss, the insurer should find out whether the loss is caused by the insurance risk.

3. Whether the lost property is insured property. The property covered by an insurance contract is not all the property of the insured, even if it is a comprehensive insurance, some property will be classified as not covered. For example, China's comprehensive property insurance clauses stipulate that land, mineral resources, aquatic resources, currency, securities and so on. Not within the scope of the subject matter insured; Gold, silver, jewelry, dams, railways, etc. It must be specially agreed and stated in the insurance policy, otherwise it does not belong to the scope of the subject matter insured. It can be seen that the insurer must carefully examine the property claimed by the insured according to the insurance policy.

4. Whether the loss occurred at the place specified in the policy. The loss insured by the insurer is usually limited by the location. For example, China's property insurance clause stipulates that only the insurer is responsible for the losses suffered by the insured property in the place specified in the insurance policy.

5. Whether the loss occurred within the validity period of the insurance policy. The insurance policies all specify the starting and ending time of the insurance validity period, and the loss must occur within the insurance validity period before the insurer can compensate. For example, the insurance period of marine cargo insurance in China is usually limited by the warehouse-to-warehouse clause, that is, the insurer's liability starts and ends from the shipper's warehouse at the place of departure specified in the insurance policy to the consignee's warehouse at the destination specified in the insurance policy, and the deadline is 60 days after the goods are unloaded from the seagoing vessel. Another example is the underwriting method of periodic or intra-period claims in liability insurance. The former means that as long as an insured accident occurs during the insurance period, the insurer has the responsibility to compensate whenever a claim is made; The latter means that no matter when the insured accident occurs, as long as the insured claims during the insurance period, the insurer has the responsibility to compensate.

6. Whether the claimant has the right to file a claim. The person claiming compensation should generally be the insured specified in the insurance policy. Therefore, when making compensation, the insurer should find out the identity of the insured to determine whether it is eligible for insurance money. For example, under a property insurance contract, it is necessary to find out whether the insured has an insurable interest in the subject matter insured at the time of loss; If a person has no insurable interest in the subject matter insured, his claim is invalid.

7. Whether the claim is fraudulent. Fraud in insurance claims is often difficult to detect, and insurers should pay attention to the following issues: (1) whether the claims documents are true; Whether the applicant has repeatedly insured, and whether the beneficiary intentionally murdered the insured; Whether the insurance date is earlier than the insurance accident date, etc.

(3) conducting a loss investigation

After reviewing the insurance liability, the insurer should send people to the scene of the accident to actually investigate the accident, so as to analyze the cause of the loss and determine the degree of the loss.

1. Analyze the cause of the loss. In insurance accidents, the causes of losses are usually complicated. For example, the reasons for the loss of a ship are that the ship itself does not have seaworthiness, the natural wear and tear of ship parts, and the influence of natural disasters or accidents. Only by analyzing the causes of the loss in detail can we determine whether it belongs to the insurer's responsibility. It can be seen that the purpose of analyzing the causes of loss is to protect the interests of the insured and clarify the scope of compensation of the insurer.

2. Determine the degree of loss. The insurer shall verify the loss item by item according to the loss list put forward by the insured, and reasonably determine the degree of loss. For example, in the case of shortage of goods, the quantity of shortage should be determined according to the original documents and the quantity of arrival; For those who cannot determine the quantity of lost goods, or some damaged goods are still intact or valuable after treatment, a reasonable depreciation rate should be estimated to determine the degree of loss.

3. Determine the right to claim. The obligations of the insured stipulated in the insurance contract are the premise of the insurer's liability for compensation. If the insured violates these matters, the insurer may refuse compensation on this ground. For example, when the risk of the subject matter insured increases, whether the insured has fulfilled the obligation to inform; After the insured accident, whether the insured has taken necessary and reasonable rescue measures to prevent the loss from expanding. These problems directly affect the right of the insured to claim compensation.

(4) Compensation insurance money

The insurer's claim against the insured shall be handled in accordance with the provisions of the insurance contract. If there is no agreement in the insurance contract, it shall be handled in accordance with the provisions of relevant laws. If the loss falls within the scope of insurance liability, the insurer shall immediately perform the liability for compensation after investigating and estimating the amount of compensation. The insurer may adjust the compensation amount according to the type of insurance policy, loss degree, subject value, insurable interest, insured amount and compensation principle. Compensation in property insurance contracts is usually monetary compensation. However, in property insurance, the insurer can also agree with the insured in other ways, such as restitution, repair, replacement or replacement with similar things.

(5) Disposal of losses and surpluses.

Generally speaking, in property insurance, damaged property will have a certain residual value. If the insurer compensates for all losses, the residual value shall be owned by the insurer, or the residual value shall be deducted from the compensation amount; If part of the loss is compensated, the insurer may discount the damaged property to the insured to offset the compensation amount.

(6) Subrogation

If the insured accident is caused by the negligence or illegal act of a third party, the third party shall be liable for the loss of the insured. The insurer may pay the insured in advance according to the provisions of the insurance contract or the law, and then the insured will transfer the right of recourse to the insurer and assist the insurer to recover from the third party.