Chinese Network Television online viewing address: http://news.cntv.cn/china/20110724/104537.shtml 【Studio】 Uniquely crafted high-quality lives, welcome to watch the "Weekly Quality Report." Our program has repeatedly reported on issues such as high insurance and low compensation, no responsibility compensation in the automobile insurance industry. After the broadcast of the program, the China Insurance Regulatory Commission issued a "Notice on Carrying out Research Work on Improving the Commercial Vehicle Insurance System" on March 29 this year, targeting problems existing in the current commercial vehicle insurance product management system, commercial vehicle insurance terms, underwriting, claims settlement processes, and service standards, and planned to promote the adjustment and improvement of the entire industry's commercial vehicle insurance products, underwriting claims settlement process systems by the end of September. Today's program focuses on the issue of car insurance claims. A business van belonging to a company in Nanjing had a blowout accident, and during the claims process, the owner believed that the insurance company's damage assessment amount was significantly different from the actual loss, leading to a disagreement between the two parties. So, is it that the insurance company's damage assessment is indeed too low, or is it that the owner believes the actual loss is too high? Let's look at today's journalist investigation. 【Main Body】 In 2009, a business van belonging to a company in Nanjing had a blowout on the highway, causing an accident. Since this vehicle was insured with Anbang Insurance Company for a limit of 480,000 yuan for vehicle damage insurance, the owner immediately reported the claim, and after the insurance company accepted it, they assessed the damage amount to be 5,820 yuan. 【Synchronous】 Owner's Lawyer Zhang Hong However, my client felt that the damage assessment amount was very different from his actual loss. Later, possibly the traffic police detachment, they reflected this incident to the traffic police detachment, and the traffic police detachment might have asked them to go to the local price bureau to redo the damage assessment. 【Main Body】 For the same incident, Anbang Insurance Company assessed the damage at 5,820 yuan, while the Zhenjiang City Price Bureau's Price Certification Center determined the loss to be 30,500 yuan, a difference of more than 5.2 times. 【Synchronous】 Owner's Lawyer Zhang Hong The basic reason is that the insurance company, as the claims responsible party, also acts as the appraiser. It's like a football match where you act as both the athlete and the referee, making it impossible to ensure the fairness of the game. 【Main Body】 Is the reality really as this lawyer said? Since the insurance company did not recognize the appraisal of the price certification center, the two parties could not reach a consensus for the time being. During their negotiations, two months later, in June 2009, this vehicle had another accident on the highway, and this time the insurance company assessed the damage amount to be 13,185 yuan. 【Synchronous】 Owner's Lawyer Zhang Hong They were dissatisfied with the insurance company's low damage assessment amount, so they towed the car back to Nanjing and went to the Nanjing Price Bureau for another damage assessment, and the Nanjing Price Bureau assessed the damage amount to be over 30,000 yuan. 【Main Body】 Due to the large disparity between the two parties, after a year of negotiation without resolution, the owner sued Anbang Property Insurance (Group) Co., Ltd., Jiangsu Branch, and the court legally accepted the case. 【Synchronous】 Judge Xing Jiadong of Gulou District People's Court of Nanjing When the owner did not sign on the damage assessment form, the defendant went to the price department themselves for another damage assessment. They believed that this damage assessment was not recognized, and they would not compensate according to it. 【Main Body】 The reporter carefully compared the insurance company's damage assessment form with the third-party appraisal center's appraisal list. It was found that the insurance company's damage assessment form was inconsistent with the third-party appraisal center's appraisal list, and even for the same component of the same vehicle, the prices on Anbang Company's own damage assessment form were different. For example, the radiator: the first damage assessment price was 660 yuan, and the second damage assessment price was 1,200 yuan, almost double the difference. Even more unimaginable is that the price of the front bumper frame of the same vehicle was assessed by Anbang Insurance Company as 240 yuan the first time, and 450 yuan the second time, while the third-party appraisal institution's appraisal price was 5,200 yuan. 【Synchronous】 Insurance Law Expert Chen Xin For the same car, the same parts, it can give two prices, which is absolutely an incomprehensible issue for consumers, and I estimate that even the executives of the insurance company themselves would find it hard to understand if they saw it. 【Explanation】 In fact, the court's judgment was very straightforward. 【Synchronous】 Judge Xing Jiadong of Gulou District People's Court of Nanjing According to the relevant evidence regulations of the Supreme People's Court on civil litigation, from the perspective of evidence, the appraisal report issued by a third party has stronger evidentiary power than the damage assessment form issued by the defendant. 【Main Body】 Ultimately, the owner legally received compensation. According to the judge, lawsuits caused by disputes over damage assessment standards account for about 30% of commercial vehicle insurance lawsuits. Notably, when disputes arise between insurance companies and owners regarding damage assessment standards, the owner has only two choices: either accept the insurance company's standard or file a lawsuit. 【Synchronous】 Judge Xing Jiadong of Gulou District People's Court of Nanjing In cases similar to ours, the owner's requests have all been supported by the court. From the perspective of evidence, we have accepted the appraisal report issued by the price certification department. 