CN107784590A

CN107784590A - The appraisal procedure and device of a kind of claim reserve

Info

Publication number: CN107784590A
Application number: CN201710083376.7A
Authority: CN
Inventors: 戴建云; 朱瑾; 周鹏
Original assignee: Ping An Technology Shenzhen Co Ltd
Current assignee: Ping An Technology Shenzhen Co Ltd
Priority date: 2017-02-16
Filing date: 2017-02-16
Publication date: 2018-03-09
Also published as: WO2018149397A1

Abstract

The embodiment of the invention discloses a kind of appraisal procedure of claim reserve, the influence for being easily assessed the professional standards and working experience of personnel for solving the assessment result of claim reserve, and assess the problem of efficiency is low.Present invention method includes：Obtain case to be assessed；Obtain the information of being in danger of the case to be assessed；Determine that the case to be assessed corresponds to the Claims Resolution insurance kind of declaration form according to the information of being in danger；Judge whether the Claims Resolution insurance kind belongs to medical class insurance kind；If the Claims Resolution insurance kind belongs to medical class insurance kind, the claim reserve of the case to be assessed is calculated according to the equal amount of damages of the part and the declaration form insurance kind number of packages；If the Claims Resolution insurance kind is not belonging to medical class insurance kind, protection amount of the declaration form under the Claims Resolution insurance kind is calculated, the claim reserve of the case to be assessed is calculated according to the default compensation ratio for the described insured amount and described Claims Resolution insurance kind being calculated.The embodiment of the present invention also provides a kind of apparatus for evaluating of claim reserve.

Description

The appraisal procedure and device of a kind of claim reserve

Technical field

The present invention relates to the appraisal procedure and device of financial services industry, more particularly to a kind of claim reserve.

Background technology

Claims Resolution money is the important expenditure of insurance company, and claim reserve is that for guarantee, it is such as from about paid pre- for insurance company The Claims Resolution money being likely to occur in phase, be prepared in advance an a number of base corresponding with the insurance responsibility that it is undertaken Gold, to ensure that insurance company possesses solvency corresponding with its insurance business scale.

At present, insurance company typically carries out the assessment of claim reserve by the appraiser of specialty.This make it that Claims Resolution is accurate The accuracy that standby gold the is assessed often appraiser pair closely related, different with the professional standards and working experience of appraiser Same case may draw different claim reserve assessment results, cause the assessment accuracy of claim reserve to be affected； In addition, with the business development of insurance company, increasing case needs to carry out the assessment of claim reserve, and passes through assessment Personnel are assessed, and are often difficult to improve on the premise of ensureing that claim reserve assesses accuracy rate to assess efficiency, in face of big During the case to be assessed of amount, the cost of claim reserve assessment is considerably increased.

The content of the invention

The embodiments of the invention provide a kind of appraisal procedure of claim reserve and device, can realize case to be assessed The automatic calculating of claim reserve, improve and assess accuracy rate and assessment efficiency.

A kind of appraisal procedure of claim reserve provided in an embodiment of the present invention, including：

Obtain case to be assessed；

Obtain the information of being in danger of the case to be assessed；

Determine that the case to be assessed corresponds to the Claims Resolution insurance kind of declaration form according to the information of being in danger；

Judge whether the Claims Resolution insurance kind belongs to medical class insurance kind；

If the Claims Resolution insurance kind belongs to medical class insurance kind, the equal amount of damages of default part of the Claims Resolution insurance kind, root are obtained The declaration form insurance kind number of packages being in danger of the case to be assessed is determined according to the information of being in danger, according to the equal amount of damages of the part and institute State the claim reserve that declaration form insurance kind number of packages calculates the case to be assessed；

If the Claims Resolution insurance kind is not belonging to medical class insurance kind, protection amount of the declaration form under the Claims Resolution insurance kind is calculated, The Claims Resolution that the case to be assessed is calculated according to the default compensation ratio for the described insured amount and described Claims Resolution insurance kind being calculated is accurate Standby gold.

Alternatively, the default compensation ratio is calculated by following steps：

Obtain the case-involving total sum insured of history of the Claims Resolution insurance kind in preset time period；

The history for obtaining the Claims Resolution insurance kind in the preset time period compensates total value；

Obtain the total number of packages of case application of the Claims Resolution insurance kind in the preset time period；

The case for obtaining the Claims Resolution insurance kind in the preset time period compensates total number of packages；

Obtain the total number of persons of insuring of the declaration form；

Obtain the total number of persons that is in danger of the declaration form；

The case-involving total sum insured of the history, the history are compensated into total value, the total number of packages of the case application, the case to compensate Total number of packages, insure total number of persons and the default compensation ratio computation model of total number of persons input that is in danger, obtain the Claims Resolution The default compensation ratio of insurance kind.

Alternatively, after case to be assessed is obtained, in addition to：

Obtain the current Claims Resolution stage of the case to be assessed；

After the claim reserve of the case to be assessed is calculated, the appraisal procedure of the claim reserve is also wrapped Include：

If the current Claims Resolution stage is the case to be assessed typing Claims Resolution information but does not pay the rank for compensating the amount of money Section, then the prediction Claims Resolution money of the Claims Resolution insurance kind is calculated according to the Claims Resolution computation rule of the Claims Resolution information and the declaration form；

The claim reserve and the prediction Claims Resolution money are contrasted, obtain comparing result；

The prediction Claims Resolution money is adjusted according to the comparing result, and the prediction obtained after adjustment is settled a claim Money is defined as the claim reserve of the case to be assessed.

Alternatively, the appraisal procedure of the claim reserve also includes：

If the current Claims Resolution stage is to have provided verifying the extenaions but not initiating the examination ＆ verification gold for the case to be assessed The stage of the payment of volume, it is determined that described to verify the extenaions as the claim reserve of the case to be assessed.

Alternatively, before information of being in danger according to determines that the case to be assessed corresponds to the Claims Resolution insurance kind of declaration form, also Including：

Judge whether that the case to be assessed corresponds to declaration form comprising corresponding with the information of being in danger according to the information of being in danger Claims Resolution insurance kind, and the date of being in danger of the case to be assessed meet the aging condition of the declaration form；

If so, then performing information of being in danger according to determines that the case to be assessed corresponds to the step of the Claims Resolution insurance kind of declaration form Suddenly；

If not, it is determined that the claim reserve of the case to be assessed is 0.

