理赔分析报告.ppt

单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,*,1,2010,年,7,月份理赔业务分析报告,理赔管理部,2010,年,8,月,2025/5/10 周六,2,2,一、赔付成本分析,二、理赔效率分析,三、未决管控分析,四、近期需要关注的几个问题,目录,2025/5/10 周六,3,3,一、总体赔付情况,截至,7,月底，全系统实现保费收入,938.40,亿元，同比增长,22.09%,；已赚净保费,681.24,亿元，同比增长,41.93%,；直接赔款,377.84,亿元，同比增长,0.66%,；赔付成本,454.74,亿元，同比增长,31.69,%,；,（1-7,月未决准备金增提,107.84,亿元，较上月,84.49,亿元增长,27.64%,）。,全险种新口径赔付率为,66.75%,，较上月环比上升,0.33,个百分点；老口径赔付率,68.51%,，较上年同比下降,3.43,个百分点。,注：,新口径赔付率是根据当月财务报表计算得出，,因今年是实行新口径的第一年，所以无同比数据,；,老口径赔付率是精算部回顾计算得出并提供的。,1-7,月份新口径赔付率走势,2025/5/10 周六,4,4,二、分险种赔付情况,从各险种情况看，新口径赔付率超过,80%,的险种有健康险,92.61%,、交强险,81.26%,；老口径赔付率上年同比增幅最大的险种有意外险（,13.44,个百分点）、交强险（,6.88,个百分点）、家财险（,6.76,个百分点），其他险种均有所下降。,赔付率,新口径（,%,）,老口径（,%,）,老口径同比,%,合计,66.75%,68.51%,-3.43%,企业财产险,65.99%,66.04%,-1.07%,家庭财产险,51.84%,53.37%,6.76%,工程险,74.30%,78.58%,-3.96%,责任险,65.38%,66.76%,-4.72%,信用保证险,34.73%,34.53%,-11.94%,机动车辆险,67.02%,69.33%,-2.41%,其中：交强险,81.26%,82.23%,6.88%,商业险,61.41%,64.09%,-7.66%,船舶险,62.36%,55.33%,-6.92%,货运险,49.39%,49.60%,-3.42%,特殊风险,26.19%,27.76%,-20.02%,农业险,79.23%,75.84%,-0.84%,意外险,47.26%,46.65%,13.44%,健康险,92.61%,94.61%,-16.39%,2025/5/10 周六,5,5,三、分公司总体赔付情况,新口径,赔付率最高的的分公司为上海（,76.16%,）、河南（,75.45%,）、福建（,73.53%,）、重庆（,72.59%,），均超过,70%,；赔付率最低的分公司为西藏（,39.13上海,76.16%,海南,65.61%,甘肃,61.17%,河南,75.45%,山东,65.32%,深圳,60.95%,福建,73.53%,湖北,65.30%,河北,60.40%,重庆,72.59%,四川,64.93%,山西,59.55%,黑龙江,69.47%,江西,64.86%,广西,59.45%,天津,68.83%,广东,64.07%,宁夏,58.21%,辽宁,68.22%,青海,63.92%,新疆,57.79%,陕西,66.62%,北京,63.18%,内蒙古,57.73%,安徽,66.15%,贵州,62.94%,厦门,57.73%,浙江,66.01%,江苏,62.82%,宁波,56.98%,吉林,65.80%,云南,62.42%,大连,55.91%,青岛,65.75%,湖南,61.94%,西藏,39.13%,系统合计,66.75%,2025/5/10 周六,5,6,6,四、分公司车险赔付情况,1,、,新口径,赔付率最高的分公司为上海（,82.62%,）、天津（,76.83%,）、黑龙江（,75.28,%,），均超过,70,%,；赔付率最低的分公司为西藏（,47.04%,）、厦门（,53.68%,）、内蒙古（,53.93%,），均低于,55%,。