پژوهشنامه بیمه
سال سی و هفتم شماره 4 (زمستان 1401)

Societies, organizations or individuals must not only face fundamental environmental changes and react to these changes, but also study the necessary forecasts to prepare for such events and strive to achieve a favorable future. Insurance  industry also is not excluded from such predictions. The objective of this research is to identify and possible events for the future of auto insurance in Iran, including those that have been for the sale and payment of this field between 5 and 20 years.

Numerous studies have been conducted by theme analysis to identify factors or other objectives; however, there are few studies in the field of future insurance studies, especially auto insurance. Many studies have analyzed the impact of future insurance trends in general, and some have focused on auto insurance in particular. Their methods are mostly trend analysis and some scenario planning. However, these studies have focused on several influential factors and except for one study, none of the studies has focused on the comprehensive identification of factors affecting the future of auto insurance, except one, which it’s scope was global and not in Iran.
This research is descriptive and survey-type, with a practical purpose and a qualitative approach to content analysis. The results of this research have been analyzed in the form of a theme network. In addition, in order to collect data, a semi-structured in-depth interview was used.

In this research, 19 insurance industry experts were interviewed through snowball sampling. In order to analyze the content of the research, two evaluators were coordinated to carry out open coding, categorization and extraction of themes with the help of MaxQDA software. In this research, reliability, transferability, verifiability and reliability have always been under control, and coding reliability was measured through Kappa Cohen, which was equal to 0.954 in the last stage. In total, the identified factors were classified into six categories: technological, political and legal, economic, social, environmental, and business. In this analysis, the initial 142 open source code, which was limited to 107 open source code after the modifications, was assigned to 900 observation units, which were finally summarized in 44 categories and 6 themes. Considering the value of future studies and the lack of implementation of similar studies in the country, the results which are remarkable, new and valuable, can be used for policy making at different levels of the governing systems, insurance companies and sales network.

Based on this research, 44 categories were identified as disease factors, in the form of six themes, which have the ability to change the future of auto insurance in Iran. The findings of this study can be used for policy-making, strategy planning, and investing in infrastructures, human capital studies etc. The results are displayed in the form of a network of themes. Due to these findings, it is important to pay attention to issues related to information technology and the impact of automotive technologies in assessing the risk and damage of auto insurance. In addition, in future research, in order to focus on more important factors, it is possible to prioritize these factors and identify key drivers, and use them in order to visualize and scenario the future of auto insurance in Iran.

The rule of passing time as one of the ways of regulating the number of lawsuits has received the attention of many legal systems. Iran’s legal system, influenced by the famous Imami jurists and due to the necessity of conforming the regulations based on Sharia standards, has considered the rule of passage of time to be obsolete according to the theory of the Guardian Council. Ambiguity in the comprehensiveness of the Guardian Council’s opinion has made the expression of views for the revalidation of the passage of time to be strengthened and its generalities accepted in specific lawsuits. Although the validity of time limit is generally considered acceptable in insurance claims under Article 36 of the Insurance Law adopted in 1316, but more than seventy years have passed since the enactment of this law and the creation of new conditions next to the topic expansion of the mechanism, requires the necessity for re-validation time limit in traffic accident insurance claims. The purpose of this research is to review the survival directions of the institution of passage of time in insurance claims and to analyze the reasons for not accepting passage of time based on the compulsory insurance law approved in 2016.

The method used in this research is descriptive-analytical, which has explained and examined the reasons of the above problem by using library sources and reading and searching in books, articles and related theoretical topics.

Although the removal of the statute of limitations for civil lawsuits from Iran’s legal system, based on the theory of the Guardian Council, has been practically recognized, the arguments for the survival of the statute of limitations in some specific lawsuits, such as insurance lawsuits, are based on the general disregard of this institution and the current legal system has made it difficult. The current research proves that: acceptance of a two- year short period of time in insurance claims challenges the idea of protecting the victim and comprehensively guaranteeing the damages caused to him in the field of traffic accidents. Therefore, unconditional protection of the victim in compulsory liability insurance does not follow this field. The broader scope of compensation in insurance rights, compared to civil liability rights, has made it difficult to determine the time of payment of damages in insurancerights, despite the lack of limitation in civil liability rights. This issue violates the principle of complete compensation in insurance rights. Also, the direct recourse of the injured party to the insurer, in addition to the basis of the contract, is an independent and legal right, which is exclusive for a short period of time, against the requirements and protective conditions of the compulsory insurance law approved in 2016. In addition, the generality of Note 2 of Article 2 and the non-restriction of Article 4 of the Compulsory Insurance Law approved in 2016 also strengthen the idea of prohibiting the time limit for filing a lawsuit against the insurer.

The guarantee of compensation for traffic accident victims and the need to compensate all losses by means of insurance makes the short period of two years to file a lawsuit unreasonable. On the other hand, the legal bases follow the necessity of not accepting the time limit for insurance claims in the field of driving, and as the contractual time limit has been considered ineffective in this area, the two-year legal time limit cannot be supported. Compulsory insurance approved in 2016, which was established according to the interests of the society and to protect the victims of traffic accidents, the basis of the insurer’s support over time, prohibits ways of compensating the vulnerability of the victim and establishes the basic and logical rights that establishes the correctness of this claim.