A kind of apparatus for evaluating of claim reserve provided in an embodiment of the present invention, including：

Case acquisition module, for obtaining case to be assessed；

Be in danger data obtaining module, for obtaining the information of being in danger of the case to be assessed；

Claims Resolution insurance kind determining module, determine that the case to be assessed corresponds to the Claims Resolution of declaration form for information of being in danger according to Insurance kind；

Judge module, for judging whether the Claims Resolution insurance kind belongs to medical class insurance kind；

Primary bank reserves computing module, if belonging to medical class insurance kind for the Claims Resolution insurance kind, obtain the Claims Resolution danger The equal amount of damages of default part of kind, the declaration form insurance kind part being in danger of the case to be assessed is determined according to the information of being in danger Number, the claim reserve of the case to be assessed is calculated according to the equal amount of damages of the part and the declaration form insurance kind number of packages；

Second line reserve computing module, if being not belonging to medical class insurance kind for the Claims Resolution insurance kind, calculate the declaration form Protection amount under the Claims Resolution insurance kind, calculated according to the default compensation ratio for the described insured amount and described Claims Resolution insurance kind being calculated The claim reserve of the case to be assessed.

Alternatively, the default compensation ratio with lower module by being calculated：

The case-involving total sum insured acquisition module of history, for obtaining the case-involving total security of history of the Claims Resolution insurance kind in preset time period Volume；

History compensates total value acquisition module, and the history for obtaining the Claims Resolution insurance kind in the preset time period is compensated total Volume；

The total number of packages acquisition module of case application, for obtaining the case application of the Claims Resolution insurance kind in the preset time period Total number of packages；

Case compensates total number of packages acquisition module, and the case for obtaining the Claims Resolution insurance kind in the preset time period is compensated Total number of packages；

Insure total number of persons acquisition module, for obtaining the total number of persons of insuring of the declaration form；

Be in danger total number of persons acquisition module, for obtaining the total number of persons that is in danger of the declaration form；

Input module, for the case-involving total sum insured of the history, the history to be compensated into total value, the total part of case application Several, described case compensates total number of packages, total number of persons and the default compensation ratio calculating mould of the total number of persons input that is in danger of insuring Type, obtain the default compensation ratio of the Claims Resolution insurance kind.

Alternatively, the apparatus for evaluating of the claim reserve also includes：

Claims Resolution stage acquisition module, for obtaining the current Claims Resolution stage of the case to be assessed；

Prediction Claims Resolution money computing module, if being the case to be assessed typing Claims Resolution letter for the current Claims Resolution stage Breath but the stage for not paying the compensation amount of money, then according to calculating the Claims Resolution computation rule of the Claims Resolution information and the declaration form The prediction Claims Resolution money for insurance kind of settling a claim；

Contrast module, for the claim reserve and the prediction Claims Resolution money to be contrasted, obtain comparing result；

Adjusting module, for being adjusted according to the comparing result to the prediction Claims Resolution money, and it will be obtained after adjustment Prediction Claims Resolution money be defined as the claim reserve of the case to be assessed.

First determining module, if for the current Claims Resolution stage be provided the case to be assessed verify the extenaions but The stage of the payment to verify the extenaions is not initiated, it is determined that described to verify the extenaions as the Claims Resolution preparation of the case to be assessed Gold.

Condition judgment module, for according to described in be in danger information judge whether the case to be assessed correspond to declaration form comprising with The Claims Resolution insurance kind corresponding to information of being in danger, and the date of being in danger of the case to be assessed meet the aging condition of the declaration form；

Trigger module, if the judged result for the condition judgment module is yes, triggers the Claims Resolution insurance kind and determine Module；

Second determining module, if the judged result for the condition judgment module is no, it is determined that the case to be assessed The claim reserve of part is 0.

As can be seen from the above technical solutions, the embodiment of the present invention has advantages below：

In the embodiment of the present invention, first, case to be assessed is obtained；Then, the information of being in danger of the case to be assessed is obtained； Determine that the case to be assessed corresponds to the Claims Resolution insurance kind of declaration form according to the information of being in danger；Next, it is determined that the Claims Resolution insurance kind is It is no to belong to medical class insurance kind；If the Claims Resolution insurance kind belongs to medical class insurance kind, the default part for obtaining the Claims Resolution insurance kind is equal Amount of damages, the declaration form insurance kind number of packages being in danger of the case to be assessed is determined according to the information of being in danger, it is equal according to the part Amount of damages and the declaration form insurance kind number of packages calculate the claim reserve of the case to be assessed；If the Claims Resolution insurance kind is not belonging to cure Class insurance kind is treated, then protection amount of the declaration form under the Claims Resolution insurance kind is calculated, according to the described insured amount and described reason being calculated The default compensation ratio for paying for insurance kind calculates the claim reserve of the case to be assessed.In embodiments of the present invention, it is possible to achieve The automatic calculating of the claim reserve of case to be assessed, the assessment result for avoiding claim reserve are assessed the specialty of personnel Horizontal and working experience influence, improves and assesses accuracy rate；And the assessment efficiency of claim reserve is greatly improved, in face of big During the case to be assessed of amount, reduce the cost of claim reserve assessment.

Brief description of the drawings

Fig. 1 is a kind of first embodiment flow chart of appraisal procedure of claim reserve in the embodiment of the present invention；

Fig. 2 is a kind of calculation procedure flow of the equal amount of damages of part of appraisal procedure of claim reserve in the embodiment of the present invention Schematic diagram；

Fig. 3 is a kind of calculation procedure stream of the default compensation ratio of appraisal procedure of claim reserve in the embodiment of the present invention Journey schematic diagram；

Fig. 4 is a kind of second embodiment flow chart of appraisal procedure of claim reserve in the embodiment of the present invention；

Fig. 5 is a kind of first example structure figure of apparatus for evaluating of claim reserve in the embodiment of the present invention；

Fig. 6 is a kind of second example structure figure of apparatus for evaluating of claim reserve in the embodiment of the present invention；

Fig. 7 is a kind of the 3rd example structure figure of the apparatus for evaluating of claim reserve in the embodiment of the present invention.

Embodiment

The embodiments of the invention provide a kind of appraisal procedure of claim reserve and device, for solving claim reserve Assessment result is easily assessed the influence of the professional standards and working experience of personnel, and assesses the problem of efficiency is low.

To enable goal of the invention, feature, the advantage of the present invention more obvious and understandable, below in conjunction with the present invention Accompanying drawing in embodiment, the technical scheme in the embodiment of the present invention is clearly and completely described, it is clear that disclosed below Embodiment be only part of the embodiment of the present invention, and not all embodiment.Based on the embodiment in the present invention, this area All other embodiment that those of ordinary skill is obtained under the premise of creative work is not made, belongs to protection of the present invention Scope.

Referring to Fig. 1, a kind of appraisal procedure one embodiment of claim reserve includes in the embodiment of the present invention：

101st, case to be assessed is obtained；

In the present embodiment, it is possible, firstly, to obtain case to be assessed.The case to be assessed can be insurance production to be assessed Product or Claims Resolution application to be assessed.