,上海,82.62%,宁波,66.38%,江西,61.21%,天津,76.93%,湖北,66.35%,深圳,61.16%,黑龙江,75.28%,陕西,66.16%,甘肃,61.11%,重庆,74.41%,山东,65.90%,广西,59.11%,吉林,72.44%,四川,65.54%,宁夏,58.57%,安徽,69.72%,贵州,65.07%,大连,58.51%,辽宁,69.40%,河南,63.95%,山西,58.32%,福建,68.61%,青岛,63.20%,广东,57.81%,湖南,68.04%,云南,62.50%,新疆,56.46%,北京,67.60%,青海,61.92%,内蒙古,53.93%,浙江,67.59%,河北,61.30%,厦门,53.68%,江苏,66.54%,海南,61.24%,西藏,47.04%系统合计,67.02%,2025/5/10 周六,7,7,五、分公司商业车险赔付情况,2,、,新口径,赔付率最高的分公司为天津（,79.98%,）、黑龙江（,75.19%,）、北京（,74.62%,）、海南（,71.93%,），均超过,70,%,；赔付率最低的分公司为湖南（,44.52%,）、厦门（,47.47%,）、西藏（,49.84%,）、江西（,49.88%,），均低于,5,0,%,。,天津,79.98%,山西,60.43%,河北,56.05%,黑龙江,75.19%,浙江,59.07%,内蒙古,55.49%,北京,74.62%,辽宁,58.61%,青岛,55.01%,海南,71.93%河南,58.50%,大连,54.04%,上海,68.61%,深圳,58.47%,江苏,53.79%,陕西,67.76%,广西,58.11%,湖北,53.14%,云南,67.68%,新疆,58.01%,宁夏,52.37%,青海,66.99%,重庆,57.81%,山东,51.16%,吉林,65.87%,宁波,57.68%,江西,49.88%,甘肃,65.46%,安徽,57.10%,西藏,49.84%,福建,64.08%,广东,56.82%,厦门,47.47%,贵州,62.62%,四川,56.52%,湖南,44.52%,系统合计,61.41%,2025/5/10 周六,7,8,8,六、分公司交强险赔付情况,3,、,新口径,赔付率最高的分公司为上海（,127.08%,）、重庆（,116.70%,）、湖南（,110.42%,），均超过,110,%,；赔付率最低的分公司为西藏（,42.42%,）、海南（,43.96%,）、北京（,44.77%,），均低于,5,0,%,。,上海,127.08%,吉林,86.36%,陕西,62.17%,重庆,116.70%,江西,85.36%,广东,60.92%,湖南,110.42%,福建,83.35%,广西,60.91%,江苏,108.97%,厦门,77.46%,新疆,54.23%,山东,104.85%,黑龙江,75.47%,山西,53.81%,宁波,104.22%,大连,75.08%,青海,53.30%,安徽,100.85%,河南,74.48%,云南,52.40%,浙江,98.69%,深圳,74.39%,甘肃,52.15%,辽宁,97.04%,河北,74.01%,内蒙古,50.18%,湖北,93.98%,宁夏,70.83%,北京,44.77%,四川,90.55%,贵州,70.12%,海南,43.96%,青岛,89.56%,天津,68.77%,西藏,42.42%,系统合计,81.26%,2025/5/10 周六,8,9,9,七、分公司非车险赔付情况,1,、,新口径,赔付率最高的分公司为河南（,161.65%,），是唯一赔付率过百的分公司；赔付率最低的分公司为西藏（,11.79%,）、宁波（,31.61%,），均低于,40,%,。,河南,161.65%,四川,62.94%,河北,54.27%,福建,90.03%,云南,62.14%,贵州,50.94%,广东,85.35%,辽宁,61.80%,江苏,50.31%,海南,80.28%,湖北,61.80%,湖南,48.92%,江西,77.76%,甘肃,61.40%,大连,48.46%,青岛,76.51%,山东,60.74%,安徽,44.54%,内蒙古,74.26%,广西,60.71%,天津,44.47%,厦门,74.03%,深圳,59.79%,北京,42.50%,青海,70.51%,新疆,59.68%,吉林,42.32%,陕西,69.25%,浙江,59.57%,黑龙江,40.52%,山西,66.48%,宁夏,55.80%,宁波,31.61%,重庆,65.12%,上海,55.66%,西藏,11.79%,系统合计,65.66%,2025/5/10 周六,9,10,10,八、车险案均赔款,截至,7,月末，,车险不涉及人伤案均赔款为,25,97,元，同比增幅,14.21%,。