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新市场行为原则:保险公司和中介必须公平对待客户

发布时间:2012-1-16
标签:保险公司 中介 
保险市场行为的监管要求有助于:加强公众对保险业的信任及消费者对保险业的信心;最大限度地减少那些商业模式不可持续或者产生信誉风险的保险公司的风险,从而补充偿付能力监管体制下的风险管理框架,为整个金融稳定作出贡献;创造保险公司公平竞争的平台,维护公平对待客户方面可以接受的商业惯例,从而支持建立稳健而有活力的保险业。

国际保险监督官协会重新修订的《保险核心原则、标准、指引和评估方法》的第19条原则是关于“市场行为”的,具体内容为:监管者就保险市场行为设定要求,以确保客户在合同缔结之前直至所有合同义务得到履行的整个过程中,都受到公平对待。该原则及为具体实施它需要遵循的若干标准、指引适用于保险公司和中介,其主要内容及精神值得各国监管部门、保险机构认真研究、借鉴。

  一、本原则的意义、适用

  保险市场行为的监管要求有助于:加强公众对保险业的信任及消费者对保险业的信心;最大限度地减少那些商业模式不可持续或者产生信誉风险的保险公司的风险,从而补充偿付能力监管体制下的风险管理框架,为整个金融稳定作出贡献;创造保险公司公平竞争的平台,维护公平对待客户方面可以接受的商业惯例,从而支持建立稳健而有活力的保险业。

  各地的包括商业惯例在内的保险市场行为是有差异的,市场行为监管的方法也随之变化。因此,在实施本原则、标准及指引时应考虑这一点,以获得公平对待客户的效果。公平对待客户的内涵包括合乎道德的行为、以善意行事、禁止滥用性行为等。

  保险市场行为的监管要求可以根据与保险公司互动的客户的性质,以及保险的种类而有所不同。监管要求的范围的确定则应当反映不公平对待客户的风险的组合概率及其影响,同时考虑客户性质和保险的种类。

  监管者对保险市场行为的质量进行有效评估时,须考虑到适用于保险产品销售及相应的保单服务的政策、流程和程序是针对法人的。如果保险公司为某一保险集团或者大型金融集团的成员,集团也应当具有适用于市场行为的恰当的政策和程序,确保全集团都公平对待客户。即使某些辖区的法律规定的要求可能低于集团使用的标准也是如此。

  监管者应当理解其他金融服务业监管者就市场行为规定的监管要求,将不必要的冲突、可能的重复监管和监管套利予以最小化。

  二、关于应有的技能、注意、勤勉的标准及指引

  (一)监管者要求保险公司和中介以应有的技能、注意、勤勉与客户交易。

  (二)主要指引为:

  “应有的技能、注意、勤勉”意味着,保险公司和中介应当像一个处于类似地位、在相同条件下的审慎的人那样去履行义务。

  保险公司和中介应当具备适当的政策和程序,以达到这样的效果,包括采取恰当的措施,确保他们的雇员和代理人满足道德上的高标准。

  三、关于公平对待客户的政策和程序的标准及指引

  (一)监管者要求保险公司和中介建立和实施公平对待客户的政策和程序,并将其作为商业文化的不可分割的组成部分。

  (二)主要指引为:

  监管者应当确保保险公司和中介具备恰当的政策和程序,以实现公平对待客户的结果。监管者应当监控这些政策和程序是否得到遵循。

  由于保险公司、中介和单个零售客户之间往往存在信息不对称,恰当的公平对待客户的政策和程序对于零售客户而言,是非常重要的。

  公平对待客户的结果是可通过多种方法实现的。有些辖区倾向于以原则为基础的方法,有些则倾向于以规则为基础的方法,而其他辖区则根据情况综合采取多种方法。

  公平对待客户最终应实现的结果可举例如下:开发和销售产品时,对客户的利益予以应有的注意;在售前、售中、售后向客户提供清楚的信息;减少不适应客户需求的销售的风险;确保给予的建议是高质量的;公平地处理客户投诉和争议;保护客户信息的私密性;管理客户的合理预期。