102nd, the information of being in danger of the case to be assessed is obtained；

After case to be assessed is obtained, the information of being in danger of the case to be assessed can be obtained.The information of being in danger is Refer to the information for the situation of being in danger for recording the case to be assessed, it can be by the applicant's typing for the application that proposes to settle a claim, can also be by The staff of insurance company submits or typing.

103rd, information of being in danger according to determines that the case to be assessed corresponds to the Claims Resolution insurance kind of declaration form；

After the information of being in danger of the case to be assessed is obtained, it can be determined according to the information of being in danger described to be assessed Case corresponds to the Claims Resolution insurance kind of declaration form.

It is understood that case to be assessed can correspond to more parts of declaration forms, and there may be multiple insurance kinds on every part of declaration form, example Such as disabled danger, serious illness insurance, danger of dieing, medical insurance.Therefore, a case to be assessed can determine one according to information of being in danger Individual, two or more Claims Resolution insurance kinds.

In general, under with a declaration form, each insurance kind can be ordered as successively according to significance level：Die danger, weight disease Danger, disabled danger and medical insurance.According to be in danger information determine Claims Resolution insurance kind when, should prioritizing selection portion declaration form about fix it is important The higher Claims Resolution insurance kind of degree.For example, it is assumed that this is in danger, information can match danger of dieing, then will not select with a declaration form Serious illness insurance, disabled danger or medical insurance.

Therefore, determining that the case to be assessed corresponds to the specific steps of the Claims Resolution insurance kind of declaration form according to the information of being in danger can With including：

First judge whether that the case to be assessed corresponds to declaration form and includes danger of dieing corresponding with the information of being in danger, and it is described The date of being in danger of case to be assessed meets on dangerous aging condition of dieing in the declaration form, if so, can then determine the Claims Resolution Insurance kind is danger of dieing, and claim reserve assessment is carried out according to the case for dieing dangerous, if it is not, then performing next step；

Judge whether that the case to be assessed corresponds to declaration form and includes serious illness insurance corresponding with the information of being in danger again, and it is described The date of being in danger of case to be assessed meets the aging condition in the declaration form on serious illness insurance, if so, can then determine the Claims Resolution Insurance kind is serious illness insurance, claim reserve assessment is carried out according to the case of serious illness insurance, if it is not, then performing next step；

Judge whether that the case to be assessed corresponds to declaration form and includes disabled danger corresponding with the information of being in danger again, and it is described The date of being in danger of case to be assessed meets the aging condition on disabled danger in the declaration form, if so, can then determine the Claims Resolution Insurance kind is disabled danger, claim reserve assessment is carried out according to the case of disabled danger, if it is not, then performing next step；

Judge whether that the case to be assessed corresponds to declaration form and includes medical insurance corresponding with the information of being in danger again, and it is described The date of being in danger of case to be assessed meets the aging condition in the declaration form on medical insurance, if so, can then determine the Claims Resolution Insurance kind is medical insurance, claim reserve assessment is carried out according to the case of medical insurance, if it is not, can then determine the case to be assessed Not comprising suitable Claims Resolution insurance kind in corresponding declaration form, therefore application of settling a claim is unqualified, can directly determine the case to be assessed Claim reserve be 0.

104th, judge whether the Claims Resolution insurance kind belongs to medical class insurance kind, if so, step 105 is then performed, if it is not, then performing Step 108；

After information of being in danger according to determines that the case to be assessed corresponds to the Claims Resolution insurance kind of declaration form, it can be determined that institute State whether Claims Resolution insurance kind belongs to medical class insurance kind, if so, step 105 is then performed, if it is not, then performing step 108.

It is understood that in the present embodiment, because the claim reserve of medical class insurance kind and non-medical class insurance kind is commented The method of estimating differs, it is therefore desirable to which the Claims Resolution insurance kind for first judging to determine belongs to medical class insurance kind or non-medical class insurance kind.

Above-mentioned medical class insurance kind can be medical insurance, and above-mentioned non-medical class insurance kind can include die danger, serious illness insurance and residual Disease danger.

105th, the equal amount of damages of default part of the Claims Resolution insurance kind is obtained；

If the Claims Resolution insurance kind belongs to medical class insurance kind, the default part that can obtain the Claims Resolution insurance kind is paid an indemnity Volume.It is understood that because the Claims Resolution money of medical class insurance kind is needed depending on specific medical expense, even identical For declaration form in the case where identical is in danger information, its medical expense for needing to compensate is also likely to difference.Therefore it is adapted to pay an indemnity using part Volume is assessed the claim reserve of medical class insurance kind.

Further, as shown in Fig. 2 the equal amount of damages of the part can be obtained by following steps：

201st, the history case sum of the Claims Resolution insurance kind in default first time period is obtained；

202nd, the history for obtaining the Claims Resolution insurance kind in the default first time period compensates total amount；

203rd, the part that the total amount calculating Claims Resolution insurance kind is compensated according to the total and described history of the history case is paid for Amount of money.

In above-mentioned default first time period, can be in nearly 1 year each month as a period.For example, can be with The total and corresponding history of history case for counting each month medical treatment class insurance kind in nearly 1 year respectively compensates total amount.For example, The history case sum in statistics one middle of the month of last Jul is B, and it is A that history, which compensates total amount, then the part of last Jul is paid for Amount of money is A/B.

In the present embodiment, for the data that the equal amount of damages of part is too high or too low, the data detail of correlation can also be carried Give staff to be examined, do not intervened if verification is errorless；If verification is wrong, manual correction exception number can be passed through According to the accurate and effective of the equal amount of damages of warranty element, so as to improve the accuracy of claim reserve assessment.

106th, information of being in danger according to determines the declaration form insurance kind number of packages being in danger of the case to be assessed；

, can be according to determining the information of being in danger after the equal amount of damages of default part of the Claims Resolution insurance kind is obtained The declaration form insurance kind number of packages being in danger of case to be assessed.From the content described in above-mentioned steps 103, a case to be assessed It can determine one, two or more Claims Resolution insurance kinds according to information of being in danger, therefore its declaration form insurance kind number of packages that can be in danger And have one, it is two or more.

107th, the Claims Resolution that the case to be assessed is calculated according to the equal amount of damages of the part and the declaration form insurance kind number of packages prepares Gold；

, can be according to the equal amount of damages of the part and institute after the equal amount of damages of the part and the declaration form insurance kind number of packages is obtained State the claim reserve that declaration form insurance kind number of packages calculates the case to be assessed.The claim reserve can pay an indemnity equal to the part The product of volume and the declaration form insurance kind number of packages.