案均最低的为海南和新疆分公司，均低于,2000,元；案均最高的为西藏和宁波分公司，均高于,4000,元。案均降幅最大的为青海、黑龙江、深圳、山西分公司，降幅达,5%,以上；增幅最大的为四川、江苏、重庆分公司，增幅达,40以上。,不涉及人伤案均赔款排名,增减幅度排名,海南,1,683.86,北京,2,481.55,上海,3,019.09,青海,-6.46%,西藏,8.99%,青岛,18.78%,新疆,1,779.40,江苏,2,528.37,甘肃,3,052.39,黑龙江,-6.21%,新疆,11.12%,浙江,21.86%,广东,2,036.04,陕西,2,577.67,重庆,3,091.63,深圳,-5.46%,河北,11.23%,江西,22.41%,广西,2,066.42,天津,2,585.49,贵州,3,116.58,山西,-5.10%,上海,11.88%,安徽,23.66%,山东,2,097.50深圳,2,640.88,青海,3,134.08,吉林,-3.79%,海南,12.29%,河南,29.45%,大连,2,203.52,辽宁,2,696.47,福建,3,135.85,天津,-2.91%,北京,13.81%,甘肃,30.93%,江西,2,283.97,吉林,2,740.26,厦门,3,140.45,湖南,-0.17%,大连,15.50%,厦门,32.06%,湖南,2,321.75,山西,2,782.06,河南,3,187.32,山东,1.54%,宁夏,17.56%,福建,36.37%,云南,2,351.36,湖北,2,795.54,河北,3,292.18,广东,1.96%,内蒙古17.89%,贵州,39.28%,黑龙江,2,419.13,安徽,2,903.70,浙江,3,688.96,辽宁,5.13%,广西,18.09%,重庆,40.65%,内蒙古,2,429.57,宁夏,2,920.40,宁波,4,118.51,云南,5.14%,宁波,18.32%,江苏,43.32%,四川,2,444.98,青岛,2,926.60,西藏,4,411.87,陕西,7.65%,湖北,18.62%,四川,44.34%,系统合计,2596.78,（元）,系统合计,14.21%,2025/5/10 周六,10,截止,7,月末，,车险涉及人伤案均,赔款为,24,562,元，,同比,增幅,7.43%。案均最,低的为,湖南,、,云南,、,海南,分公司，,均低于20000元；案均最高的为,厦门和青岛分公司，均高于,35000,元。案均降幅最大的为,山东和山西分公司，降幅达,4%,以上；,增幅,最大的为青岛,、湖北、江西,分公司，增幅达,20%,以上。,涉及人伤案均赔款排名,增减幅度排名,湖南,16,240.10,重庆,23,073.68,西藏,26,748.29,山东,-4.69%,吉林,4.60%,四川,12.42%,云南,16,921.64,江西,23,117.14,安徽,27,459.67,山西,-4.06%,西藏,4.88%,浙江,12.54%,海南,17,063.27,浙江,23,339.43,青海,28,034.38,黑龙江,-3.98%,安徽,5.32%,厦门,14.20%,宁波,20,070.86,甘肃,23,828.32,河北,28,741.75,深圳,-3.16%,河北,5.64%,河南,14.21%,新疆,20,283.86,天津,25,277.41,山西,29,349.87,内蒙古,-2.50%,上海,6.49%,青海,15.56%,贵州,20,592.21,吉林,25,504.72,辽宁,31,267.00,湖南,-1.01%,宁波,6.58%,宁夏,16.80%,广西,21,320.93,陕西,25,577.15,山东,31,640.54,辽宁,0.50%,新疆,7.18%,贵州,17.73%,北京,21,481.61,宁夏,25,868.52,深圳,32,163.19,大连,1.58%,江苏,7.90%,重庆,17.98%,江苏,21,692.10,福建,25,991.57,大连,32,183.55,广东,2.04%,陕西,8.76%,海南,18.80%,四川,21,803.62,黑龙江,26,135.06,内蒙古,32,218.19,云南,3.01%,广西,11.14%,江西,22.29%,广东,22,660.57,河南,26,277.32,青岛,38,920.41,福建,3.22%,天津,11.23%,湖北,23.15%,湖北22,928.93,上海,26,374.97,厦门,42,870.42,北京,3.83%,甘肃,11.51%,青岛,26.74%,系统合计,24562.48(,元）,系统合计,7.43%,2025/5/10 