Objetivo: Identificar os instrumentos de trabalho e ferramentas documentais utilizados pelos auditores em uma seguradora de saúde e comparar os achados e os modelos de auditoria da empresa com a literatura. Método: Trata-se de um estudo qualitativo, descritivo exploratório, realizado em uma seguradora de saúde de grande porte no município de Barueri/SP. Para coleta dos dados foi utilizado um formulário semiestruturado e posteriormente análise documental e análise de conteúdo, que envolveu também o mapeamento dos processos e observação de campo. Resultados: As atividades dos auditores, exceto no que compreende as atividades de regulação médica (análises das solicitações de procedimentos médicos, exames, liberação de medicamentos de alto custo para tratamento oncológico e remoção), são meramente gerenciais. Utilizam contratos firmados com os prestadores de serviços médico-hospitalares, tabelas de honorários médicos, como a CBHPM e AMB, guia farmacêutico Brasíndice e revista Simpro, além de tabelas próprias de preços, consensos, guidelines e o Rol da ANS como instrumentos de trabalho e ferramentas documentais. Há diferenças nas atividades realizadas pelos médicos auditores e enfermeiros auditores. Os profissionais informaram que os objetivos da auditoria visam garantir a qualidade na realização do procedimento autorizado, reduzir os desperdícios e consequentemente os custos assistenciais através da análise das contas hospitalares e acompanhamento do segurado durante o período de internação. Conclusões: O papel dos auditores está centrado na redução dos custos médico-hospitalares. As atividades dos médicos e enfermeiros auditores são bem definidas dentro das operadoras de planos de saúde, apesar das competências descritas na regulamentação das atividades desses profissionais serem bem mais amplas e irem além das atividades mecanicistas evidenciadas nessa pesquisa e na literatura. A intensificação e incentivo de estudos nessa área permitirão a verificação dos modelos de auditoria existentes nas seguradoras e operadoras de plano de saúde, com vistas à remodelagem dos processos para melhor aproveitamento das habilidades desses profissionais e garantia de melhor qualidade na oferta dos serviços de saúde com o desenvolvimento de indicadores para avaliação da qualidade dos prestadores de serviços, assegurando, consequentemente, controle dos custos assistenciais e estudos de modelos de remuneração viáveis à manutenção do sistema de saúde suplementar. A proposta de um novo modelo de processo na área de auditoria com autonomia de sistema possibilitará o gerenciamento de cada etapa do processo fazendo correções necessárias sem causar prejuízo à empresa e segurado no que tange ao tempo para análise das solicitações médicas / Aim: Identify the instruments of work and documented tools used by auditors on a Health insurance company and comparing the results found and models of the audit company with literature. Method: It is a quantitative study, exploratory descriptive, realized by a large Health insurance company in the city of Barueri/SP. To collect the data it was used a semistructured form and further documented analyzes and content analyses, that involves also mapping processes and field observation. Results: The activities of auditors, except on medical regulations (analyses of medical procedures\' requests, exams, high-cost medication release for oncological treatments and removals), are merely managerial. Using contracts made with the providers of medical and hospital services, medical schedule charts, like CBHPM and AMB, pharmaceutical guide Brasíndice and Simpro magazine, also the price charts, consensus, guidelines and ANS roll as work tools and documented tools. There are differences in the activities performed by the medical auditors and nurses auditors. The professionals informed that the goal of the audit aims to ensure the quality on the doing of authorized procedure, reduce the waste and therefore the care costs through the analyses of hospital bills and monitoring the secured during the period of hospitalization. Conclusion: The role of auditors is centered on the medical and hospital cost reduction. The medical and nurses activities are well defined on health insurance operators, despite the competences described on the activities of those professionals being widely and going beyond the activities evidenced on this research and on the literature. The intensification on studies in this field will let the verification of existent audit models on insurances and on health care operators, in view of the processes remodeling for a better use of the skills of those professionals and the guarantee of a better quality on the health services offers with the development of evaluation indicators on the quality of the services providers, ensuring, therefore, control of care costs and studies of models of feasible remuneration to the maintenance of supplementary health system. The proposal of a new model of process on audit field with system autonomy will provide the management of each process step making needed corrections without causing harm to the company and the insured regarding the time for the analysis of medical requests

Dissertation is engaged in the sphere of life insurance as a product of insurance business and banking. This work demonstrates the significance of life insurance and describes types of life insurance and analyzes co-temporary development of these products. There is a review of the market in Czech Republic. The own research focused on the comparison of the offer of term assurances of particular insurers is the important part of the thesis. Finally is the recommendation for the expansion of this type of insurance included.

