本文的目的在於：找出人壽保險業申訴率與評議率的決定因子。我們採用2012年至2021年臺灣人壽保險業資料，實證結果發現：較佳清償能力與規模較小的業者，會收到較多的申訴；在評議率方面，當監理預算的攀升，銷售較多投資型保險、較佳清償能力的公司，會有較高的評議率。至於健康保險賣越多的公司以及公股公司，則有較低的評議率。我們進一步利用「成功調解之申訴案件、占申訴案件的比率」作為被解釋變數，發現健康險銷售較多、規模較小、獲利能力較佳、與屬於金控的公司，有申訴案件較容易被調解的現象。

(178_M692cf0448e605_Abs.pdf(檔案不存在))

The purpose of this paper is to identify the determinants of complaint and ombudsman ratios in the life insurance industry. Using complaint and ombudsman data on life insurers in Taiwan from 2012 to 2021, we find that insurers with higher solvency and smaller size have more complaints; when regulatory budget expenses rise, insurers that sell more investment-linked products and have higher solvency experience higher ombudsmen ratios, while state-owned insurers with a higher level of health insurance premiums have lower ombudsman ratios. We further find that complaint cases from smaller insurers that sell more health insurance and more profitable insurers that belong to financial holding companies have the characteristic of being relatively easy to settle.

(178_M692cf0448e605_Abs.pdf(檔案不存在))

中華民國人壽保險商業同業公會。（2020）。我國健康險商品之市場概況。 The Life Insurance Association Of The Republic Of China. (2020). Market overview of health insurance products in Taiwan. 邵之雋、蕭育仁（2020）。期貨交易者風險認知、法律知識與交易爭議之關聯性研究。中華民國期貨業商業同業公會研究報告與學刊，叢書036。 https://www.futures.org.tw/file/attachmentStatic/4028859e71a6c7c90171dd4b3b1c1737 Shao, Z. J., & Hsiao, Y. R. (2020). The Relationship between Trader’s Derivative Financial Literacy, Legal Awareness and Transaction Dispute. Chinses National Furures Association Research Report and Journal, Collection 036. https://www.futures.org.tw/file/attachmentStatic/4028859e71a6c7c90171dd4b3b1c1737 林志潔、黃馨儀（2022）。金融消費評議制度回顧及展望。全國律師，26（1），23-34。https://www.twba.org.tw/upload/article/20221215/b35406ba279545e8a3d7e53164dfbc39/b35406ba279545e8a3d7e53164dfbc39.pdf Lin, C. C., & Huang, H. Y. (2022). Review and Prospect of Financial Ombudsman. Taiwan Bar Journal, 26(1), 23-34. https://www.twba.org.tw/upload/article/20221215/b35406ba279545e8a3d7e53164dfbc39/b35406ba279545e8a3d7e53164dfbc39.pdf 保險申訴調處委員會（2012）。保險理賠申訴調處之理論與實務（初版）。財團法人保險事業發展中心。 Insurance Complaints and Redress Committee (2012). The Theory and Practice of Insurance Claims Complaint Mediation (1st ed.). Taiwan Insurance Institute. 郭正雅（2013，6月）。月配息保單和你想的不一樣。今周刊，861。https://www.businesstoday.com.tw/article/category/80405/post/201306200020/ Kuo, C. Y. (2013, June). Monthly dividend policy is different from what you think. Business Today, 861. https://www.businesstoday.com.tw/article/category/80405/post/201306200020/ 孫彬訓，2025，「三大公股壽險公司合力推廣房貸壽險」，工商時報，https://www.ctee.com.tw/news/20240113700762-430305, accessed on Octber 11, 2025. Sun, B. S.(2025). The three major state-owned life insurance companies jointly promote mortgage life insurance. Commercial Times, accessed on Octber 11, 2025. 陳瑞祥、許永明（2020）。台灣產險業再保險市場存在有資訊不對稱嗎？分位數迴歸與自然試驗法之應用。管理評論，39（1），21-42。 