周六,11,12,12,一、赔付成本分析,二、理赔效率分析,三、未决管控分析,四、近期需要关注的几个问题,目录,2025/5/10 周六,12,13,13,一、案件处理率,7,月份案件处理率为,100.62,%，,有26家分公司案件处理率超过,达标值,9,5,%,，,16,家分公司因处理了大量历史赔案，本指标过百,。,各分公司应继续加快赔案,特别是历史赔案的处理速度,。案件处理率最高的为湖北、,天津、,山东,分公司，均超过,110%,；,最低的为,广东、宁波、西藏、浙江分公司。,从,1-7,月份情况看，案件处理率在,2,月份略有下降，此后逐月提高。,湖北,123.59%,29.66%,大连,100.59%,5.29%,内蒙古,95.92%,2.12%,天津,115.43%,18.99%,安徽,100.40%,10.01%,海南,95.74%,9.17%,山东,111.29%,20.94%,甘肃,100.40%,8.30%,江西,94.67%,4.31%,广西,109.27%,16.44%,吉林,100.18%,-4.06%,青岛,93.83%,4.54%,四川,109.20%12.94%,江苏,98.94%,5.48%,黑龙江,93.74%,-4.14%,重庆,108.66%,26.84%,云南,98.65%,-4.25%,厦门,93.34%,-5.00%,河南,104.65%,13.70%,湖南,98.27%,5.12%,青海,93.31%,6.22%,陕西,104.54%,19.12%,新疆,98.11%,5.08%,上海,93.03%,3.13%,福建,103.98%,12.64%,山西,97.96%,2.85%,浙江,92.87%,2.64%,辽宁,103.63%,7.33%,宁夏,97.69%,2.70%,西藏,91.56%,3.72%,河北,101.18%,8.98%,北京,97.49%,0.79%,宁波,91.43%,-3.71%,贵州,100.98%,6.03%,深圳,96.84%,-10.89%,广东,90.11%,-6.16%,系统合计,100.62%,2025/5/10 周六,14,14,二、车险理赔周期,车险当年报案当年结案案件理赔周期（报案到结案天数）为,29.44,天，同比减速,0.52,%,。理赔周期最短的为大连、山西分公司，均低于,20,天；最长的为天津、河南、上海分公司，均超过,4,0,天，应加快案件处理速度。,大连,17.82,-12.49%,宁波,27.57,8.73%,浙江,31.77,10.59%,山西,1875,18.02%,广西,27.81,-11.34%,云南,31.88,8.94%,内蒙古,21.17,19.96%,甘肃,28.08,-10.47%,重庆,32.22,-10.27%,海南,21.67,-21.23%,江苏,28.59,3.25%,四川,32.43,3.48%,新疆,21.99,-4.82%,黑龙江,28.75,7.26%,湖北,33.85,-24.38%,深圳,23.78,-9.21%,山东,28.91,49.12%,安徽,34.45,-3.88%,宁夏,24.33,31.66%,陕西,29.51,-13.84%,西藏,36.51,20.88%,青海,25.38,-28.68%,广东,29.61,-10.01%,贵州,37.18,-11.92%,辽宁,25.96,7.63%,青岛,29.62,10.86%,福建,37.96,23.26%,河北,25.98,11.33%,厦门,29.64,14.65%,上海,40.27,-13.60%,吉林,26.07,-13.70%,北京,31.26,3.78%,河南,41.13,20.35%,湖南,27.51,-19.07%,江西,31.57,21.93%,天津,45.83,40.99%,系统合计,29.44,（天）,2025/5/10 周六,15,15,三、结案率,1,、,件数结案率,（当年立案当年结案件数,/,当年（总立案件数,-,立案注销件数,-,立案拒赔件数）*,100%,）为,70.54%,，离目标值,85%,还有相当大差距。