The insurance industry is one of the most used professions and the popularity of general insurance services is increasing. Meanwhile, insurance companies that can create better satisfaction (CX) for their policyholders will earn more profit. Research has shown that many customers are willing to pay more for better or higher quality customer service or experience. On the other hand, today the use of insurance services has become one of the most important necessities of any society and almost all citizens deal with one or more types of insurance depending on their type of work, income and social activity, but in recent years, this industry faced with many problems and one of the ways to support the industry out of problems and increase revenue, is to create a pleasant experience and reduce confusion for customers. Therefore, the purpose of this study is to provide a model of customer experience of confusion in choosing services from insurance companies.

The current research was carried out by using a qualitative method and foundational data theory (Strauss and Corbin's approach). The statistical population of this study includes managers and experts in marketing, sales, etc. of four insurance companies: Pasargad, Tejaratno, Mihan and Parsian. Using purposive sampling and conducting fifteen interviews, the researchers achieved theoretical adequacy and saturation and obtained the data they needed for analysis using triple coding. The purpose of sampling in qualitative research is to better understanding the phenomenon, so sampling in this study is purpose-based, because the purpose of qualitative research is not to generalize the findings to the community from which the sample was selected. For this purpose, the researcher used participants who were managers and experts in the insurance industry through interview tools.

After extracting the required data, the researchers presented their final model in the form of six main dimensions and twenty-seven sub-dimensions by analyzing the data and using open, axial and selective coding. Based on the findings obtained from the application of the data based strategy and in order to examine the dimensions and key components of the customer experience of confusion in choosing services from insurance companies, a total of six main dimensions were identified. The first dimension is "customer experience" and includes the quality of customer relationship, appropriate insurance information and long term relationship with the brand, satisfaction in paying premiums, discount on issuance, targeted advertising and customer trust. The second dimension is "strategy" and consists of three key components, including the variety of insurance services, brand credibility and a pleasant customer experience. The third dimension is "causal conditions", which include lack of proper needs assessment, financial dissatisfaction, failure to address customer complaints, delays in payment of damages and providing inappropriate information to the customer. The fourth dimension is the underlying conditions and includes the credibility of the insurance brand, the transparency of the insurance brand and the mental image of the insurance brand. The fifth dimension is called "consequence" and includes six components of negative publicity, changing the time of buying insurance, canceling the purchase of insurance, reducing the purchase of insurance, increasing mental involvement and making the wrong decision. Also, in this research, during the interviews with the scholores, they identified the factors that he mentioned as an intervening variable and include increasing the market share, completing the product portfolio and ease of shopping for customers.

The findings of this research showed that founded on the data-based approach and triple coding, the researcher's paradigm model consists of six components called damages, customer experience, brand reputation, confusion, online insurance sales and brand equity. What is crucial for customers and reduces confusion is the ability of insurance companies to provide the desired customer service to create a pleasant experience. To be successful and reduce confusion, an insurance company must develop in line with changing customer needs. Find markets and products and be more dynamic than competitors to meet customer needs. At the end, suggestions are provided to create a pleasant experience and reduce customer confusion.

Customer retention is always considered as the most important principle in all industries, and the insurance industry is no exception. During the recent years in the Iranian society, with the increase in the sale of life insurance policies, the retention of insurance customers has become more and more important to the managers and experts of the insurance industry so that they can keep a wide range of customers. Nowadys, creating a sense of satisfaction in life insurance customers as a management art has been noticed by insurance companies. The more customers the insurance company can keep happy, the less they worry about redemptions and exits. The main goal of this research is to implement data mining methods in predicting customer churn and identifying factors affecting customer churn in the life insurance products of one of Iran's insurance companies. The purpose of customer loss forecasting is to identify the desired class or class related to insurance policies that are suspended or canceled at the request of the policyholder before the end of the insurance coverage period.

In this paper, we have tried to classify life insurance customers based on abdication or non-withdrawal using data mining algorithms such as random forest, decision tree, logistic regression and neural network. The data used in this research include the information of life insurance policies of an insurance company in 2019 in Tehran province, which has a high and appropriate share in the portfolio of the insurance industry. To evaluate and compare these 4 methods, different criteria will be used. In the field of data mining, and in particular the problem of classification, the confusion matrix as a special tabulation makes it possible to visualize the performance of an algorithm. The confusion matrix shows how many true and false predictions have been made for each class, and based on these values, different criteria for classification evaluation and accuracy measurement can be defined.

The results of the research show that random forest, decision tree, logistic regression and neural network algorithms have high performance in predicting the class related to customer churn. Based on the results of the research, the probability of re-buying was better in women and people with high-risk jobs and older age. On the other hand, people who initially paid the insurance premium annually or chose a lower premium and a higher percentage of capital change factor and capital risk, the probability of their redemption was less.