In recent years the popularity of Islamic insurance policies has grown rapidly with many companies across the world providing this service. London is said to be the hub for Islamic finance. It is well known for welcoming innovative financial methods. The FSA have already authorised the insurance company Salaam Halal to provide policies based on Shariah principles. The FSA, however, announced that they must operate within the same legal framework as all other insurance policies. Consequently English law has to be applied in Islamic policies taken in this country. However, in many aspects, Shariah principles contradict English insurance law. This thesis aims to discover how they contradict and recommend how the Islamic insurance policies can be applied in English law without breaking Shariah principles. As Shariah principles merely provide a wide boundary within which any law can be applied, this thesis analyses English insurance law first, and then discusses how Islamic insurance policies can operate within the English framework. In many cases, English insurance law crosses the boundary of Shairah principles due to its unfair consequences. Consequently making English insurance law fairer could be the best solution to allow the use of Islamic insurance policies under English law. Pragmatically, the thesis focuses mainly on problems within current English insurance law and recommends possible solutions. In many cases, the solutions suggested by the Law Commission are found to be incapable of establishing fairness. The majority part of this thesis is spent trying to establish a fairer framework for English insurance law. This fairer English insurance law is found to be Shariah compliant in most cases. In some cases it is not complaint due to operational differences between the two legal systems. In these cases, the thesis recommends that the Islamic insurer should incorporate certain terms to make policies Shariah compliant without breaching English insurance law.

Companiesissuing insurance cover, in return for insurance premiums, face the payments ofclaims occurring according to a loss distribution. Hence, capital must be heldby the companies so that they can guarantee the fulfilment of the claims ofeach line of insurance. The increased incidence of insurance insolvencymotivates the birth of new legislations as the European Solvency II Directive.Companies have to determine the required amount of capital and the optimalcapital allocation across the different lines of insurance in order to keep therisk of insolvency at an adequate level. The capital allocation problem may betreated in different ways, starting from the insurance company balance sheet.Here, the running process and efficiency of four methods are evaluated andcompared so as to point out the characteristics of each of the methods. TheValue-at-Risk technique is straightforward and can be easily generated for anyloss distribution. The insolvency put option principle is easily implementableand is sensitive to the degree of default. The capital asset pricing model isone of the oldest reliable methods and still provides very helpful intermediateresults. The Myers and Read marginal capital allocation approach encouragesdiversification and introduces the concept of default value. Applications ofthe four methods to some fictive and real insurance companies are provided. Thethesis further analyses the sensitivity of those methods to changes in the economiccontext and comments how insurance companies can anticipate those changes.

Master thesis, 65 pages, 18 pictures, 4 table, 39 literature sources, 5 appendages, Lithuanian language. The object of the work- insurance service marketing. The subject of the work - the research of the insurance service marketing. The aim of the work – to establish and estimate service marketing significance in an insurance business and to make suggestions of marketing implementation for companies. The goals of the work: 1.To analyse the nascency determinant elements of insurance service marketing. 2.To settle and describe a conception, functions, and essential things of insurance service marketing. 3.To analyze the peculiarities of the insurance service marketing and their determinant elements. 4.With reference to facts, to settle the size of Lithuanian insurance service market, to measure the structure of insurance service suppliers’ market and its competitive ability. 5.To find out consumers’ opinion about insurance service. 6.To estimate need and conditions of insurance service marketing implementation. Methods of the research: empirical research (questionnaire), unstruktural interview, analysis and synthesis of nonfiction, statistical material analysis, graphics, comparable, generalization. Analysing Lithuanian and foreign countries nonfiction and periodic literature about insurance service marketing, it is defined the organization particularity of the insurance service marketing, its expedience of adaptability and facility in Lithuanian insurance companies.

Den svenska försäkringsbranschen är gigantisk och det finns över 400 försäkringsbolag att välja mellan. Detta leder till hård konkurrens inom branschen, och försäkringsbolagen tvingas slåss om kunderna.Uppsatsens syfte är att analysera vilka försäkringsrelevanta faktorer som kan förklara försäkringstagares val av försäkringsbolag. Uppsatsen bygger på kvantitativ metod och en positivistisk infallsvinkel med en deduktiv ansats används.Uppsatsen indikerar att följande faktorer har positiv påverkan på försäkringstagare i valet av försäkringsbolag: Lågt pris på försäkringstjänsten, hög kvalitet på försäkringstjänsten, bra försäkringspersonal, lättåtkomligheten, starkt varumärke och banktjänstemäns påverkanEn medveten avgränsning som gjorts är att enbart fokusera på svenska privatpersoner, vilket lämnar utrymme för liknande forskning i ett globalt perspektiv. Ett förslag på fortsatt forskning är därför att analysera vilka faktorer som förklarar företags val av försäkringsbolag.Forskningen har varit begränsad inom försäkringsbranschen, såväl nationellt som internationellt. Mycket av tidigare forskning har fokuserat på befintliga kunder och hur de bibehålls. När det gäller vår inriktning är forskningen nästintill obefintlig. Vi hoppas att uppsatsen kan bidra med nyttig information till bland annat försäkringsbolag, då det torde vara av intresse för dem att veta vad som förklarar personers val av försäkringsbolag. / With more than 400 companies to choose between, the Swedish insurance sector is gigantic. The competition is fierce, and the insurance companies have to fight over customers and market shares. Our purpose with this dissertation is to analyze which insurance relevant factors determine which company the private consumer chooses. This dissertation has a quantitative research method, a positivistic philosophy and a deductive approach. Our study indicates that the following factors have a positive influence on insurers in their selection of insurance companies : Low price, high quality insurance service, professional staff, high accessibility and strong trademarks. Bank employees also tend to have influence on insurers in their selection of insurance companies. This study selectively focuses on the Swedish market, leaving room for further research in a global perspective. Additional research regarding companies selection of insurance companies may therefore be interesting. Research has traditionally focused on the existing customers, and how to keep them. In contrast, research concerning how people choose their insurance company has been limited, both nationally and internationally. We believe this dissertation may be of value for insurance companies because the knowledge of the factors may be important for attracting customers.

