پژوهشنامه بیمه
سال سی و سوم شماره 1 (بهار 1397)

The main purpose of this paper is to present an enterprise risk management for insurance companies in line with establishing Corporate Governance System with supervisory considerations. Therefore, we initially introduce theoretical aspects of international standards and frameworks of Enterprise Risk Management and then we present a theoretical pattern for establishing Enterprise Risk Management System based on Own Risk and Solvency Assessment System in insurance companies. Next, in addition to explain the results of lack of a comprehensive risk management pattern in Iranian insurance companies, we introduce this as one of the main reasons to decrease Solvency Margin Ratio of these companies. Finally, we present a proposed structure and also describe the role and position of this structure in managing insurance companies with supervisory considerations. In this proposed pattern, in addition to explain an interactive approach based on bilateral cooperation between risk management department and other departments of an insurance company, we propose a reporting system based on kind of risk self-declaration.
In this pattern, we first explained interactions and relationships between risk department and other parts of organization based on bilateral cooperation and second proposed a reporting system including self-reporting process.

The insurance industry is prone to fraud due to its nature. In car insurance, the insurer covers all damages brought to third parties by vehicle or vehicle load. In recent ýyears, given the growth of this kind of insurance, it has become necessary to identify the factors ýinfluencing decisions that damage be paid for a forgery claim.ý One way to discover and deal with these sorts of frauds is to investigate ýthe information cited in the cases putting forth the damage claim through ýthird-party insurance. data mining is an appropriate way to interact with ýthese data banks; Also, it may provide valuable knowledge acquired ýfrom these databases. In the present study, the attempt is made to explore ýthe fraud patterns in the third-party insurance by investigating up to 142 ýthird-party cases and six variables. The findings indicate that the decision tree and neural net algorithms have better performance in identifying fraudulent, non-fraudulent and suspicious cases than the support vector machine algorithm.

The insurance industry of Iran has been experienced dramatic growth in the last decade. And insurance agents play a major role in transaction volume in this industry. Therefore, the selectionprocess of new agents is of vital importance. This study focuses on the characteristics of data warehousing and the appropriate data mining techniques to be used to support agent selection in the insurance industry. We examined three common data mining methods – discriminant analysis, decision trees and artificial neural networks –to predict the duration of service, sales premiums, and persistence indices of insurance agents. The results revealed that work experience, job position, age, marital status, previous occupation, past annual income, and insurance policies sold are the important factors influencing the length of stay for new insurance agents, the number of insurance policies sold, and the extension of insurance policies sold. This study specifically aimed to design and develop an intelligent decision support system, namely an ‘Intelligent Agent Recruitment Assistant for Insurance’ companies, to help insurance managers to select quality agents.

The insurance industry is among those which require policyholders to play an active role. Without the participation of policyholders, companies active in this industry will not be able to provide desirable services. The present study amied to investigate the relationship of participatory behavior and citizenship behavior of customers (policyholders) with their intention for refusing purchase from an insurance company. In this study, a sample of 385 people was selected by using Cochran’s formula and based on simple random sampling method, an author-made questionnaire was used for measuring research variables. Research data was analyzed by using the structural questionnaire. It should be noted that the results of the structural equations analysis through AMOS software shows that costumer (policyholder) participation behavior, citizenship behavior and satisfaction have a significance negative effect on customer purchase refusal intention, and that costumer participation behavior and citizenship behavior have a significance positive effect on costumer satisfaction.

Outstanding loss reserves is one of the crucial actuarial issues in general insurance. In this paper, we consider a developed Bayesian method for modeling bivariate outstanding loss reserves data of lines of third party insurance and auto body insurance of an Iranian insurance company based on the bivariate Student's t and the bivariate Pearson type VII distributions. When the data does not follow the assumptions of normality, heavy-tailed distributions such as the Student's t and the Pearson type VII distributions provide robust inferences. These distributions belong to the class of the scale mixtures of normal distributions. The hierarchical structure of this class allows that under a Bayesian paradigm, the parameter estimation is simplified by sampling from normal distribution using Markov Chain Monte Carlo (MCMC) methods. We consider three models including ANOVA, ANCOVA, and random-walk for the mean of the sampling distributions. In addition, a sensitivity study to detect influential cases is performed based on the Kullback– Leibler divergence. Results show that the random-walk model under the bivariate Student's t distribution has a better performance.

In Iran’s legal system, insurable interest is a basic requirement of a valid insurance contract in which there is no considerable literature about it. Therefore, the present investigation considers the legal requirements of insurable interest with a comparative approach and also proceeds to assess these requirements. Thus, on the one hand, the obtaining rule of insurable interest in personal insurances and, on the other, the meaning of insurable interest in indemnity insurances have been studied. Also, due to the relationship between insurable interest and public policy and according to the articles (12) and (23) of Iran’s insurance law, the performance guarantee of lack of insurable interest has been discussed. Furthermore, by the legislative philosophy of insurable interest, the efficiency of this doctrine in reducing the risk of moral hazard has been mentioned. In the end, social desirability as the criterion consent of insured for life insurance, the scrapping insurable interest in liability insurances and insufficient efficacy of the insurable interest doctrine against the moral hazard risk are cited as the most important conclusions of this study.