Regulations Governing Business Solicitation, Policy Underwriting and Claim Adjusting of Insurance Enterprises Article 8
The internal claim adjusting system and procedure of an insurance enterprise shall contain and explicitly specify at least the following particulars:1.The qualifications, job descriptions, on-the-job training and reward/discipline of the employed claim adjusters.2.Operating procedure and flow chart for accepting claims and benefit approval, including at least the expensing and accounting treatment of claim settlement expenses, claim investigation, evaluation and adjustment, hierarchy of authority, and claims recovered from reinsurers.3.The following situations are prohibited:(1) Claim adjustment work is performed by someone without the qualification of claim adjuster.(2) Evaluating and approving claim benefit without considering the content of the insurance product.(3) Engaging in other practices that impair the rights and/or interests of policyholders.4.Other matters to be complied with as prescribed by the competent authority.
中文原文 保險業招攬及核保理賠辦法第8條
保險業訂定其內部之理賠處理制度及程序，至少應包含並明定下列事項：
一、聘用理賠人員之資格、職掌範圍、在職訓練及獎懲。
二、受理申請理賠至簽署理賠同意之作業程序及流程圖，其中至少應包含理賠處理費用之報支及帳務處理、理賠之調查、評估及理算、分層負責授權權限、再保險攤回等。
三、不得有下列情事：
（一）未具理賠人員之資格執行理賠簽署作業。
（二）未依保險商品內容予以評估並簽署理賠。
（三）其他損害保戶權益之情事。
四、其他主管機關規定應遵行之事項。
一、聘用理賠人員之資格、職掌範圍、在職訓練及獎懲。
二、受理申請理賠至簽署理賠同意之作業程序及流程圖，其中至少應包含理賠處理費用之報支及帳務處理、理賠之調查、評估及理算、分層負責授權權限、再保險攤回等。
三、不得有下列情事：
（一）未具理賠人員之資格執行理賠簽署作業。
（二）未依保險商品內容予以評估並簽署理賠。
（三）其他損害保戶權益之情事。
四、其他主管機關規定應遵行之事項。