Insurance Law, Regulation and Professional Ethics
This domain tests the legal rules that decide claims and the regulatory and ethical framework in which actuaries sign their names. Expect fact patterns - a non-disclosure, a disputed exclusion clause, a late claim decision - and questions asking which statutory clock or doctrine governs.
Insurance contract law (保险法)
- 保险利益: the applicant must have an insurable interest in the life insured (self, spouse, children, parents and other permitted relationships).
- 如实告知义务 follows the 询问告知 principle: the applicant answers only what the insurer asks. The insurer may rescind within 30 days of learning of the breach and within two years of contract formation.
- 不可抗辩条款: after two years from formation the insurer can no longer rescind; if the insured event occurs, it must pay.
- 说明义务 for exclusions: an exclusion clause not clearly explained to the applicant does not take effect.
- Claim handling: timely assessment; complex cases within 30 days absent contrary agreement in the contract, payment within 10 days of agreement, and 先予支付 of the ascertained amount within 60 days.
- Ambiguity in standard-form clauses is construed in favour of the insured or beneficiary.
Regulation
- The 国家金融监督管理总局 was formed in 2023, absorbing the insurance supervisory functions of 银保监会.
- Supervision runs on three tracks: 偿付能力 (偿二代二期), market conduct, and corporate governance.
- 中国精算师协会 administers the profession; the 总精算师 and 精算责任人 sign actuarial filings and carry personal accountability for their accuracy.
- Consumer protection operates under the 银行保险机构消费者权益保护管理办法 (issued December 2022, effective 1 March 2023).
Ethics
- Core duties: honesty, objectivity, professional competence, confidentiality, avoidance of conflicts of interest, compliance with law, and disclosure of material uncertainty in any actuarial opinion.
Worked example
A policy is formed on 1 March 2021; the insured dies on 20 June 2023. On 5 July 2023 the insurer discovers that a chronic illness was not disclosed at underwriting. Although the 30-day rescission clock only began when the insurer learnt of the breach, the two-year limit from formation has already expired, so 不可抗辩 bars rescission and the claim must be paid. The 30-day rule governs how long the insurer has once it knows; the two-year rule governs whether it may act at all.
Traps that cost marks
- Conflating the 30-day and two-year limits.
- Assuming 不可抗辩 protects an insured event deliberately staged by the beneficiary - the protection does not extend to claims fraud.
- Treating 说明义务 as the same duty as 告知义务; they run in opposite directions.