【Main Body】 Notably, although these lawsuits almost always result in consumer victories, after resolving individual lawsuits, the insurance company still maintains non-recognition of third-party appraisals in normal claims processes. This means consumers can seek third-party appraisals, but doing so will lead to litigation, and they can only receive compensation through court rulings. In fact, the damage disputes reflected in litigation cases are just the tip of the iceberg in insurance damage issues. For many years, the unfair practice known as "ten out of ten car insurance claims are insufficient" has been one of the霸王rules that car insurance consumers have been forced to endure. 【Studio】 The price department's appraisal of the loss exceeded 30,000 yuan, while the insurance company's damage assessment was only over 5,000 yuan, a significant discrepancy. This phenomenon is called "ten out of ten car insurance claims are insufficient" by insurance experts, revealing the severity and universality of the problem. Why do insurance companies deliberately lower the damage assessment amounts? 【Main Body】 After a nine-month in-depth investigation, the reporter learned that most insurance companies internally have such a document called the "Commonly Used Models Spare Parts Price Directory Table." This directory lists in detail the common spare part prices for various commonly used models. However, what puzzled the reporter was that most spare parts in the directory had two prices: one called market price, and the other called Jingyou price. The two prices differ greatly; for example, the so-called market price for the front bumper of a Passat is 580 yuan, while the so-called Jingyou price is 1,010 yuan. The so-called market price for Lingyu fog lights is 95 yuan, while the Jingyou price is 299 yuan, differing by more than three times. According to insiders, this so-called price directory is one of the main references for insurance company damage assessments. Pan Hao: Joined the Chinese insurance industry in 1995. Responsible for auto damage insurance underwriting and claims work for six years in various positions. Since 2010, he has collaborated with Nanjing University on research into the Chinese Insurance Product Index. 【Synchronous】 Insurance Practice Expert Pan Hao These two prices are actually two sets of standards, one being the so-called aftermarket parts standard. Reporter: Which is the aftermarket part? Market price. Reporter: The market price is the aftermarket part? Yes, its Jingyou price is actually the regular price for original equipment manufacturer (OEM) parts from 4S stores. Reporter: What does Jingyou mean? Jingyou is actually the data provided by Jingyou company for the price of OEM parts from 4S stores. 【Main Body】 Experts explain: OEM parts (also called original equipment manufacturer parts) refer to parts produced by manufacturers authorized by the car manufacturer, which must be certified by the manufacturer or the manufacturer's designated certification system. There are brand logos on the parts. Aftermarket parts refer to parts produced by manufacturers not authorized by the car manufacturer. They have their own factory names and trademarks but no car brand logos. The expert told the reporter that there is a significant price difference between the two types of parts on the market. 【Synchronous】 Insurance Practice Expert Pan Hao During the damage assessment process, the assessor may encounter some clients with strong rights protection awareness, and clients who are familiar with cars and are more professional. When encountering such clients, if they still use aftermarket parts, these professional clients, or clients with strong rights protection awareness, obviously cannot accept it. In situations where repairs or damage assessments cannot be done using aftermarket parts, the insurance company's damage assessors will use OEM parts. However, the proportion of cases using OEM parts in current practice is absolutely low. The proportion of clients using aftermarket parts exceeds 80%. 【Main Body】 But under the clear existence of two sets of standards, why would damage assessors consistently choose aftermarket prices? The secret lies in a certain insurance company's "2010 Assessment Method for Each Institution's Operating Goals," which indicates that insurance company staff resort to using aftermarket parts and other means to lower compensation amounts out of necessity. To truly understand the meaning of this document, we need to start with the term "payout ratio." 【Synchronous】 Insurance Practice Expert Pan Hao The payout ratio is a key assessment data used by insurance companies to measure their claims payment expenditures. There are four methods to calculate the payout ratio. The official calculation method specified by the CIRC is called the comprehensive payout ratio. Regardless of the method used to calculate the payout ratio, it cannot be separated from two core indicators. These two core indicators are claims expenditure and outstanding claims reserve. 【Main Body】 Experts point out that since the outstanding claims reserve is calculated based on the claims amount of already compensated cases, whether it is claims expenditure or outstanding claims reserve, it is directly related to each individual case of daily damage assessment by insurance companies. 【Synchronous】 Insurance Practice Expert Pan Hao In every compensation case, if the insurance company's damage assessment amount is too high or relatively high, it will directly lead to an increase in claims expenditure and also an increase in the provision for outstanding claims. The increase in these two figures will create a cumulative effect, causing the insurance company's payout ratio indicator to become even larger. That is to say, the insurance company's payout ratio indicator is directly related to the damage assessment amount in each case by our insurance company's damage assessors. 