件数结案率最高的为大连，是唯一超过,80%,的分公司；最低的为上海、河南分公司，均低于,60%,。,2,、,金额结案率,（当年立案当年结案案件的结案金额,/,（当年立案当年结案案件的结案金额,+,当年立案未结案件的总估损金额）*,100%,）为,45.94%,，同样离目标值,60%,还有相当大的差距。金额结案率最高的为北京、宁夏，均超过,60%,；最低的为上海、海南、青岛，均低于,35%,。,各分公司既要加快件数的处理速度，又要加快金额的处理速度，不能只赔小额赔案，积压大额赔案，否则将会引起客户服务满意度的下降和未决赔款准备金的增提。,大连,81.25%,广西,73.99%,江苏,67.09%,宁夏,79.55%,北京,73.49%,宁波,66.10%,辽宁,79.46%,湖南,73.40%,湖北,65.92%,甘肃,77.57%,山东,73.19%,重庆,65.35%,山西,77.28%,黑龙江,73.17%,福建,65.34%,内蒙古,77.22%,河北,72.92%,天津,64.60%,新疆,77.11%,云南,71.54%,西藏,64.47%,吉林,76.32%,深圳,70.44%,浙江,63.89%,海南,76.24%,青岛,69.97%,贵州,62.57%,四川,74.85%,青海,69.39%,安徽,61.86%,江西,74.68%,广东,68.50%,河南,56.07%,陕西,74.31%,厦门,67.68%,上海,55.65%,系统合计,70.54%,北京,63.88%,广西,50.63%,江苏,42.51%,宁夏,60.44%,湖南,49.98%,湖北,42.30%,吉林,59.19%,浙江,49.12%,河南,42.29%,云南,58.56%,深圳,48.76%,广东,39.60%,西藏,57.03%,宁波,48.26%,江西,38.69%,甘肃,54.36%,贵州,48.04%,天津,38.27%,新疆,53.26%,重庆,47.32厦门,37.90%,四川,53.16%,福建,46.55%,山东,36.85%,山西,53.07%,大连,46.03%,安徽,35.03%,陕西,52.08%,黑龙江,43.83%,青岛,34.97%,内蒙古,51.53%,河北,43.40%,海南,34.24%,青海,50.89%,辽宁,42.55%,上海,30.16%,系统合计,45.94%,2025/5/10 周六,15,2025/5/10 周六,16,17,17,一、赔付成本分析,二、理赔效率分析,三、未决管控分析,四、近期需要关注的几个问题,目录,2025/5/10 周六,17,18,18,一、未决存量情况,7,月底未结赔付件数为477,万件，同比增加,0.46%,；未结赔款,437,亿，同比下降,2.07%,。其中车险占比最大，未结赔付件数为,400,万件，占全险种的,83.86%,，未结赔款,290,亿，占全险种的,66.36%,，应予以重点关注，防止未决存量过多。,未结赔付件数（件）,同比增减,%,未结赔款,(,元,),同比增减,%,合计,4,772,182,0.46%,43,730,416,277.58,-2.07%,企业财产险,97,130,-3.35%,4,357,327,021.41,-8.81%,家庭财产险,45,670,5.40%,160,732,499.43,-26.98%,工程险,8,505,62.62%,956,316,101.96,-26.38%,责任险,176,099,17.95%,2,300,944,110.70,-17.19%,信用保证险,1,036,12.61%,49,779,801.18,-13.11%,机动车辆险,4,002,800,1.55%,28,992,717,910.77,5.04%,船舶险,7,541,10.31%,1,800,516,682.62,-2.62%,货运险,32,612,11.56%,1,342,950,690.66,-14.32%,特殊风险,918,49.03%,1,322,646,012.30,-29.31%,农业险,185,625,-2231%,754,548,765.14,-21.36%,意外险,183,521,-7.77%,704,373,386.21,-10.66%,健康险,7,678,-1.83%,61,560,807.25,-0.70%,其他,23,047,-14.86%,926,002,487.93,12.57%,2025/5/10 周六,19,19,二、未结滞案率,全系统出险超过两年的未结赔案占比，即未结滞案率为,8.30%,（目标值,3%,），,指标完成情况不理想。