Further, because for same insurance company, identical malpractice insurance is typically only once compensated, and If when multiple declaration form insurance kinds in the case to be assessed be present and including same malpractice insurance, it is likely to occur and computes repeatedly part.Cause This, can also obtain and compensate responsibility number cnt_liab, different declaration form insurance kinds under each declaration form insurance kind of the case to be assessed Quantity cnt_liab_sub comprising same responsibility, it is assumed that the equal amount of damages of part of this area is medi_r, and declaration form insurance kind number of packages is Cnt_pol, then the Reserve Fund of each each responsibility of declaration form insurance kind is medi_r/ (cnt_pol*cnt_liab*cnt_liab_ sub).Finally, the claim reserve that can obtain the case to be assessed is sum (medi_r/ (cnt_pol*cnt_liab*cnt_ Liab_sub)), sum is summing function, namely after the Reserve Fund of each responsibility is calculated, the responsible Reserve Fund of institute it With the claim reserve equal to the case to be assessed.

108th, protection amount of the declaration form under the Claims Resolution insurance kind is calculated；

If the Claims Resolution insurance kind is not belonging to medical class insurance kind, guarantor of the declaration form under the Claims Resolution insurance kind can be calculated Volume.It is understood that the protection amount of the Claims Resolution insurance kind can be calculated according to the agreement of the declaration form.For example, Claims Resolution insurance kind is Die danger, premium is annual 10000, and insurant dies in 20 years, can disposably compensate 500,000, and this 500,000 are the body Therefore the protection amount of danger.Specific insured amount calculating can be found from the contract engagement of declaration form, and here is omitted.

109th, calculated according to the default compensation ratio for the described insured amount and described Claims Resolution insurance kind being calculated described to be assessed The claim reserve of case.

After the protection amount of the declaration form under the Claims Resolution insurance kind is calculated, can according to be calculated described insured amount and The default compensation ratio of the Claims Resolution insurance kind calculates the claim reserve of the case to be assessed.The default compensation ratio can be pre- First calculate or count according to historical data and obtain, it is to be understood that the compensation ratio of difference Claims Resolution insurance kind typically differs, example There is respective default compensation ratio such as die danger, serious illness insurance and disabled danger.

In the present embodiment, if the Claims Resolution insurance kind is non-medical class insurance kind, the claim reserve of the case to be assessed can be with Equal to the insured amount product with the default compensation ratio.

Further, as shown in figure 3, the default compensation ratio can be calculated by following steps：

301st, the case-involving total sum insured of history of the Claims Resolution insurance kind in preset time period is obtained；

302nd, the history for obtaining the Claims Resolution insurance kind in the preset time period compensates total value；

303rd, the total number of packages of case application of the Claims Resolution insurance kind in the preset time period is obtained；

304th, the case for obtaining the Claims Resolution insurance kind in the preset time period compensates total number of packages；

305th, the total number of persons of insuring of the declaration form is obtained；

306th, the total number of persons that is in danger of the declaration form is obtained；

307th, the case-involving total sum insured of the history, the history are compensated into total value, the total number of packages of the case application, the case Total number of packages, insure total number of persons and the default compensation ratio computation model of total number of persons input that is in danger are compensated, is obtained described The default compensation ratio for insurance kind of settling a claim.

For above-mentioned steps 301~304, in above-mentioned preset time period, can be in nearly 1 year each month as one The individual period.For example, the case-involving total sum insured of history of the non-medical class insurance kind of each month in nearly 1 year can be counted respectively, described is gone through History compensates total value, the total number of packages of the case application and the case and compensates total number of packages.Wherein, the case-involving total sum insured of above-mentioned history refers to It is related to the total sum insured for compensating case under the Claims Resolution insurance kind, is set to A；Above-mentioned history compensates total value and refers to be related under the Claims Resolution insurance kind Total compensation money of the final compensation of case is compensated, is set to B；The above-mentioned total number of packages of case application refers to be managed under the Claims Resolution insurance kind The total number of packages of case of application is paid for, or can consider the total number of packages for being determined as case to be assessed, is set to C；And above-mentioned case is paid for Total caseload that total number of packages refers to finally be compensated on the basis of case application is paid, is set to D.

For above-mentioned steps 305, above-mentioned total number of persons of insuring refers to that the case to be assessed of this in the present embodiment corresponds to the total of declaration form Number of insuring, be set to E.

For above-mentioned steps 306, the above-mentioned total number of persons that is in danger refers to that the case to be assessed of this in the present embodiment corresponds to the total of declaration form Number of being in danger, be set to F.

For above-mentioned steps 307, the default compensation ratio computation model can specifically include：

If meet F/E>2*D/C, then default compensation ratio=(B/A) * (D/C+ (F/E-D/C)/2)；

If meet D/C>2F/E, then default compensation ratio=(B/A) * (D/C- (D/C-F/E)/2)；

If the above situation is unsatisfactory for, default compensation ratio=(B/A) * (D/C).

In the present embodiment, the data too high or too low for presetting compensation ratio can also be detailed by the data of correlation Submit to staff to be examined, do not intervened if verification is errorless；If verification is wrong, manual correction exception number can be passed through According to ensure the accurate and effective of default compensation ratio, so as to improve the accuracy of claim reserve assessment.

In addition, the default payout ratio of the default compensation ratio, then 1 year of the Claims Resolution insurance kind for calculating multiple months Example can take the average of the default compensation ratio in multiple months.

In the present embodiment, corresponding with default compensation ratio is to preset to refuse to pay ratio, in general, default to refuse to pay ratio =1- presets compensation ratio, therefore the above-mentioned default compensation ratio used in systems can also be in the form of presetting and refuse to pay ratio Stored record.

It should be noted that above-mentioned steps 301~307 are applied to die danger, serious illness insurance and disabled dangerous default payout ratio The calculating of example.Wherein, further, when calculating the default compensation ratio of disabled danger, history specifically can also be compensated into total value B It is subdivided into the history comprising disabled ratio and compensates total value B1 and the history compensation total value B2 not comprising disabled ratio.Above-mentioned " bag Containing disabled ratio " refer to whether the statistics of history compensation total value considers disabled ratio as factor.

Therefore, similarly, estimating the default compensation ratio of the deformity danger of disabled ratio includes：

If meet F/E>2*D/C, then default compensation ratio=(B1/A) * (D/C+ (F/E-D/C)/2)；

If meet D/C>2F/E, then default compensation ratio=(B1/A) * (D/C- (D/C-F/E)/2)；

If the above situation is unsatisfactory for, default compensation ratio=(B1/A) * (D/C).

And the default compensation ratio for estimating the deformity danger of no disabled ratio includes：

If meet F/E>2*D/C, then default compensation ratio=(B2/A) * (D/C+ (F/E-D/C)/2)；

If meet D/C>2F/E, then default compensation ratio=(B2/A) * (D/C- (D/C-F/E)/2)；

If the above situation is unsatisfactory for, default compensation ratio=(B2/A) * (D/C).