順應國際會計準則發展趨勢，我國於2008年12月發布財務會計準則第40號公報「保險合約之會計處理準則」，並自2011年1月1日施行。面臨第40號公報與過去截然不同的會計處理程序與財報揭露要求，本國保險公司是否已有足夠的準備與專業足以應付這項保險會計作業轉換所帶來的衝擊？ 　　本研究透過問卷調查從業務執行者之角度分析第40號公報對本國外商保險業者之影響。研究發現本國外商保險公司雖然已具備依據IFRS 4或US GAAP編製財務報表之經驗，但受訪人員一致認為第40號公報的實施將導致整體作業成本增加，而相關法令及緩衝配套措施未及時修訂係導入作業面臨的最大障礙。此外，IFRS 4第二階段以公平價值衡量保險負債的要求影響重大，風險資本適足性及增資壓力成為適用該號公報首要挑戰，業者甚至考慮變更保險商品的設計以因應之。 　　據此，本研究建議保險業由董事會高層授權成立專案小組統籌導入計劃及委任外部專家協助，並且進行全面試算與分析供決策參考。主管機關將保險財務與監理會計分離並及時修訂相關法令及緩衝的配套措施，以減緩保險業者所受之衝擊；並及早評估第二階段的影響，以緩和漸進的方式達到IFRS 4第二階段之要求。 / Vow to adapt accounting standards with IFRS, Taiwan issued GAAP No.40, the Accounting Standards for Insurance Contracts in 2008, which will be effective starting from 2011. With different accounting and disclosure requirements GAAP No.40 requires, are Taiwan insurance companies capable and ready to implement the new standards without any impact? 　　This research tries to study and analyze survey from staffs of foreign insurers in Taiwan regarding impacts of adopting the new accounting standards, although almost foreign insurers in Taiwan are capable of compiling their financial reports in accordance with IFRS or US GAAP requirements to their parent company. The questionnaire results indicate that all respondents agree that overall costs will increase due to adopt the new standards and lacking of the related regulations and supporting measures to the new standards will be a major challenge in operating levels. Furthermore, using fair value to measure insurance liabilities in phase II of IFRS 4 will cause huge impact for all insurers. The critical challenges of the new standards are the adequacy of Risk-Based Capital and additional capital requirements, which might even force the insurers to resign the products in order not to fail to comform RBC ratio. 　　Therefore, this research has 3 suggestions for insurers and 3 suggestions for authorities, respectively: 1.to be fully authorized by Board of Directors to set up IFRS 4 project team to implement the stardard as soon as possible; 2.to look for outside experts supports; 3.to make pre-test of the impact of the new stardard as the reference for insurers’ business plans and strategies; 4.to separate insurance financial accountings with insurance regulatory requirements; 5.to provide supporting policies or amend regulations to mitigate negative impacts from the new standards; 6.to make an overall study and analysis on phase II of IFRS 4 to ensure insurance companies can implement phase II smoothly and successfully.

Liability insurance concerns an insured’s insurance of its legal liability towards a third party for the latter’s loss. This specialised type of insurance is rather neglected in South African insurance law. There is a lack of understanding of the intricacies of liability insurance and its unique challenges. This flows primarily from its complex nature as third-party insurance, which involves legal obligations between multiple parties, and a lack of statutory regulation of the distinctive contractual aspects of liability insurance. Furthermore, limited authority exists on contentious legal aspects as a result of the relatively small number of judicial decisions in this field of law. It is also evident that liability insurance constantly evolves as new grounds of liability emerge and new insurance products develop in response to the changing demands of society. The rise of consumerism and the increase in third-party claims amplify the economic significance of the law of liability insurance in South Africa. A substantial knowledge gap remains in our jurisprudence, irrespective of the recent introduction of new statutory instruments aimed at regulating insurance practice in general. These reforms have not as yet been applied critically to liability insurance, and no specialised legislation in South Africa regulates aspects of this branch of insurance as is the case with microinsurance. The focus in this thesis is on two main issues: the insurer’s duty effectively to indemnify the insured, and the insurer’s defence and settlement of third-party claims brought against the insured. As a subsidiary theme, this thesis analyses legal uncertainties that may persist during pre-contractual negotiations, the liability insurance contract lifecycle, and even after the expiry of the contract. Legal challenges can be addressed by novel and creative application of the national law. Potential solutions can be gleaned from the other progressive jurisdictions reviewed – English and Belgian law. It is evident that this research may prompt Parliament to develop specific rules and regulations for liability insurance contract law. This thesis includes a check list of some of the most important disclosure duties for procuring liability insurance cover, its operation, and claims processes. / Mercantile Law / LL.D.