http://doi.org/10.6656/MR.202001_39(1).CNI021 Chen, J. H., & Shiu, Y. M. (2020). Does Asymmetric Information Exist in the Reinsurance Markets of Taiwan? Applying Quantile Regression and Natural- Experiment Method. Management Review, 39(1), 21-42. http://doi.org/10.6656/MR.202001_39(1).CNI021 財團法人金融消費評議中心，「評議流程圖」， https://www.foi.org.tw/Article.aspx?Lang=1&Arti=358, accessed on Octber 11, 2025. Financial Ombudsman Institution, “Dispute Flowchart”, https://www.foi.org.tw/Article.aspx?Lang=1&Arti=358, accessed on Octber 11, 2025. 張旭華、呂鑌洧（2009）。運用 TRIZ-based 方法於創新服務品質之設計-以保險業為例。品質學報，16（3），179-193。 Chang, H. H., & Lu, P. W. (2009). Using a TRIZ-based Method to Design Innovative Service Quality-A Case Study on Insurance Industry. Chinses Society for Quality, 16(3), 179-193. 張邦茹、林惠芳、鄭鎮樑、林治皓（2008）。壽險業非理賠申訴率之研究從通路的角度分析比較。保險專刊，24（2），185-208。 Chang, P. R., Lin, H. F., Cheng, C. L., & Lin, C. H. (2008). The Study in Consumer Complaint of Life Insurance Industry from Distribution Comparison. Taiwan Insurance Review, 24(2), 185-208. 張志宏（2006，07月26日）。從投資型保險商品申訴案件談如何確保消費者權益之作法。財團法人保險事業發展中心，專欄文章, https://www.tii.org.tw/tii/research/research06/000009.html, accessed on October 12, 2025. Chang, C. H. (2006, July 26). Discussion on how to ensure the rights and interests of consumers from complaint cases of investment-type insurance products. Taiwan Insurance Institute, column article. https://www.tii.org.tw/tii/research/research06/000009.html, accessed on October 12, 2025. 許永明、黃芳文（2015）。風險資本額制度對產險業使用再保險的影響。經濟論文，43（3），381-411。 Shiu, Y. M., & Huang F. W. (2015). Effects of Risk-Based Capital on Reinsurance Use: Evidence from the Taiwan Non-Life Insurance Industry. Academia Economic Papers, 43(3), 381-411. 彭金隆（2018）。保險爭議需要防範於未然。《Advisers財務顧問》雜誌，356（2018年12月號）。 Peng, J. L. (2018). Insurance disputes need to be prevented before they happen. Adviser, 356(2018, December). 彭金隆（2022）。從根本避免保險爭議其實有明確方向。《Advisers財務顧問》雜誌，398（2022年6月號）。 Peng, J. L. (2022). There is a clear direction avoid insurance disputes fundamentally. Adviser, 398(2022, June). 詹芳書、許永明、陳柏欣（2015）。再保險使用與資本結構：以台灣產險業為例。管理評論，34（1），63-81。http://doi.org/10.6656/MR.2015.34.1.CHI.63 Chan, L. F. S., Shiu, Y. M., & Chen, B. S. (2015). Non-Life Insurers' Reinsurance Use and Capital Structure: Evidence from Taiwan. Management Review, 34(1), 63-81. http://doi.org/10.6656/MR.2015.34.1.CHI.63 臺灣經濟研究院，2003，公股股權管理問題之研究，臺北；行政院經濟建設委員會。 Taiwan Institute of Economic Research, 2003, Research on the Management of Public Shares, Taipei, Council for Economic Planning And Development, Executive Yuan. 劉俊廷、吳瑞雲、江朝峰（2017）。保險經代人能否提供較佳的理賠服務品質？：台灣汽車責任保險實證。臺大管理論叢，27（2S），119-147。 http://doi.org/10.6226/NTUMR.2017.NOV.RM104-004 Liu, C. T., Wu, J. Y., & Chiang, C. F. (2017). Do Insurance Brokers or Agents Provide Superior Claim Service Quality?: Empirical Evidence on Automobile Liability Insurance in Taiwan. NTU Management Review, 27(2S), 119-147. http://doi.org/10.6226/NTUMR.2017.NOV.RM104-004 蕭景元、許永明（2019）。衍生性金融商品、再保險與風險－以英國壽險業為例。經濟論文，47（2），253-295。 