| Notice of the China Insurance Regulatory Commission on Issuing the Opinions of the China Insurance Regulatory Commission on Strengthening the Protection of the Rights and Interests of Insurance Consumers | | 中国保险监督管理委员会关于印发《中国保监会关于加强保险消费者权益保护工作的意见》的通知 |
| (No. 89 [2014] of the China Insurance Regulatory Commission) | | （保监发〔2014〕89号） |
| All departments and training centers of the China Insurance Regulatory Commission (“CIRC”); all local CIRC offices; Insurance Association of China; Insurance Society of China; China Association of Actuaries; China Insurance Security Fund Co., Ltd.; China Insurance Information Technology Management Co., Ltd.; all insurance group (holding) companies; and all insurance companies: | | 机关各部门、培训中心，各保监局，中国保险行业协会，中国保险学会，中国精算师协会，中国保险保障基金有限责任公司，中国保险信息技术管理有限责任公司，各保险集团（控股）公司，各保险公司： |
| In order to effectively protect the rights and interests of insurance consumers under new situations, the CIRC has developed the Opinions of the China Insurance Regulatory Commission on Strengthening the Protection of the Rights and Interests of Insurance Consumers, which are hereby issued to you for your implementation in light of your actual circumstances. | | 为进一步做好新形势下保险消费者权益保护工作，我会制定了《中国保监会关于加强保险消费者权益保护工作的意见》。现印发给你们，请结合本单位实际贯彻执行。 |
| China Insurance Regulatory Commission | | 中国保监会 |
| November 14, 2014 | | 2014年11月14日 |
| Opinions of the China Insurance Regulatory Commission on Strengthening the Protection of the Rights and Interests of Insurance Consumers | | 中国保监会关于加强保险消费者权益保护工作的意见 |
| Protecting insurance consumers is the prerequisite and foundation of the survival and development of the insurance industry. Protecting the lawful rights and interests of consumers is the primary function of insurance regulatory authorities and the common responsibility of the insurance industry. In order to effectively implement the spirit of the Fourth Plenary Sessions of the 18th CPC Central Committee and the Several Opinions of the State Council on Accelerating the Development of the Modern Insurance Service Industry (No. 29 [2014], State Council) and further protect the rights and interests of insurance consumers under new situations by promoting supervision according to the law, protecting the rights of consumers in strict accordance with the law and advancing the protection of rights according to the law, the following opinions are hereby offered. | | 保险消费者是保险业赖以生存发展的前提和根基。保护消费者合法权益是保险监管机构的核心职能，是保险行业的共同责任。为贯彻落实党的十八届四中全会精神和《国务院关于加快发展现代保险服务业的若干意见》（国发〔2014〕29号），推进依法监管、严格依法保护、倡导依法维权，进一步做好新形势下保险消费者权益保护工作，现提出以下意见。 |
| I. General requirements | | 一、总体要求 |
| 1. Guiding thoughts. By closely centering on the general requirements of “attaching importance to service, strictly implementing supervision, preventing risks, and enhancing development,” under the premise of perfecting the systems and improving the mechanisms, with the focus on implementing preventive protection and procedural protection, with the strengthening of the primary responsibilities of insurance companies and implementation of transparency supervision as the core and the intensification of investigation and punishment and strengthening of supervision and assessment as the means, based on focusing on consumers' education and promoting the building of industry integrity, efforts shall be made to resolve outstanding issues of consumers' vital interests, enhance consumers' insurance knowledge and right protection capabilities, and protect the lawful rights and interests of consumers. | | （一）指导思想。紧紧围绕“抓服务、严监管、防风险、促发展”的总体要求，以完善制度、健全机制为前提，以实施预防性保护、过程性保护为重点，以强化公司主体责任、实施透明度监管为核心，以加大查处力度、加强监督考核为手段，以注重消费者教育、推进行业诚信建设为基础，着力解决关系消费者切身利益的突出问题，着力提升消费者的保险知识水平和维权能力，切实保护消费者的合法权益。 |
