| IntroductionAccident insurance is a previous kind of life insurance. It means that the policyholder should pay a certain amount of money to the insurance company, if some accidents which result in death, disability and so on happened to the policyholders during the limited period of time for the insurance, the company should give the whole or part of the risk to the policyholders according to the contract. At present, accident insurance in our country contains personal AI and organizational AI. The main risks include: 1 tourism insurance 2 air AI 3 AI for students and infants 4 AI for passengers on road, and so on. Since 1982, as the recovering of the life insurance in our country, AI has developed greatly: the a-mount of the trade has been increasing and the service area has been enlarging. Take the earning of the risk for example, in 1985, it was 148.16 million, and in 1993 , it increased to 25208.2 million. As the increasing of amount of AI, some problems existing in it are becoming evident by and by. On the risk designing, the in -put is low and can not deal with the actual injury cases;the insurance standard are too simple, for different kinds of accident risks, it can not think o-ver the risk ratios , the accident results and the state of putting in. As a result of lacking of medical knowledge, workers can only examine the truth of different kinds of receipts knowing nothing about the common diseases that often happen to people having the same occupation. According to the theories of medicine and insurance, our research analyzed the accident injury cases happened during August , 2005 to December, 2005. It provides scientific rules for the design, verification and claim of accident risk.Subjects and Methods1. SubjectsWe collected 2042 accident claim cases during the period of August 2005 to December 2005. According to the administer groups and the contents of accepting assurance, accident insurance contains two part. One is the insurance that is issued to the society by the insurance company, including voluntary administering insurance and the forcing insurance which is stipulated by laws. The other one is the risks that are designed specially for the students and babies, the administer group of it is simple and the safety responsibility can be accident or disease.2. Methods2.1 Look up the claim cases and the disease stuff and analyze the accident causes, location of the injury, disablement, age and the occupation distribution.2. 2 Analyze the injury happening ratio and the ratio of different injury location statistically.2. 3 Analyze the claim indexes of the star risk species in the accident insurance , combining the trade indexes of the company in 2005.2.4 Part of the data is put into the computer for analysis, using SPSS10. 0 for Windows.Results1. Distribution of the gender and age2042 claim cases in an insurance branch company in Shengyang during August 2005 to December 2005 contains 1419 men and 623 women. The mean age is 23.36 years.2. Composition situation of the occupationThe 2042 cases for reward during August 2005 to December 2005 contain 1094 students and infants, 53.57%;247 clients, 12.09%;432 workers, 21.16%;25farmers, 1.22%;96 business -men, 4.7%;80 persons who are out of work, 3. 92%;civil ser - vants, people who work for the education, architecture and health,68 in total,3.72%.3. Distribution of the injury causes and locationsIn the 2042 claim cases in an insurance branch company of Shengyang during August 2005 to December, the separate ratios of the daily - life injuries, injuries during work , traffic accidents , injuries by others, diseases of the total injury causes are 76. 19% , 15. 43% ,1. 62% ,3. 04% ,1. 86% ,1. 86%;and the respective ratio of brain injury , facial injury, extremities and joint injury , trunk and visceral injury, eyes, ears and noses injury, multi - injury, death, diseases and others are 8. 86% ,10.33% ,55. 93% , 10. 38% ,5. 78% ,2.06% ,0. 59% , 4.21%.4. Situation of the total claim paymentIn the investigation of the 2042 cases of accidental injuries , according to the related items of the (The disability degree of the life - insurance and the meter of the risk paid back)) ,3 people were evaluated as invalid , accounting to 0. 