壽險業客戶申訴之研究

Abstract

保險契約之訂立，不僅對於消費者而言係攸關其保障及權義，對保險公司而言則更是一份長期的承諾，任何爭議或糾紛，都必須妥善處理，否則就失去保險的效用、本質與意義，筆者從事壽險業保戶申訴業務相關工作多年，冀能將實務工作中所學習到的經驗及所遇到的困難或問題作一整理、分析，俾為相關領域所需者之參考，本研究之目的如下: 一、探討壽險保戶申訴的主要原因及其對壽險業者營運的影響 二、以T公司為例，整理出改善保戶申訴處理流程及降低保戶申訴率之建議方案，以做為壽險業提昇保戶服務之參考 三、提出處理保戶申訴遇到的問題及意見，以作為主管機關監理之參考及未來法律修改之建議

本研究先確定研究範圍，以壽險業官方統計資料進行探討保戶申訴之主要原因並其對壽險業者在營運面的影響，再以T公司為例，更細部地探討其申訴流程及原因，並使用DMAIC方法尋求改善申訴處理流程及降低保戶申訴率之建議，本研究之結論如下: 一、招攬糾紛是壽險業保戶申訴的最主要原因。 二、從保險商品的設計、行銷、服務到保險給付均須將避免客戶申訴當成重要的檢核事項，才能真正降低並預防保戶申訴的發生。 三、重視企業內設立保戶申訴的機制，可以顧及消費者的權益並適度減少訴訟。 四、申訴處理流程之改善不僅要重視案件處理的速度，同時也要注重處理的品質才能真正維護客戶的權益。 除上述研究結論外，本研究並提出對主管機關申訴監理、法律修改及對後續研究者之建議如下: 一、建議主管機關在計算保險公司綜合申訴率並進而為差異化管理時，對於申訴案件處理的品質也應納為重要之評估內容。 二、某些程度的病徵仍屬應告知事項，要保書之書面告知事項中應設定明確的描述並要求客戶據實回覆，以確保保險公司核保之權利並避免爭議。 三、考量比照保險公司，公告其他銷售通路之申訴率或對之為差異化管理。 四、建議修改保險法第64條第3項，使保險事故發生於契約訂立二年內者，保險公司仍得行使解除契約之權利。 五、進一步蒐集各國資料作深入的探討，以研究何為最適宜之保戶申訴管道。 六、從法律觀點對保戶申訴原因再深入研究，以做為日後法院判決之參考。 七、再深入研究，如何從商品設計、行銷、服務到保險給付的每一個環節，均將避免客戶申訴事項設置適當之檢核，以確認可以達到避免客戶申訴之目的。

An insurance contract is essential for consumers to comprehend and uphold their rights and obligations and for an insurance company to honor its long-term commitment. Therefore, any arguments and disputes arising from insurance contracts must be handled with discretion; otherwise, the purpose of and trust in insurance will be lost and defeated. I have been engaged in management of customer complaints in life insurance companies for years and hope to make some contribution to the life insurance industry by collecting and analyzing related data so that experience I have learned from my job can be shared with others and that solutions may be attained to solve problems and meet challenges in this area faced by the industry. The purpose of the study is stated as follows: 1.To study and analyse the major reasons of customer complaints in the life insurance industry and their influence on operations of life insurance companies. 2.By taking T Company as an example, to come up with suggestions and plans to improve the work flow of customer complaint handling and decrease the customer complaint ratio. 3.To identify key issues triggering customer complaints and find feasible solutions, which may be of value to regulators in supervision, regulation or legislation in the future. In this paper, I first define the scope of research and then probe into the major reasons of customer complaints and their influence on life insurance operations based on government statistics. Taking T Company as an example, I then study and analyze the reasons of customer complaints and the work flow of handling complaints by applying the DMAIC methodology to find ways to improve the work flow of handling customer complaints and decrease the customer complaint ratio. Below is a brief summary of the conclusion for my research： 1.Disputes arising from the solicitation process is one of the main reasons for customer complaints in the life insurance industry. 2.Effective precautions against customer disputes must be integrated in a life insurance company’s key functions and processes such as product development, marketing and sales, policy services and claims procedures, preferably formally included in the functional checklist, in order to minimize or prevent customer complaints. 3.If a company truly cares about customers and attaches great importance to customer complaints handling, it will protect customers’ rights and interests and reduce potential litigations against the company. 4.Improvement of the customer complaints handling workflow consists of both the speed of processing such cases and the quality of the handling. Both are the key to ensure customers’ rights and interests. In addition to the above-mentioned conclusion, as a result of my research, I have come up with a few suggestions as follows for the reference of the competent authority in supervising and regulating customer complaints handling, legislators interested in related legislation and researchers who may want to conduct follow-up researches: 1.That the regulator should include the quality of customer complaints handling in the evaluation criteria when monitoring and supervising life insurance companies’ customer complaint ratios, thereby attaining differential management. 2.That certain symptoms should be declared in application - The application form should provide detailed and definitive descriptions of those symptoms and require applicants to reply truthfully so as to protect insurer’s rights to underwrite insurance cases and avoid disputes. 3.That the regulator should consider publishing the complaint ratios of not only insurance companies but all distributors or applying differential management. 4.That part of the Insurance Law (article 64, item 3) should be amended to allow insurers to terminate an insurance policy if the insured incident occurs within 2 years since the policy issuance. 5.That further information from other countries should be gathered and studied in an attempt to try to develop the most appropriate institution(s) for handling customer complaints. 6.That further study and research for the reasons of customer complaints should be conducted from the legal point of view for the reference of the court in adjudication. 7.That further in-depth studies should be conducted on how to integrate precautions against customer complaints in insurance companies’ product design, marketing, policyholder services and insurance payment procedures so as to reduce customer complaints to the minimum.