| 2. Basic principles. First, compliance with the laws and reasonableness shall be adhered to. The protection of the lawful rights and interests of consumers shall comply with the laws, stipulations with the parties to insurance contracts shall be respected, and consumers' reasonable claims shall be supported to the full extent permitted by the law. Second, openness and transparency shall be adhered to. Attention shall be paid to information disclosure and transparent supervision shall be strengthened, and the information related to consumers' rights and interests involved in the business operation of insurance enterprises and government supervision shall be disclosed in a timely and proactive manner, so as to provide sufficient information for consumers to make selections. Third, coordinated promotion shall be adhered to. Communication and cooperation with the relevant government departments, judicial authorities, consumer organizations and news media shall be strengthened to guide the public's active participation and joint protection of the lawful rights and interests of consumers. | | （二）基本原则。一是坚持依法合理。依照法律规定保护消费者的合法权益，尊重保险合同当事人约定，在法律允许的范围内支持消费者的合理诉求。二是坚持公开透明。注重信息披露，加强透明度监管，及时、主动公开保险企业经营和政府监管中涉及消费者权益的相关情况，为消费者的选择提供充分信息。三是坚持协同推进。加强与政府有关部门、司法机关、消费者组织及新闻媒体的沟通协作，引导社会公众积极参与，共同保护消费者的合法权益。 |
| 3. Objectives and tasks. By 2020, efforts will be made to build a scientific and effective system for the protection of the lawful rights and interests of consumers, establish and improve the working mechanism for the protection of consumers' rights and interests, and create a working pattern with multi-participation and coordinated promotion in the protection of consumers' rights and interests. The quality and level of insurance service will be enhanced substantially and the behaviors of damaging consumers' lawful rights and interests will be curbed effectively. Consumers' satisfaction will be improved significantly, consumers' awareness and capability to protect rights will be strengthened significantly and the image and social reputation of the insurance industry will be improved effectively. | | （三）目标任务。到2020年，努力形成科学有效的消费者权益保护制度体系，建立起健全完善的消费者权益保护工作机制，搭建起多方参与、协同推进的消费者权益保护工作格局。保险服务质量和水平大幅提升，损害消费者合法权益的行为得到有效遏制。消费者满意度明显提高，消费者的维权意识和能力显著增强，保险行业形象和社会信誉切实改善。 |
| II. Strengthening the primary responsibilities of insurance companies | | 二、强化保险公司主体责任 |
| 4. Establishing the business philosophy of customers first. Insurance companies shall intensify their service awareness, meet customers' needs to develop diversified insurance products, and provide personalized, customized, and high-quality insurance services. They shall practice the core values of the insurance industry, be honesty and trustworthy in their business operation, and treat consumers in a fair manner. | | （四）树立客户第一的经营理念。保险公司要强化服务意识，适应客户需求开发多样化的保险产品，提供个性化、定制化、高品质的保险服务。践行保险行业核心价值理念，诚实守信经营，公平对待消费者。 |
| 5. Setting contractual rights and duties in a fair and reasonable manner and determining the rates of insurance products. Insurance companies shall develop insurance contract clauses in accordance with the law and such clauses shall not violate the prohibitive or compulsory provisions of laws and regulations; ensure that the rights and obligation of the both parties to an insurance contract are fair and reasonable; prepare insurance contract clauses under the principles of clear and simple structures and concentrated and explicit contents which are conducive to finding and reading, promote the text standardization of contracts, and seek the popularization of wording. Where any insurance contract clause is void as determined by a people's court, the insurance company shall report to an insurance regulatory authority. Insurance companies shall improve the pricing models of insurance products and properly determine the rates of products. | | （五）公平合理设定合同权利义务和厘定产品费率。保险公司要依法制定保险合同条款，不得违反法律法规的禁止性和强制性规定，确保保险合同双方权利义务公平合理；按照结构清晰简单、内容集中明确、利于查找阅读的原则编制保险合同条款，推进合同文本标准化，力求文字表述通俗化；保险合同条款被人民法院裁判认定为无效的，要主动向保险监管机构报告；完善保险产品定价模型，合理确定产品费率。 |