其中：仅有甘肃、江西、宁夏、内蒙古四家分公司控制较好在,3%,以内；天津分公司最高达,27.44%,，增幅也最大,+16.11%,。分公司应组织专门力量，分析原因，加大对历史未结赔案的处理速度和清理力度。,甘肃,0.65%,-1.73%,广西,6.15%,3.90%,大连,8.50%,-1.60%,江西,1.97%,-0.55%,云南,6.23%,3.53%,黑龙江,8.81%,4.22%,宁夏,2.42%,-0.59%,湖北,6.40%,1.64%,辽宁,9.19%,3.29%,内蒙古,2.84%,-0.39%,宁波,6.63%,1.68%,河南,9.80%,5.60%,浙江,4.02%,-0.01%,重庆,6.74%,4.40%,贵州,10.03%,5.89%,湖南,4.36%,-0.14%,新疆,6.83%,0.69%,四川,1048%,4.75%,江苏,4.41%,0.03%,厦门,7.06%,2.99%,广东,11.17%,5.06%,青海,4.77%,2.30%,山西,7.32%,3.15%,陕西,11.98%,3.24%,北京,4.83%,-3.65%,河北,7.52%,2.73%,上海,12.55%,7.76%,西藏,5.04%,0.35%,深圳,7.60%,0.99%,青岛,14.29%,4.50%,福建,5.44%,3.04%,安徽,8.42%,4.37%,吉林,15.10%,6.20%,山东,5.83%,1.79%,海南,8.47%,4.13%,天津,27.44%,16.11%,系统合计,8.30%,2025/5/10 周六,20,20,三、限时立案率,全系统限时立案率（车险报案后,3,日立案件数,+,非车险报案后,5,日立案件数）,/,总立案件数*,100%,。）为,89.04,%,，即将达到,90%,的控制目标。限时立案率最高的为山西和新疆分公司，均超过,9,5,%,；最低的为西藏和北京分公司，均低于,80,%,。立案及时性差，将影响未决赔款准备金的准确计提，各分公司应继续加大对立案及时性的管控。,山西,95.80%,3.32%,江西,91.54%,7.38%,四川,87.84%,11.01%,新疆,95.35%,10.86%,云南,91.48%,12.71%,广西,87.57%,1585%,河北,94.68%,7.88%,福建,90.16%,6.03%,大连,87.42%,19.54%,吉林,94.07%,12.07%,湖南,89.98%,12.20%,广东,86.66%,14.63%,重庆,93.69%,18.56%,贵州,89.95%,13.08%,宁夏,86.49%,5.57%,青岛,93.26%,7.64%,厦门,89.86%,6.31%,河南,86.13%,12.62%,黑龙江,92.67%,6.88%,浙江,89.73%,13.64%,陕西,85.02%,15.49%,天津,92.46%,15.31%,宁波,89.55%,22.30%,湖北,84.56%,16.75%,深圳,92.38%,4.89%,辽宁,89.20%,5.22%,内蒙古,82.13%,7.73%,山东,92.20%,6.27%,海南,88.43%,16.69%,青海,81.20%,9.02%,安徽,91.70%,10.13%,甘肃,88.37%,13.45%,北京,79.64%,13.68%,上海,91.64%,27.98%,江苏,88.11%,8.54%,西藏,77.42%,20.28%,系统合计,89.04%,2025/5/10 周六,20,21,21,四、延时立案率,全系统延时立案率（车险报案,10,日立案件数,+,非车险报案,20,日立案件数）,/,总立案件数*,100为,1.52%,（目标值,5%,）指标完成情况较好。