次標準體壽險保單核保理賠分析

本文利用保險公司標準體保單及次標準體保單的理賠資料及承保條件，透過迴歸模型加以實證分析，盼能找出次標準體保單死亡相關風險的顯著因素，提供該壽險公司核保與理賠人員參考，並對於次標準體保單核保與理賠提出改進意見。本研究之結論如下：一、在投保金額與次標準體關係之實證分析，結果顯示次標準體保單死亡件會比標準體保單死亡件有較高的投保金額，而年齡較高的保戶也會傾向購買較高的保額。二、在次標準體保單死亡及生存與否之實證分析，結果顯示次標準體保單死亡件會比次標準體保單生存件有較高的投保年齡與較長的繳費年期。建議壽險公司對於投保年齡較高或是繳費年期較長的次標準體保戶，採取更審慎核保機制，以降低保險公司經營次標準體保單之風險。三、從實務訪談得知，若風險控管得宜，保險公司承保次標準體保單，可以增加業務量，對於保險公司獲利並不會帶來負面的影響。

關鍵字

次標準體；核保；理賠

並列摘要

This purpose of this paper is analyzing the risk of substandard policies by claim data and underwriting condition for the standard and substandard policies of one life insurance company in Taiwan. I use the traditional ordinary least square and logistic model to proceed with empirical study. Moreover, I also interview with chief of underwriter department of one life insurance company. Wish our conclusions can provides this life insurance company to deal with the underwriting and claim for substandard policies more efficiency. The main results are described as following: 1.By using the traditional ordinary least square model, I find that the death substandard policies will have the higher insured amount than the death standard policies and elder persons also intend to buy high insured amount. 2.By using the logistic model which the dependent variable is substandard insured be survival or death, I find that the death substandard insured will have the higher age and longer payment year time than the survival standard insured. This result indicate that the life insurance company should enact more prudent underwriting rule for substandard insured with elder age and longer payment year time to avoid risk of the substandard policies. 3.From the interview with chief of underwriting department, if to control risk is appropriate, there is no negative impact for profit of life insurance company when increasing the business volume of substandard policies.