In the present embodiment, first, case to be assessed is obtained；Then, the information of being in danger of the case to be assessed is obtained；According to The information of being in danger determines that the case to be assessed corresponds to the Claims Resolution insurance kind of declaration form；Next, it is determined that whether the Claims Resolution insurance kind belongs to In medical class insurance kind；If the Claims Resolution insurance kind belongs to medical class insurance kind, the default part for obtaining the Claims Resolution insurance kind is paid an indemnity Volume, the declaration form insurance kind number of packages being in danger of the case to be assessed is determined according to the information of being in danger, is paid an indemnity according to the part Volume and the declaration form insurance kind number of packages calculate the claim reserve of the case to be assessed；If the Claims Resolution insurance kind is not belonging to medical class Insurance kind, then protection amount of the declaration form under the Claims Resolution insurance kind is calculated, according to the described insured amount and described Claims Resolution danger being calculated The default compensation ratio of kind calculates the claim reserve of the case to be assessed.In the present embodiment, it is possible to achieve case to be assessed The automatic calculating of the claim reserve of part, avoid claim reserve assessment result be assessed personnel professional standards and from The influence of industry experience, improve and assess accuracy rate；And the assessment efficiency of claim reserve is greatly improved, in face of substantial amounts of to be evaluated When estimating case, reduce the cost of claim reserve assessment.

For ease of understanding, a kind of appraisal procedure of claim reserve in the present invention will be carried out more from another point of view below Detailed description, referring to Fig. 4, a kind of second embodiment of appraisal procedure of claim reserve includes in present invention implementation：

401st, case to be assessed is obtained；

402nd, the information of being in danger of the case to be assessed is obtained；

403rd, information of being in danger according to determines that the case to be assessed corresponds to the Claims Resolution insurance kind of declaration form；

Therefore, before information of being in danger according to determines that the case to be assessed corresponds to the Claims Resolution insurance kind of declaration form, may be used also With including：Judge whether that the case to be assessed corresponds to declaration form comprising corresponding with the information of being in danger according to the information of being in danger Settle a claim insurance kind, and the date of being in danger of the case to be assessed meet the aging condition of the declaration form, if so, then perform according to described in Information of being in danger determines the step of case to be assessed corresponds to the Claims Resolution insurance kind of declaration form, if not, it is determined that the case to be assessed Claim reserve be 0.

If in view of the differentiation of the significance level between danger of dieing, serious illness insurance, disabled danger and medical insurance, can also specifically wrap Include process step in detail below：

404th, judge whether the Claims Resolution insurance kind belongs to medical class insurance kind, if so, step 405 is then performed, if it is not, then performing Step 408；

After information of being in danger according to determines that the case to be assessed corresponds to the Claims Resolution insurance kind of declaration form, it can be determined that institute State whether Claims Resolution insurance kind belongs to medical class insurance kind, if so, step 405 is then performed, if it is not, then performing step 408.

405th, the equal amount of damages of default part of the Claims Resolution insurance kind is obtained；

406th, information of being in danger according to determines the declaration form insurance kind number of packages being in danger of the case to be assessed；

, can be according to determining the information of being in danger after the equal amount of damages of default part of the Claims Resolution insurance kind is obtained The declaration form insurance kind number of packages being in danger of case to be assessed.From the content described in above-mentioned steps 403, a case to be assessed It can determine one, two or more Claims Resolution insurance kinds according to information of being in danger, therefore its declaration form insurance kind number of packages that can be in danger And have one, it is two or more.

407th, the Claims Resolution that the case to be assessed is calculated according to the equal amount of damages of the part and the declaration form insurance kind number of packages prepares Gold；

408th, protection amount of the declaration form under the Claims Resolution insurance kind is calculated；

409th, calculated according to the default compensation ratio for the described insured amount and described Claims Resolution insurance kind being calculated described to be assessed The claim reserve of case；

If meet D/C>2F/E, then default compensation ratio=(B/A) * (D/C- (D/C-F/E)/2)；

410th, the current Claims Resolution stage of the case to be assessed is obtained；

After the case to be assessed is obtained, the current Claims Resolution stage of the case to be assessed can be obtained.It can manage Solution, current Claims Resolution stage refer to the stage that is presently in of the case application Claims Resolution to be assessed, such as can include described treat Assess case typing Claims Resolution information but do not pay the stage of the amount of money of compensating, provided the case to be assessed verify the extenaions but Described stage of payment to verify the extenaions, etc. is not initiated.

If the 411st, the current Claims Resolution stage is the case to be assessed typing Claims Resolution information but does not pay the compensation amount of money Stage, then according to it is described Claims Resolution information and the declaration form Claims Resolution computation rule calculate it is described Claims Resolution insurance kind prediction Claims Resolution Money；

If the current Claims Resolution stage is the case to be assessed typing Claims Resolution information but does not pay the rank for compensating the amount of money Section, the then prediction that the Claims Resolution insurance kind can be calculated according to the Claims Resolution computation rule of the Claims Resolution information and the declaration form are settled a claim Money.

Above-mentioned " information of typing Claims Resolution " refers to information typing of settling a claim, you can be calculated according to specific Claims Resolution information The Claims Resolution money of the case to be assessed；And above-mentioned " do not pay and compensate the amount of money " although the money that refers to settling a claim can calculate, Do not determine and audit the compensation money for showing that insurance company compensates finally.Therefore, can be with according to the Claims Resolution computation rule of the declaration form Calculate the prediction Claims Resolution money of the Claims Resolution insurance kind.The Claims Resolution computation rule is typically made an appointment in declaration form.

412nd, the claim reserve and the prediction Claims Resolution money are contrasted, obtains comparing result；

413rd, the prediction Claims Resolution money is adjusted according to the comparing result, and the prediction that will be obtained after adjustment Claims Resolution money is defined as the claim reserve of the case to be assessed；

For above-mentioned steps 412 and 413, because the claim reserve being calculated and the prediction Claims Resolution money are to be evaluated to this The assessment for estimating the claim reserve of case is respectively provided with reference value, therefore first can be contrasted both, then according to contrast As a result it is adjusted, to improve the assessment accuracy of claim reserve.

If claim reserve is unset_amt, prediction Claims Resolution money be do_amt, and specific contrast and set-up procedure can be as Under：

If meet do_amt>2*unset_amt, then finally adjust obtained claim reserve final_amt=do_amt- (do_amt-unset_amt)/2；

If meet unset_amt>2*do_amt, then finally adjust obtained claim reserve final_amt=do_amt+ (unset_amt-do_amt)/2；

If the above situation is unsatisfactory for, obtained claim reserve final_amt=do_amt is finally adjusted.

Final claim reserve is obtained by the adjustment for money of being settled a claim to prediction so that the assessment result of claim reserve is more Accurately.

If the 414th, the current Claims Resolution stage is to have provided verifying the extenaions but not initiating described careful for the case to be assessed The stage of the payment of the core amount of money, it is determined that described to verify the extenaions as the claim reserve of the case to be assessed.