延时立案率最低的为湖南、山西、云南分公司，均低于,0.7,%,；最高的为青海、湖北、宁夏、河南、西藏分公司，均高于,3,%,。,湖南,0.67%,-3.71%,山东,1.05%,-3.10%,陕西,1.77%,-9.56%,山西,0.68%,-1.85%,青岛,1.06%,-2.74%,江苏,1.87%,-4.75%,云南,0.70%,-8.69%,上海,1.07%,-17.05%,安徽,1.91%,-5.32%,黑龙江,0.80%,-1.96%,江西,1.07%,-4.32%,内蒙古,2.30%,-3.69%,重庆,0.83%,-10.32%,辽宁,1.13%,-4.14%,甘肃,2.47%,-6.85%,新疆,0.91%,-4.47%,宁波,1.19%,-10.58%,北京,2.62%,-6.32%,河北,0.93%,-3.28%,天津,1.22%,-6.40%,广西,2.74%,-15.19%,四川,0.94%,-2.61%,浙江,1.23%,-2.70%,西藏,3.02%,-18.23%,厦门,0.96%,-3.82%,福建,1.65%,-3.53%,河南,3.26%,-6.57%,广东,1.00%,-8.58%,大连,1.71%,-6.49%,宁夏,3.50%,-5.35%,深圳,1.01%,-4.91%,贵州,1.75%,-5.06%,湖北,3.96%,-8.97%,吉林,1.03%,-2.21%,海南,1.77%,-5.77%,青海,4.04%,-7.82%,系统合计,1.52%,2025/5/10 周六,22,22,五、立案注销及恢复率,1,、立案注销率,全系统为,20.10%,，同比上升,10.62,个百分点。其中湖北和重庆分公司注销率超过,30%,，说明上述公司能够及时清理无效数据，但同时反映出日常工作中产生的垃圾数据过多，注销时一定要注意准确性和合规性，防止错误注销。北京和海南分公司注销率低于,10%,，应注意及时清理未结赔案，防止无效数据沉淀，影响未决存量；另一方面，能否表明上述分公司的未结数据质量较高，不需要大量注销赔案？还有待于持续观察。,2,、立案注销恢复率,全系统为,0.13%,，同比下降,0.53,个百分点。其中天津和湖北分公司恢复率最低为,0.01%,；宁夏、宁波、辽宁分公司最高均为,0.51%,。,北京,8.52%,上海,16.82%,湖南,22.58%,海南,9.73%,甘肃,17.55%,福建,22.80%,黑龙江,10.99%,青岛,18.24%,浙江,23.38%,大连,11.01%,天津,18.30%,贵州,24.01%,新疆,11.30%,深圳,18.63%,河南,25.06%,内蒙古,13.45%,吉林,19.81%,宁波,25.18%,云南,1407%,广西,20.05%,辽宁,26.59%,广东,14.25%,江西,20.42%,江苏,26.95%,四川,14.35%,陕西,20.47%,山东,27.74%,厦门,15.08%,宁夏,21.03%,安徽,28.80%,青海,15.63%,河北,21.37%,重庆,32.50%,西藏,16.75%,山西,21.45%,湖北,35.76%,系统合计,20.10%,天津,0.01%,贵州,0.06%,厦门,0.17%,湖北,0.01%,甘肃,0.06%,深圳,0.19%,安徽,0.02%,河北,0.07%,云南,0.19%,江西,0.02%,海南,0.07%,大连,0.24%,广东,0.02%,陕西,0.07%,山西,0.25%,吉林,0.03%,重庆,0.08%,西藏,0.31%,江苏,0.03%,北京,0.10%,新疆,0.32%,湖南,0.03%,河南,0.11%,青海,0.36%,黑龙江,0.04%,内蒙古,0.14%,四川,0.49%,上海,0.05%,浙江,0.14%,辽宁,0.51%,福建,0.05%,青岛,0.15%,宁波,0.51%,广西,0.06%,山东,0.16%,宁夏,0.51%,系统合计,0.13%,2025/5/10 周六,22,23,23,六、,2009,年底车险未结清单赔案估损充足率,截止到,2010,年,8,月,11,日，共结案处理,2009年底车险立案未决赔案,132.5,万件，已决金额为,134.8,亿元，而这些赔案在,2009,年底清单中的逐案估损金额为,104.3,亿元，已结案部分的估损充足率（,2009,年底逐案估损金额,/2010,年实际结案的已决金额）为,77.41%,。