SAS515-承保理赔讲义.ppt

* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * 水险索赔 Claims documents handling: Claims process: The people involved Marine claims 索赔文件及处理： 索赔流程： 相关人员 * 第十二章 欺诈的识别和防范 This session covers: Fraud articles: ● “Fraud detection in insurance claims” ● “Insurance fraud – victimless crime?” Section 12. Fraud detection and prevention 本章讲述： 欺诈文章： 《保险理赔中如何发现欺诈》 《保险欺诈——没有受害人的犯罪？》 *  谢谢大家！Thank you ! * * * * * * * * * * * * * * * * * * * * * * * * * * * * * 争议解决方案 A legal requirement in some countries A useful strategy, regardless of law IDR and EDR Dispute resolution 某些国家有法律要求 有用的策略，无关法律 内部争议解决（IDR）与外部争议解决（EDR） * 最后核查与结案 Finalising internally Finalising externally Final review and file closing 完成内部流程 完成外部流程 * 第十一章 各险种的索赔 This session covers: Liability claims Personal lines claims Commercial lines claims Marine claims Section 11. Line-specific claims 本章讲述： 责任险索赔 个人业务索赔 商业业务索赔 水险索赔 * 责任险索赔 Operative clause: Has the 3rd part suffered loss? Did the loss arise out of an “occurrence?” Did the occurrence arise out of the business specified? Is the policy on a claims-made or losses occurring basis? Liability claims 操作条款： 第三方是否遭受损失？ 损失是由“事故”所致吗？ 事故是在指定的业务中发生的吗？ 保单采用索赔发生制还是事故发生制？ * Public Products Liability Claims “Personal Injury” means: Death, bodily injury, sickness, disease, disability, shock, fright, mental anguish mental injury; False arrest, wrongful detention or imprisonment, malicious prosecution, wrongful eviction, assault or battery, libel, slander, defamation of character or invasion of right of privacy which occurs during the Period of Insurance * 公众及产品责任险索赔 “人身伤亡”指在保险期间发生的： 死亡、身体伤害、不适、疾病、惊吓、恐惧、精神痛苦及精神伤害； 非法逮捕、非法拘留或关押、恶意起诉、不正当驱逐、殴打及人身攻击、污蔑、诽谤、侮辱或侵犯隐私权 Public Products Liability Claims “Property Damage” means: Physical damage to, physical loss of or physical destruction of tangible property that occurs during the Period of Insurance including any resultant loss of use; or * 公众及产品责任险索赔 “财产损失”指： 在保险期间发生的有形财产的物理损失、损毁或灭失，包括由此引起的使用损失；或 Public Pro