A Study on some factors associated short-term claim in Life Insurance Company

[[abstract]]為避免因逆選擇契約與道德危險案件伺機滲入保險公司，侵蝕保險公司的利潤並造成費率的不公平。本論文最主要的目的是提昇核保部門鑑別危險的能力、降低理賠處理成本及維持費率的公平性，以確保險公司的財務安全。研究的資料型態屬案件控制研究法中的回溯研究，用獨立性檢定來探討被保險人性別、投保當時保險年齡、主約險種型態、累計醫療保額、繳法、招攬業務員職級、招攬業務員的體檢授權、招攬業務員學歷、投保當時體檢狀況等變數與短期理賠發生之關係。並以主約險種型態、繳法及累計醫療保額三種變數應用邏吉斯迴歸模型推算短期理賠發生機率，以了解短期理賠的發生率較高的族群。 實証結果發現，購買主約險種型態、累計醫療險保額、繳法、招攬業務員職級及招攬業務員的體檢授權與短期理賠有顯著相關，並以購買主約險種型態、累計醫療險保額、繳法應用邏吉斯迴歸發生當主約險型為保障型、累計醫療險額度在2000元以下或3001~4000元及繳法為月繳、季繳者發生短期理賠的機率最高。 根據研究結果提出下列建議：監理機關應協助保險業者改善目前保險公司對可保資訊搜集管道、強化保險犯罪防治中心的功能並修改不合時宜的法令；保險業者應對於初階業務員扶植正確的風險觀念、改變業務員的薪資給付結構並加強一般投保額度的案件核保等以避免逆選擇契約與道德危險案件[[abstract]]The purposes of this study are to increase the ability of underwriters’ risk appraisal, decrease the cost of claim process, and maintain the fair rates that avoid adverse selection contracts and moral risk cases that cause a drop in profits and cause unfair rates. The type of data in this research is the retrospective study of case-control study. We address the relationships between the variables and the short-term claim by Chi-Square test. The variables are: insured gender, age at entry, types of master contract, insured accumulated sum of medical insurance, methods of the premium, agents’ grade of position, agents’ authority of medical examination, agents’ educational background, and medical report at entry. There are three variables: the types of master contract, methods of premium, and insured accumulated sum of medical insurance are selected using a logistic regression model and the odds of short-term claim for those variable are also evaluated through the same model. The study has shown that the short-term claim is significantly related to purchasing the types of master contract, insured accumulated sum of medical insurance, methods of the premium, agents’ grade of position, and agents’ authority of medical examination. For example, in a logistic regression model we have identified that the combination of the protection master contract with medical coverage below NT$ 2,000 or NT$ 3,001 between 4,000, and the methods of monthly or quarterly premium would give the highest probability of a short-term claim. According to the findings of the study, there are some recommendations: the superintendents should help the insurance companies to search the information of insurability, strength the functions of the Insurance Crime Prevention Institute, and amend the untimely law; and the insurance companies should help the junior agents to have a clear conception about risk, to change the structure of agents’ salary, and to speed the underwriting of insured contracts with normal sum to avoid the adverse selection contracts and cases of moral ris