If the current Claims Resolution stage is to have provided verifying the extenaions but not initiating the examination ＆ verification gold for the case to be assessed The stage of the payment of volume, then can directly determine described in verify the extenaions as the claim reserve of the case to be assessed.

It is understood that in the case where verifying the extenaions and having provided, illustrate that the amount for which loss settled of the case to be assessed (is equal to Verify the extenaions) it has been determined that do not carry out the payment of amount for which loss settled under the stage yet simply, therefore can directly determine that this verifies the extenaions For the claim reserve of case to be assessed.

Further, in the present embodiment, after determining or calculating the claim reserve of case to be assessed, may be used also To carry out the verification of accuracy to the claim reserve of various product.Accuracy verification can be carried out from three dimensions, respectively For the total throughout of general comment appraisal, the evaluation quantity of each product category and assessment case.It will simply introduce three dimensions below The step of accuracy verifies：

General comment is estimated：

Data below is obtained from database first：This month assess case load allCnt, of that month overall evaluation amount of money allAmt, Assess last month case load allCntOld, overall evaluation amount of money allAmtOld last month, last year it is of that month assess case load allCntLast, This month last year overall evaluation amount of money allAmtLast, last month last year assess case load allCntOldLast and general comment last month last year Estimate amount of money allAmtOldLast.

Then, according to the above-mentioned data got, judge that general comment is estimated with the presence or absence of situation about increasing sharply, if in the presence of, for The data specifically increased sharply are examined, and are specifically included：

(if allAmtall-allAmtOld)>The growth threshold values * (allAmtallLast-allAmtOldLast) of setting, Then judge whether allCnt-allCntOld is more than case and increases threshold values * (allCntLast-allCntOldLast), if greatly In, then analyze surge case residing for link.If analysis find some area of some link there is a situation where it is suspicious explode, need Turn relative region verification.If examining discovery has problem, need to carry out relevant treatment adjustment, re-start school after the completion of adjustment again Test.Wherein, during analysis, the Reserve Fund that can capture the case declaration form insurance kind of larger Reserves (specifically captures The larger case load and larger preparation gold number control that data volume is configured), then examine the calculating process factor for causing super large value. In whole checking procedure, processing is adjusted if being related to insured amount problem Ze Xu reinsurances company and being responsible for the personnel that core is protected, is adjusted It is whole complete to re-start verification again；If being related to plus-minus guarantor's problem, the personnel that Ze Xu reinsurances company is responsible for saving from damage are adjusted place Reason, has adjusted and has re-started verification again；If being related to Claims Resolution typing accepts problem, Ze Xu reinsurances company is responsible for the personnel of Claims Resolution Processing is adjusted, has adjusted and has re-started verification again.

In addition, if crawl is repeatedly evaluated the case of Reserve Fund, and of that month increasing value is more than the growth threshold values of setting, then The factor for this time causing change to occur need to be analyzed, the reason for then analyzing " core is protected, saves from damage, settled a claim " again, has analyzed and has carried out phase again Pass is handled, and subsequently re-starts verification again.

On the other hand, according to the above-mentioned data got, it can also judge that the situation with the presence or absence of bust is estimated in general comment, if In the presence of being examined, specifically included for the data of specific bust：

(if allAmtall-allAmtOld)<The growth threshold values * (allAmtallLast- of setting AllAmtOldLast), then judge whether allCnt-allCntOld is less than case and increases threshold values * (allCntLast- AllCntOldLast), if it is less, analyzing the link residing for bust case, some area is deposited if analysis finds some link In the situation of suspicious bust, then need to turn relative region verification.If examining discovery has problem, need to carry out relevant treatment adjustment, Verification is re-started after the completion of adjustment again.

In addition, if crawl is repeatedly evaluated the case of Reserve Fund, and of that month reduced value is more than the reduction threshold values of setting, then The factor for this time causing change to occur need to be analyzed, the reason for then analyzing " core is protected, saves from damage, settled a claim " again, has analyzed and has carried out phase again Pass is handled, and subsequently re-starts verification again.

The evaluation quantity of each product category：

Calculate the value for assessing case load and claim reserve of this month, the assessment case of last month respectively according to different product major class The value of part amount and claim reserve, the product category to differ greatly is extracted after contrast and analyzed, analysis wherein which Product category undergos mutation, which the mechanism mutation, whether concentrate some declaration forms situations such as, then again sends out analysis result data The specified post for giving designated area and/or general headquarters is examined, as found to need to adjust after examining, then after the completion of adjustment again Re-start verification.

Assess the total throughout of case：

Data below is obtained from database first：Assess case load cnt_old last month, last month assesses this month and wound up the case cnt_ Old_end, of that month input cnt_new, of that month input and assessment cnt_new_reck, this month amount of winding up the case cnt_new_end.Then The data got are put into following equatioies to be verified：

Cnt_new_reck=cnt_old-cnt_old_end+cnt_new-cnt_new_end

Generally, the equation should be identical that if finding, equation is invalid, and difference detailed data is extracted Come, give each area and analyzed and processed.

Furthermore it is also possible to be verified for the detail of case, following situation is specifically included：

If case carries out last month and of that month assessment simultaneously, and case process does not change, but of that month assessment gold Volume and the assessment amount of money of last month are inconsistent, then need to pick out detailed data, give each area and are analyzed and processed；

If case carries out the assessment of last month, and case process does not change, but carries out of that month assessment, then needing will be bright Count accurately according to picking out, give each area and analyzed and processed；

If case carries out last month and of that month assessment simultaneously, and case process does not change, but of that month assessment production Category is not inconsistent with the assessment product category of last month, then needs to pick out detailed data, gives each area and is analyzed Processing.

A kind of appraisal procedure of claim reserve is essentially described above, a kind of assessment of claim reserve will be filled below Put and be described in detail.

Fig. 5 shows a kind of first example structure figure of apparatus for evaluating of claim reserve in the embodiment of the present invention.

In the present embodiment, a kind of apparatus for evaluating of claim reserve includes：

Case acquisition module 501, for obtaining case to be assessed；

Be in danger data obtaining module 502, for obtaining the information of being in danger of the case to be assessed；

Insurance kind of settling a claim determining module 503, determine that the case to be assessed corresponds to declaration form for information of being in danger according to Claims Resolution insurance kind；

Judge module 504, for judging whether the Claims Resolution insurance kind belongs to medical class insurance kind；

Primary bank reserves computing module 505, if belonging to medical class insurance kind for the Claims Resolution insurance kind, obtain the Claims Resolution The equal amount of damages of default part of insurance kind, the declaration form insurance kind part being in danger of the case to be assessed is determined according to the information of being in danger Number, the claim reserve of the case to be assessed is calculated according to the equal amount of damages of the part and the declaration form insurance kind number of packages；

Second line reserve computing module 506, if being not belonging to medical class insurance kind for the Claims Resolution insurance kind, calculate the guarantor The singly protection amount under the Claims Resolution insurance kind, according to the default compensation ratio meter for the described insured amount and described Claims Resolution insurance kind being calculated Calculate the claim reserve of the case to be assessed.