| 6. Regulating the sale activities. Insurance companies shall establish differentiated sales systems based on product characteristics and consumers' risk tolerance, and sell appropriate products to consumers with corresponding needs. No insurance company may use advertisements or other promotion methods to conduct misleading publicity in respect of insurance product clauses and the service quality; obstruct a consumer from performing or induce any insurance applicant not to perform the obligation of telling the truth in sales activities; forge or modify any insurance contract without permission, or provide false certifications to consumers; or exaggerate the earnings of an insurance products, conceal any important part of a contract, or provide any false product information. An insurance company is prohibited from signing an insurance contract with a consumer without the consumer's written authorization or be subsequently ratified to do so on behalf of the consumer or commit any violation of laws, administrative regulations, or the provisions of the CIRC. If an insurance product is sold via telephone or the Internet, the telephone recordings and online sales traces related to the rights and obligations of both parties shall be retained. Insurance companies shall improve the provisions of agency contracts, regulate the sales activities of insurance intermediary institutions which act on behalf of them, and assume relevant liabilities for sales activities conducted by insurance intermediary institutions in violation of regulations. | | （六）规范销售行为。保险公司要根据产品特点和消费者风险承受能力建立区分销售制度，将合适的产品销售给有相应需求的消费者。不得利用广告或者其他宣传方式对保险条款内容和服务质量等做引人误解的宣传；不得在销售活动中阻碍消费者履行如实告知义务，或者诱导其不履行如实告知义务；不得伪造、擅自变更保险合同，或者为消费者提供虚假证明材料；不得夸大保险产品收益，隐瞒合同重要内容，提供虚假产品信息；禁止未经消费者书面授权或者追认而代替其签订保险合同以及其他违反法律、行政法规和保监会规定的行为。通过电话或者互联网销售保险产品，保留与双方权利义务相关的电话录音和网络销售痕迹。完善委托合同约定，规范与其有代理关系的保险中介机构的销售行为，并对保险中介机构的违规销售行为承担相应责任。 |
| 7. Settling insurance claims in a timely and fair manner. Insurance companies shall establish fair and transparent procedures for claim settlement and dispute resolution, optimize work processes, simplify formalities for the settlement and payment of claims, and settle and pay claims in a timely and fair manner. In case of any deduction, refusal to indemnify or proportioned indemnity, sufficient reasons shall be explained to claimants. Insurance companies shall establish and improve an expedite claim settlement mechanism for small claims, clean up the backlog of claims on a regular basis, and may not delay in claim settlement or underpay the indemnity, or refuse to indemnify without any reason. | | （七）及时公允理赔给付。保险公司要建立公正透明的理赔给付处理和争议解决程序，优化工作流程，简化理赔给付手续，及时、公道地开展理赔给付。对涉及免赔、拒赔和比例赔付等情况，向索赔人充分说明理由。建立完善小额赔款快速理赔机制，定期开展积压赔案清理工作，不得拖赔、惜赔和无理拒赔。 |
8. Enhancing the quality and level of insurance service. Insurance companies shall continuously improve their services, innovate on service modes, enrich their services, and strengthen the building of service networks. They shall develop the service standards for various aspects including sales, underwriting, after-sales visits, property preservation, claim settlement, and payment of compensation, make service commitments, disclose service standards and commitments to the public, and accept social supervision. After receiving consumers' reporting of accidents and their claims, insurance companies shall guide them in filing claims, notify them of claim settlement and payment procedures, time limits and claim documents, and provide the information about the status of claim settlement and payment in a timely manner
．．．．．． | | （八）提升保险服务质量和水平。保险公司要不断改进服务，创新服务模式，丰富服务内涵，加强服务网络建设。建立销售、承保、回访、保全和理赔给付等各环节的服务标准，制定服务承诺，并将服务标准和承诺公开，接受社会监督。接到消费者出险报案后，要指导其提出索赔申请，告知理赔给付程序、时限、索赔资料等，并及时提供有关理赔给付状态的信息。
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