【Main Body】 The insurance company's assessment method shows that the insurance company's most important assessment indicators are only two: the first is the comprehensive payout ratio, which accounts for 50% weight. That is to say, the level of the comprehensive payout ratio will definitely have a major impact on the completion of the assessment indicators. Finally, the insurance company's assessment method stipulates that "the performance-based salary of all employees and the basic salary of the institution's leadership team are linked to the monthly comprehensive assessment coefficient." Experts point out that although each insurance company's operating target assessment method has various complex expressions, the basic principle is consistent. That is, if the individual case compensation amount decreases, the comprehensive payout ratio decreases, and the monthly performance-based salary for all employees and the basic salary of the institution's leader increases or is maintained. 【Synchronous】 Insurance Practice Expert Pan Hao If the insurance payout ratio indicator decreases this month, then his income will increase; if the insurance payout ratio indicator rises this month, then his income will decrease. That is to say, his payout ratio assessment is directly related to his monthly income. Therefore, under this mechanism, our insurance company's damage assessors, or other management employees, whether it's their senior executives or their grassroots frontline on-site damage assessors, will try their best to lower the payout ratio indicator for the month during the damage assessment process. 【Main Body】 Experts point out that insurance companies are commercial enterprises, and choosing to evaluate employees based on customer satisfaction or based on payout ratios is merely a matter of business philosophy. However, when this evaluation is combined with two pricing standards like OEM parts and aftermarket parts, and when it forces grassroots employees towards maliciously low compensation, the issue becomes more complicated. 【Main Body】 Like Pan Hao, Wu Xiaofei, who now works as a rights protection editor for a certain insurance professional website, was once also an insider in the insurance industry. From 2008 to 2010, he worked in the insurance company for two years. The only difference from Pan Hao is that Wu Xiaofei was always a claims adjuster. This career experience left a deep impression on him. 【Synchronous】 Former Insurance Company Claims Adjuster Wu Xiaofei After escaping danger and at the scene, during the damage assessment process, generally speaking, prices can be pressed down as much as possible, and now this is a very common problem. During the damage assessment, aftermarket parts prices are generally used, which is very common. 【Main Body】 Little Wu thought that since the car damage occurred, it should be normally assessed. So he tried to work fairly. But the results surpassed his expectations. 【Synchronous】 Former Insurance Company Claims Adjuster Wu Xiaofei Basically, people like us were laid off by the company. Reporter: What category are you in? Those who handle things well. Reporter: What does handling things well mean? It means having a higher customer satisfaction rate. Reporter: More were laid off. 【Main Body】 Insurance experts also pointed out that not all employees are willing to use aftermarket parts to assess customers' losses. 【Synchronous】 Insurance Practice Expert Pan Hao I encountered such a case. A claims adjuster used the price of OEM parts to assess the customer's loss, and the assessment amount was over 8,000 yuan. However, during the reporting process, the insurance company's claims manager rejected his plan and reassigned a claims specialist. The insurance company's claims specialist reassessed the damage, and the assessment amount was only 4,000 yuan, half of the original employee's assessment amount. The means used by this specialist, that is, this claims specialist, were actually very simple—using aftermarket parts to replace OEM part prices. 【Main Body】 Experts point out that the current problems in China's insurance industry have long surpassed the red line of harming consumer interests, and quite a few insurance companies have even harmed the industry's own interests in pursuit of illegitimate gains. 【Synchronous】 Insurance Practice Expert Pan Hao Insurance companies sell insurance, selling a promise of security. Consumers buy insurance, buying a promise of security. Why are consumers willing to use real money to buy a promise? This is determined by the insurance industry's greatest principle of integrity. What is the greatest principle of integrity? Simply put, when consumers encounter risks, the insurance company will make its utmost effort to honor the original promise. This is the rationality basis for the existence of the insurance company's commercial behavior. National leaders have repeatedly emphasized that entrepreneurs' blood vessels should flow with moral blood. Don't be overly self-righteous. When an industry doesn't even care about the rationality basis for its existence, how can we talk about moral blood? 【Studio】 Through our investigation, we discovered two key issues behind the phenomenon of "ten out of ten car insurance claims are insufficient." One is that insurance companies can lower car insurance damage assessment amounts by secretly using aftermarket parts instead of original parts. According to the evidence provided by insurance insiders in the program, this phenomenon is quite widespread, and most car owners are unaware of it. Another issue is that some insurance companies' assessment indicators for car insurance damage assessors are directly linked to car insurance damage assessment amounts. If they don't follow the company's requirements and assess at a lower price, it will not only affect their income but may even cost them their jobs as damage assessors. To put it bluntly, if you let the insurance company pay more money, the company will deduct your money, or even break your rice bowl. Insurance industry experts point out that as commercial enterprises, insurance companies pursuing profits is beyond reproach, but the prerequisite is not to harm consumers' rights and public interests. Our news channel will also continue to focus on the various unreasonable phenomena and problems existing in vehicle insurance claims. Thank you for watching the "Weekly Quality Report," see you next week at the same time.