Fig. 6 shows a kind of second example structure figure of apparatus for evaluating of claim reserve in the embodiment of the present invention.

As shown in fig. 6, further, the default compensation ratio can be by being calculated with lower module：

The case-involving total sum insured acquisition module 507 of history, the history for obtaining the Claims Resolution insurance kind in preset time period are case-involving Total sum insured；

History compensates total value acquisition module 508, and the history for obtaining the Claims Resolution insurance kind in the preset time period is paid for Pay total value；

The total number of packages acquisition module 509 of case application, for obtaining the case of the Claims Resolution insurance kind in the preset time period Apply for total number of packages；

Case compensates total number of packages acquisition module 510, for obtaining the case of the Claims Resolution insurance kind in the preset time period Compensate total number of packages；

Insure total number of persons acquisition module 511, for obtaining the total number of persons of insuring of the declaration form；

Be in danger total number of persons acquisition module 512, for obtaining the total number of persons that is in danger of the declaration form；

Input module 513, for the case-involving total sum insured of the history, history compensation total value, the case application is total Number of packages, the case compensate total number of packages, insure total number of persons and the default compensation ratio calculating of the total number of persons input that is in danger Model, obtain the default compensation ratio of the Claims Resolution insurance kind.

Fig. 7 shows a kind of the 3rd example structure figure of the apparatus for evaluating of claim reserve in the embodiment of the present invention.

As shown in fig. 7, further, the apparatus for evaluating of the claim reserve can also include：

Claims Resolution stage acquisition module 514, for obtaining the current Claims Resolution stage of the case to be assessed；

Prediction Claims Resolution money computing module 515, if being managed for the current Claims Resolution stage for the case to be assessed typing Pay for information but do not pay the stage for compensating the amount of money, then calculated according to the Claims Resolution computation rule of the Claims Resolution information and the declaration form The prediction Claims Resolution money of the Claims Resolution insurance kind；

Contrast module 516, for the claim reserve and the prediction Claims Resolution money to be contrasted, obtain contrast knot Fruit；

Adjusting module 517, for being adjusted according to the comparing result to the prediction Claims Resolution money, and it will be obtained after adjustment To prediction Claims Resolution money be defined as the claim reserve of the case to be assessed.

Further, the apparatus for evaluating of the claim reserve can also include：

First determining module 518, if golden to have provided the examination ＆ verification of the case to be assessed for the current Claims Resolution stage Volume but the stage for not initiating the payment to verify the extenaions, it is determined that described to verify the extenaions as the Claims Resolution standard of the case to be assessed Standby gold.

Further, the apparatus for evaluating of the claim reserve can also include：

Condition judgment module 519, judge whether that the case to be assessed corresponds to declaration form bag for information of being in danger according to Containing insurance kind of settling a claim corresponding with the information of being in danger, and the date of being in danger of the case to be assessed meets the timeliness bar of the declaration form Part；

Trigger module 520, if the judged result for the condition judgment module 519 is yes, trigger the Claims Resolution danger Kind determining module；

Second determining module 521, if the judged result for the condition judgment module 519 is no, it is determined that described to treat The claim reserve for assessing case is 0.

It is apparent to those skilled in the art that for convenience and simplicity of description, the system of foregoing description, The specific work process of device and unit, the corresponding process in preceding method embodiment is may be referred to, will not be repeated here.

In several embodiments provided herein, it should be understood that disclosed system, apparatus and method can be with Realize by another way.For example, device embodiment described above is only schematical, for example, the unit Division, only a kind of division of logic function, can there is other dividing mode, such as multiple units or component when actually realizing Another system can be combined or be desirably integrated into, or some features can be ignored, or do not perform.It is another, it is shown or The mutual coupling discussed or direct-coupling or communication connection can be the indirect couplings by some interfaces, device or unit Close or communicate to connect, can be electrical, mechanical or other forms.

The unit illustrated as separating component can be or may not be physically separate, show as unit The part shown can be or may not be physical location, you can with positioned at a place, or can also be distributed to multiple On NE.Some or all of unit therein can be selected to realize the mesh of this embodiment scheme according to the actual needs 's.

In addition, each functional unit in each embodiment of the present invention can be integrated in a processing unit, can also That unit is individually physically present, can also two or more units it is integrated in a unit.Above-mentioned integrated list Member can both be realized in the form of hardware, can also be realized in the form of SFU software functional unit.

If the integrated unit is realized in the form of SFU software functional unit and is used as independent production marketing or use When, it can be stored in a computer read/write memory medium.Based on such understanding, technical scheme is substantially The part to be contributed in other words to prior art or all or part of the technical scheme can be in the form of software products Embody, the computer software product is stored in a storage medium, including some instructions are causing a computer Equipment (can be personal computer, server, or network equipment etc.) performs the complete of each embodiment methods described of the present invention Portion or part steps.And foregoing storage medium includes：USB flash disk, mobile hard disk, read-only storage (ROM, Read-Only Memory), random access memory (RAM, Random Access Memory), magnetic disc or CD etc. are various can store journey The medium of sequence code.

Described above, the above embodiments are merely illustrative of the technical solutions of the present invention, rather than its limitations；Although with reference to before Embodiment is stated the present invention is described in detail, it will be understood by those within the art that：It still can be to preceding State the technical scheme described in each embodiment to modify, or equivalent substitution is carried out to which part technical characteristic；And these Modification is replaced, and the essence of appropriate technical solution is departed from the spirit and scope of various embodiments of the present invention technical scheme.