147% of the total, and the separate payment ratios are 10% ,30% ,100%.5. Injury causes and locations of the first type of insurance category There are 527 daily -life injuries, 315 injuries during work, 20 traffic accidents, 52 accidents happened in tourism, 17injuries by others, 37 patients. And the respective number of brain injury, facial injury, extremities and joint injury, trunk and visceral injury, eyes, ears and noses injury, multi - injury, death and other injuries is 56,37,572,158,69,37,10,46.6. Injury causes and locations of the second type of insurance category There are 1029 daily -life injuries, 13 traffic accidents, 10 accidents happened in tourism, 21 injuries by others, 1 patient. And the respective number of brain injury, facial injury, extremities and joint injury, trunk and visceral injury, eyes, ears and noses injury, multi - injury, death and other injuries is 125 , 174, 570, 54, 69, 26, 2, 40.7. Comparison of the happening ratio and injury location of the two insurance typeThere is statistical difference on the happening ratio of the accidents be-tween the two insurance types ( x =6.435 P=0.011 < 0.05), so is the happening ratio of different injury locations ( P < 0. 05 ). The respective x°f brain injury, facial injury, extremities and joint injury, eyes, ears and noses injury, trunk and visceral injury is 20. 8, 82. 6, 9.215, 6.49,71. 37.8. Comparison of the cheating cases for claim and the death rate of the two insurance typeThe respective ^2 value of the cheating cases for claim and the death rate in the two insurance types is 39.3 and 8.431 ,P <0.05.9. Insurance trade indexes and the interior value indexes of the star insurance typePayment: the payment of the Star 1 card is 126540 yuan, Star 2 card is 332285. 38 yuan,Star 3 card is 329372. 3 yuan, Star 4 card is 493681.72 yuan and the payment of the Star 5 card is 45916 yuan. The respective accident happening ratio of the five types of Star Card is 1.02% , 1.95% ,0. 77% , 0. 123% , 0.123%. In the five star card ,only one Star 3 card was rejected and the rejecting ratio is 0.0058% 0 The respective estimation of the pure in - put of the five different card is723 yuan, 987 yuan, 2495.24 yuan, 23508.65 yuan, 2186.48 yu -an.Conclusion1. From the personel distribution of accident compensative case in life - insurance company of Shenyang, we conclude that personal insurance industry of village area is the weak element, the development of personal insurance industry in those area is focal point, accordingly, insurance density and insurance extent are enlarged in personal insurance industry in china.2. The incidence rate of accident in younger child and adolescent is higher than adult, but the degree of injure is lower than adult, impaired positions are more extensive. The degree of accidental injury is worse, the impaired position has close relationship with occupation, mainly located in limbs and joints. So, safety education to younger child and adolescent and safety in production to workmen should be enforced.The disabled compensation of personal insurance industry is in forced that is not adapted of many kinds of accident type in insurance market. The compensative standard should be adjusted according to various accident type. Common principle is that expensive accident type should enhance the rule of disabled compensation to avoid occurance of insurance deception, the low accident type should loose the rule of disabled compensation to strengthen safeguard of those accident type.3. At present, the compensation of the accident insurance has been losing the basic function of itself, the main appearance is that it has lost the insurance function of the later period. At the same time, the sum of payment for some accident insurance species has exceeded the limitation of the pure put — in.4. The present payment reference of the accident insurance has not adapted to the needs of the different species in the insurance market. The payment reference should be adjusted, according to the differences of every species. Increasing the payment reference for the disability with regard to the species of high put- in, that is the general principle. At the same time, strengthen the protection for insurance cheating, loosen the payment reference for disability with regard to the insurance of low put - in. As a result, the ensuring of this kind of insurance species can be enhanced.5. To aim directly at the existing problems in the accident insurance, the insurance waste ratio should be settled scientificly with regard to the risk rate, payment ratio, death, disability, interest factors, expense ratio, and so on. In the management, pay attention to balance the insurance fee for different species and consummate the investment, enhance the precaution for insurance accident and the development of the complement or the substitute products. In verification of the insurance, control the occupation risk strictly to be in step with the insurance species which the policyholders have chosen;inspect the claim cases with high put -in with great care;enhance the medicolegal expertise work. |
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