Considering that life insurance is usually long-term and also considering the liquidity needs of customers and the current economic conditions of the society, insurance companies should pay more attention to life insurance customers. Also, they should put fidelity programs in order to keep customers on their agenda by continuously monitoring the customer's behavior during the insurance policy.

Determining the fair insurance premium and proportional to the amount of risk requires full disclosure of the facts about the risk that is insured. Most of the time, it is difficult to access such complete information, in such a situation, the use of past information, including the claimed damages, can be used as a suitable measure to identify the level of risk. In this research, by using the past years’ losses, customers are divided into two categories of low-risk and high- risk insurers, and then via applying of Lindley’s log distortion function, an appropriate insurance premium is introduced, which is called a distorted insurance premium.

In this research, in addition to statistical simulation, real damage data is used for calculations. First, by using R software, four types of distribution: Bohr, Weibull, Gamma and Pareto were simulated with approximately 10,000 data from each, and then the results of the theorems were evaluated. Then, with the help of about 35,000 observations related to losses claimed by an insurance company, the results were evaluated and analyzed in the form of a case study.

According to the claimed modeling, Burr heavy tail distribution is accepted as the final distribution. With the help of the Hill estimator and the value at risk of the 90th percentile of this distribution, the amount of the damage threshold is estimated as 19,800,000 Rials. Therefore, 10% of the insurance policyholders cause a loss of more than 19,800,000 Rials to the company every year and increase the loss factor and the basic insurance premium of all people. The classification of low-risk and high-risk people and the use of log Lindley distortion function allows, in addition to observing the principles of optimality (positive homogeneity, non-extremity, collective uniformity and non-negative overhead), the calculated insurance premium for each class is proportional to be a risk.

If low-risk and high-risk customers are not separated, the amount of insurance premium for all members of society is the same and equal to 17,012,700 Rials. This amount will be a large amount for people with low risk or people without damage, so after classifying customers and recalculating the insurance premium for low risk and high risk people, it will be calculated as 5,610,700 and 54,295,700 Rials respectively. The big difference between the insurance premiums of the two classes shows the big difference in the amount of risk. Therefore, in the end, the importance of classifying the society of insurance policyholders is an essential issue. There is no limit in using this method and when the distribution of damages is heavy, using this method can be very useful and efficien.

The extent of fraudulent use of insurance benefits is one of the basic problems of social and commercial insurances, which causes huge damage to policyholders, insured persons and society To combat this abnormality, our legislator criminalized Article 97 of the Social Security Law and Article 61 of the Third Party Insurance Law, approved in 2016, as an independent crime and imposed two punishments, imprisonment and a fine. In American law, at the federal level, fraudulent use is prosecuted under general headings such as fraud, however, some forms of fraudulent use are considered an independent crime in Article 1033, Chapter 18 of the Criminal Code. Following the latter approach, all states have criminalized all forms of fraudulently obtaining benefits as a specific offense.

The method which is used in this research is analytical and descriptive, which explains and inferred legal materials with the methods of legal and interpretive reasoning.

The research carried out is showing that there are many ambiguities in terms of the constituent elements of crime and punishment. In both penal systems, the mentoined crime is amongst the intentional crimes whose physical behavior constitutes a positive material act, with the difference that some states have exceptionally accepted the omission of the act in workers' insurance. Also, in both models, the fact that the operation is fraudulent is a condition that must precede the collection of funds and its cause; However, unlike fraud, there is no need for negligence on the part of the organization or the insurer. In terms of the element of result, American law does not consider the realization of loss or the acquisition of benefits as a condition, but in Iranian law, the crime under Article 61 is a restricted crime and the benefit of the perpetrator is a condition. However, Among the opinions, regarding the absoluteness or binding nature of the crimes under Article 97, the legal principles and interpretation, in favor of the accused, are more compatible with the theory of obligation. The penal policy of our legislator is dual and ramshackle, and legislatively, it has chosen a strict form in the third party insurance law, this duality is the product of two agents of time and different modality of insurances. In the American system, the aforementioned crimes are punishable, but with the approval of Article 15 of the Law on Reduction of Imprisonment in 2019, they are subjected to the general provisions of Article 122 and are not punished. From the point of view of formal rules of crime, fraudulent use is subject to the passage of time due to its penal nature. The crime under Article 97 is a forgivable crime and depends on the organization's complaint, but the fraudulent acquisition of third-party insurance becomes unforgivable, which is in line with the general principle of crimes.

Examining different dimensions of the issue shows that the existing penal policy is far from the ideal situation and cannot achieve the goals of the legislator. On the other hand, unlike the United States, this policy will be unilateral and to the detriment of the insured, and it will not cover the criminal behavior that companies use to defraud the insured from legal benefits. In order to fix these disadvantages, it is necessary to amend the mentioned articles and determine the punishments according to the severity and importance of the crime. In this article, the fraudulent use of insurance benefits was investigated in the light of the Iranian and American criminal systems, with a view to the approval of new laws, including the revised penal law of 2019.