Claims

A kind of 1. appraisal procedure of claim reserve, it is characterised in that including：

Obtain case to be assessed；

Obtain the information of being in danger of the case to be assessed；

Determine that the case to be assessed corresponds to the Claims Resolution insurance kind of declaration form according to the information of being in danger；

Judge whether the Claims Resolution insurance kind belongs to medical class insurance kind；

If the Claims Resolution insurance kind belongs to medical class insurance kind, the equal amount of damages of default part of the Claims Resolution insurance kind is obtained, according to institute The declaration form insurance kind number of packages being in danger that information of being in danger determines the case to be assessed is stated, according to the equal amount of damages of the part and the guarantor Single insurance kind number of packages calculates the claim reserve of the case to be assessed；

If the Claims Resolution insurance kind is not belonging to medical class insurance kind, protection amount of the declaration form under the Claims Resolution insurance kind is calculated, according to The default compensation ratio for the described insured amount and described Claims Resolution insurance kind being calculated calculates the claim reserve of the case to be assessed.
2. the appraisal procedure of claim reserve according to claim 1, it is characterised in that the default compensation ratio passes through Following steps are calculated：

Obtain the case-involving total sum insured of history of the Claims Resolution insurance kind in preset time period；

The history for obtaining the Claims Resolution insurance kind in the preset time period compensates total value；

Obtain the total number of packages of case application of the Claims Resolution insurance kind in the preset time period；

The case for obtaining the Claims Resolution insurance kind in the preset time period compensates total number of packages；

Obtain the total number of persons of insuring of the declaration form；

Obtain the total number of persons that is in danger of the declaration form；

The case-involving total sum insured of the history, the history are compensated into total value, the total number of packages of the case application, the case and compensate total part Several, described insure total number of persons and the default compensation ratio computation model of total number of persons input that is in danger, obtain the Claims Resolution insurance kind Default compensation ratio.
3. the appraisal procedure of claim reserve according to claim 1, it is characterised in that obtain case to be assessed it Afterwards, in addition to：

Obtain the current Claims Resolution stage of the case to be assessed；

After the claim reserve of the case to be assessed is calculated, the appraisal procedure of the claim reserve also includes：

If the current Claims Resolution stage is the case to be assessed typing Claims Resolution information but does not pay the stage for compensating the amount of money, The prediction Claims Resolution money of the Claims Resolution insurance kind is calculated according to the Claims Resolution computation rule of the Claims Resolution information and the declaration form；

The claim reserve and the prediction Claims Resolution money are contrasted, obtain comparing result；

The prediction Claims Resolution money is adjusted according to the comparing result, and the prediction obtained after adjustment Claims Resolution money is true It is set to the claim reserve of the case to be assessed.
4. the appraisal procedure of claim reserve according to claim 3, it is characterised in that the assessment of the claim reserve Method also includes：

If the current Claims Resolution stage is to have provided verifying the extenaions but not initiating described verify the extenaions for the case to be assessed The stage of payment, it is determined that described to verify the extenaions as the claim reserve of the case to be assessed.
5. the appraisal procedure of claim reserve according to any one of claim 1 to 4, it is characterised in that according to institute State before information of being in danger determines the Claims Resolution insurance kind that the case to be assessed corresponds to declaration form, in addition to：

Judge whether that the case to be assessed corresponds to declaration form and includes reason corresponding with the information of being in danger according to the information of being in danger Insurance kind is paid for, and the date of being in danger of the case to be assessed meets the aging condition of the declaration form；

If so, then performing information of being in danger according to determines the step of case to be assessed corresponds to the Claims Resolution insurance kind of declaration form；

If not, it is determined that the claim reserve of the case to be assessed is 0.
A kind of 6. apparatus for evaluating of claim reserve, it is characterised in that including：

Case acquisition module, for obtaining case to be assessed；

Be in danger data obtaining module, for obtaining the information of being in danger of the case to be assessed；

Claims Resolution insurance kind determining module, determine that the case to be assessed corresponds to the Claims Resolution danger of declaration form for information of being in danger according to Kind；

Judge module, for judging whether the Claims Resolution insurance kind belongs to medical class insurance kind；

Primary bank reserves computing module, if belonging to medical class insurance kind for the Claims Resolution insurance kind, obtain the Claims Resolution insurance kind The default equal amount of damages of part, the declaration form insurance kind number of packages being in danger of the case to be assessed, root are determined according to the information of being in danger The claim reserve of the case to be assessed is calculated according to the equal amount of damages of the part and the declaration form insurance kind number of packages；

Second line reserve computing module, if being not belonging to medical class insurance kind for the Claims Resolution insurance kind, the declaration form is calculated in institute The protection amount under Claims Resolution insurance kind is stated, according to calculating the default compensation ratio for the described insured amount and described Claims Resolution insurance kind being calculated The claim reserve of case to be assessed.
7. the apparatus for evaluating of claim reserve according to claim 6, it is characterised in that the default compensation ratio passes through It is calculated with lower module：

The case-involving total sum insured acquisition module of history, for obtaining the case-involving total sum insured of history of the Claims Resolution insurance kind in preset time period；

History compensates total value acquisition module, and the history for obtaining the Claims Resolution insurance kind in the preset time period compensates total value；

The total number of packages acquisition module of case application, for obtaining the total part of case application of the Claims Resolution insurance kind in the preset time period Number；

Case compensates total number of packages acquisition module, and the case for obtaining the Claims Resolution insurance kind in the preset time period compensates total part Number；

Insure total number of persons acquisition module, for obtaining the total number of persons of insuring of the declaration form；

Be in danger total number of persons acquisition module, for obtaining the total number of persons that is in danger of the declaration form；

Input module, for the case-involving total sum insured of the history, the history to be compensated into total value, the total number of packages of the case application, institute State case and compensate total number of packages, insure total number of persons and the default compensation ratio computation model of total number of persons input that is in danger, obtain To the default compensation ratio of the Claims Resolution insurance kind.
8. the apparatus for evaluating of claim reserve according to claim 6, it is characterised in that the assessment of the claim reserve Device also includes：

Claims Resolution stage acquisition module, for obtaining the current Claims Resolution stage of the case to be assessed；

Prediction Claims Resolution money computing module, if for the current Claims Resolution stage be the case to be assessed typing settle a claim information but The stage for compensating the amount of money is not paid, then the Claims Resolution is calculated according to the Claims Resolution computation rule of the Claims Resolution information and the declaration form The prediction Claims Resolution money of insurance kind；

Contrast module, for the claim reserve and the prediction Claims Resolution money to be contrasted, obtain comparing result；

Adjusting module, for being adjusted according to the comparing result to the prediction Claims Resolution money, and the institute that will be obtained after adjustment State the claim reserve that prediction Claims Resolution money is defined as the case to be assessed.
9. the apparatus for evaluating of claim reserve according to claim 8, it is characterised in that the assessment of the claim reserve Device also includes：

First determining module, if being to have provided verifying the extenaions but not sending out for the case to be assessed for the current Claims Resolution stage Play the stage of the payment to verify the extenaions, it is determined that described to verify the extenaions as the claim reserve of the case to be assessed.
10. the apparatus for evaluating of the claim reserve according to any one of claim 6 to 9, it is characterised in that the Claims Resolution The apparatus for evaluating of Reserve Fund also includes：

Condition judgment module, for according to described in be in danger information judge whether the case to be assessed correspond to declaration form comprising with it is described Claims Resolution insurance kind corresponding to information of being in danger, and the date of being in danger of the case to be assessed meet the aging condition of the declaration form；

Trigger module, if the judged result for the condition judgment module is yes, trigger the Claims Resolution insurance kind determining module；

Second determining module, if the judged result for the condition judgment module is no, it is determined that the case to be assessed Claim reserve is 0.