  确保客户得到公平对待往往要求,保险公司和中介将公平对待客户作为其商业文化的组成部分,而且支持这一目标的政策和程序恰当地嵌入了组织中。

  将公平对待客户嵌入保险公司或者中介的文化,包括以下内容:领导,即公平对待客户的责任应当由董事会和高级管理人员承担;战略,即商业战略设计应当纳入公平对待客户目标;决策,即所有影响客户的决策应当受到特别的审查,以确认其是否支持公平对待客户;内控,即为了使公平对待客户受到监控,相关的管理信息应予以识别、收集和评估,包括建立内控报告,提供最有价值的信息;行为管理,即公司应当招聘具有高道德标准的职员和代理人,培训相关职员,对行为的评估应当包括公平对待客户;薪酬,即薪酬结构应当在质量方面予以检查,确保不存在将导致不公平对待客户的动机。

  监管者应当可以获知保险公司和中介的关于公平对待客户的政策和程序。监管者可以鼓励保险公司和中介将相关政策和程序作为好的做法予以公开,特别是他们的索赔处理、投诉处理和争议解决方面的政策和程序。

  除了检查保险公司和中介的关于公平对待客户的政策和程序,监管者可以就他们所期望的结果发布指引,以帮助保险公司和中介建立恰当的政策和程序。

  四、关于考虑不同客户的利益的标准及指引

  (一)监管者要求保险公司在开发和销售保险产品时,应考虑不同类型的客户的利益。

  (二)主要指引为:

  1.在某些辖区,监管者通过产品审批方法满足上述标准,即检查保险产品是否符合相关法律。这些法律不仅包括精算标准,还包括保护客户的规则,例如禁止某些类型的责任免除。其他一些辖区则采取以原则为基础的方法,即赋予保险公司的董事会和高级管理人员更大的责任,以确保产品的开发和销售能实现法律原则所希望的结果。

  2.产品审批方法

  当监管者有权力审批合同条款或者定价,审批程序应当在保护客户、保险产品的创新和选择之间维持平衡。监管者在某些特定情况下更适宜对合同条款或者定价进行审批。例如,保险公司与理财能力较差的客户发生交易,产品很复杂,或者产品是法律强制要求的保险合同,包括汽车责任保险或者健康保险。

  在这些情况下,监管者可以检查产品是否符合以下事项:经批准的保单限额;特定风险的承保,程序或者条件;不存在被禁止的责任免除;遵守保单语言方面的特别要求。

  3.以原则为基础的方法

  监管者采取以原则为基础的方法时,可以就有关对保险公司的要求发布指引。它可以包括:

  (1)产品开发和销售应当使用恰当的客户需求信息。

  (2)产品开发(包括来自第三方的产品)应当由保险公司内部每个合适的部门具备相应能力的人员,对新产品的主要特征及相关的披露材料进行深入的评估。

  (3)在销售产品或者提供服务时,保险公司应当对与产品有关的商业模式、现有法律和监管规定、风险管控方法进行尽职调查。特别是建立及实施的政策、程序和内控应当使保险公司能够:提供一个可持续的保险产品;以需求适应产品的客户为目标,避开需求不适应产品的客户;通过考虑相关因素,包括环境的变化,或者可以损害客户利益的保险公司的不同政策,评估源自产品的风险;确保分销方法适合产品,特别是要对照目前有效的法律和监管规定,以及核查分销时是否应当提供关于产品的建议;在产品投放后予以监控,确保其满足目标客户的需求,并参照良好的商业惯例评估不同分销方法的成效,如有必要则采取矫正行动。

  (4)保险公司应当为中介提供支持,确保后者理解目标市场,从而减少错误销售的风险。

  五、关于清楚、公平和不误导的推销方式的标准及指引

  (一)监管者要求保险公司和中介以清楚、公平和不误导的方式推销产品和服务。

  (二)主要指引为:

  在保险公司和中介推销一个保险产品之前,他们应当采取合理的措施,确保所提供的信息是准确、清楚、不误导的。理想的状态应当是,建立一个对指向客户的广告材料和其他联络渠道进行独立检查的流程,而不是由准备或者设计它们的人和组织进行检查。

  如果后来保险公司和中介了解到其所提供的信息是不准确、不清楚、误导的,他们应当撤回信息,而且在合理可行的情况下,通知其所知道的正在依赖这些信息的任何人。

  提供的信息应当:容易理解;与该产品的绝大多数客户所合理期望的结果相一致;以引人注意的方式说明客户可请求的任何利益的基础,以及重要的限额;不隐藏、缩减或者模糊处理重要的陈述和警告。

  保险公司应当将准确、清楚、不误导的信息提供给客户以及依赖信息向客户提出建议的中介。
 

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