估损充足率最高的为湖南，也是唯一过百的公司；充足率最低的为湖北，不足,60%,。,湖南,119.70%,河北,81.30%,新疆,72.80%,大连,98.60%,厦门,80.20%,内蒙古,72.50%,安徽,94.70%,辽宁,80.10%,广西,71.90%,天津,94.60%,贵州,79.50%,甘肃,70.00%,黑龙江,93.00%,西藏,77.70%,四川,68.50%,宁波,92.80%,海南,77.50%,河南,68.20%,宁夏,92.40%,江西,76.30%,福建,67.70%,山东,91.60%,吉林,75.80%,广东,66.90%,上海,89.30%,青海,75.60%,重庆,66.00%,深圳,87.70%,浙江,75.30%,青岛,64.50%,江苏,83.50%,云南,74.90%,山西,63.60%,北京,82.90%,陕西,73.90%,湖北,57.40%,系统合计,77.41%,2025/5/10 周六,23,24,24,一、赔付成本分析,二、理赔效率分析,三、未决管控分析,四、近期需要重点关注的问题,目录,2025/5/10 周六,24,25,25,（一）加强对地市分公司赔付成本和理赔管理工作的监控和督导,目前公司经营已进入下半年关键阶段，总公司已根据各分公司上半年理赔质量、理赔服务、理赔管控等情况，下发了,理赔管理建议书,。各分公司要对照建议书中的内容，结合本公司经营和各项理赔指标完成情况，查找差距，巩固发扬好的做法和举措，改进不足。同时分公司要根据赔付率预算目标的完成进度，加强对地市分公司理赔指标和理赔工作的监控和督导，采取下发督导函、现场检查、调整地市公司理赔权等方式进行有针对性、有效性管理，为全年理赔工作目标的顺利实现打下基础。,近期需重点关注的问题,2025/5/10 周六,26,26,（二）积极开展赔案核查和理赔质量的自查自纠工作,国家审计署对我司的审计工作已基本结束，理赔工作是本次审计的重点之一。审计结果反映出一些分支机构在理赔依法合规经营方面存在比较严重的问题，如制造假赔案套取费用；在赔案中虚列理赔费用，通过虚假公估费套取费用；理赔手续不规范等。总公司已针对问题分公司下发了督导函，并且总公司,已经成立了,赔案核查组，近期将在系统内全面开展理赔质量检查工作。,检查范围包括理赔省集中建设、赔案质量、理赔标准化建设等内容，请分公司提前组织开展自查整改工作。,近期需重点关注的问题,2025/5/10 周六,26,27,27,（三）坚决落实,“,十亿降赔,”,工作方案,各分公司要坚决落实年初理赔工作会议中确定的十大降赔举措，加强理赔成本控制，坚决落实,“,十亿降赔,”,工作方案，确保理赔工作目标的实现。具体工作包括：,要加大核损、核价、核赔工作力度，充分发挥理赔省、地集中核损、核价、核赔的管控优势，切实减少赔款漏损，严格控制理赔成本支出；要加强未决赔案管理，对拟注销,/,拒赔类未决赔案、已注销,/,拒赔类未决赔案、无效数据及仍处未决状态的四类赔案，按照清单进行核查，确保未决件数和金额准确等。,近期需重点关注的问题,2025/5/10 周六,27,28,28,（四）做好理赔人员业务培训及考核工作,九月份总公司将开始对全系统,理赔线人员进行,“,三师九员,专业技术序列任职资格考试，目前已到了最后的准备冲刺阶段。各分公司要高度重视，认真组织理赔人员,参加周六的理赔全险种、各岗位、理赔实务等内容的视频培训，,力争取得优异的成绩,。同时以此为契机，加强理赔人员的专业能力建设，提高员工素质。,近期需重点关注的问题,2025/5/10 周六,28,29,29,（五）,注意做好大灾防御和理赔工作,目前全国正处在汛期灾害发生的高峰时节，今年的灾情相当严重，受灾分公司一定要周密部署，科学调配，技术把关，全力做好大灾理赔工作。同时各分公司在汛期内要积极主动掌握信息，提前做好保险标的灾害预防工作。各分公司要根据当前灾情的发展，加强与当地政府的协调与沟通，争取政府在各方面的支持，遇有疑难或有争议的案件，聘请外部专家参与查勘定损。依法履行保险合同义务，杜绝拖赔、惜赔、无理拒赔等损害被保险人合法权益的行为，确保理赔资金支付给受灾保户。,近期需重点关注的问题,2025/5/10 周六,29,谢谢！,THANK,YOU,！,2025/5/10 周六,31,