Hsiao, C. Y., & Shiu, Y. M. (2019). Derivatives, Reinsurance And Risk Evidence From The UK Life Insurance Industry. Academia Economic Papers, 47(2), 253-295. Abednego, C. C. N., & Dachayar, M. (2020). The improvement of online transaction return process, by using business process reengineering approach: Case study of a state-owned bank. International Journal of Advanced Science and Technology, 29(7s), 3562-3570. Adams, M., Hardwick, P., & Zou, H. (2008). Reinsurance and corporate taxation in the United Kingdom life insurance industry. Journal of Banking & Finance, 32(1), 101-115. http://doi.org/10.1016/j.jbankfin.2007.09.006 Agarwal, S., Driscoll, J. C., Gabaix, X., & Laibson, D. (2009). The age of reason: Financial decisions over the life cycle and implications for regulation. Brookings papers on Economic Activity, 2009(2), 51-117. http://doi.org/10.1353/eca.0.0067 Altman, M. (2012). Implications of behavioural economics for financial literacy and public policy. The Journal of Socio-Economics, 41(5), 677-690. http://doi.org/10.1016/j.socec.2012.06.002 Baranoff, E., & Sager, T. (2003). The relations among organizational and distribution forms and capital and asset risk structures in the life insurance industry. The Journal of Risk and Insurance, 70(3), 375-400. http://doi.org/10.1111/1539-6975.t01-1-00057 Barlow, J., & Møller, C. (1996). A Complaint is a Gift: Using Customer Feedback as a Strategic Tool (1st ed.). Berrett-koehler publishers. Barrese, J., Doerpinghaus, H. I., & Nelson, J. M. (1995). Do independent agent insurers provide superior service? The insurance marketing puzzle. The Journal of Risk and Insurance, 62(2), 297-308. http://doi.org/10.2307/253793 Barrese, J., & Nelson, J. M. (1992). Property-liability insurance distribution systems. The Journal of Risk and Insurance, 59(3), 375-397. Beck, T., Cull, R., & Jerome, A. (2005). Bank privatization and performance: Empirical evidence from Nigeria. Journal of Banking & Finance, 29(8-9), 2355-2379. http://doi.org/10.1016/j.jbankfin.2005.03.018 Bei, L. T., & Shang, C. F. (2006). Building marketing strategies for state-owned enterprises against private ones based on the perspectives of customer satisfaction and service quality. Journal of Retailing and Consumer Services, 13(1), 1-13. http://doi.org/10.1016/j.jretconser.2004.07.002 Browne, M. J., Carson, J. M., & Hoyt, R. E. (2001). Dynamic financial models of life insurers. North American Actuarial Journal, 5(2), 12-26. https://doi.org/10.1080/10920277.2001.10595981 Cambra-Fierro, J., Melero, I., & Sese, F. J. (2015). Managing complaints to improve customer profitability. Journal of Retailing, 91(1), 109-124. http://doi.org/10.1016/j.jretai.2014.09.004 Carson, J. M., McCullough, K., & Russell, D. T. (2005). Complaint ratios and property- casualty insurer characteristics. Journal of Insurance Issues, 28(2), 151-166. Chan, T. S. F. (1998). Consumer complaints, racial discrimination, and distribution channels in private passenger auto insurance. Journal of Insurance Regulation, 17(1), 24-43. Charoenwong, B., Kwan, A., & Umar, T. (2019). Does regulatory jurisdiction affect the quality of investment-adviser regulation? American Economic Review, 109(10), 3681-3712. http://doi.org/10.1257/aer.20180412 Chen, M. S., & Chang, P. L. (2010). Distribution channel strategy and efficiency performance of the life insurance industry in Taiwan. Journal of Financial Services Marketing, 15(1), 62-75. http://doi.org/10.1057/fsm.2010.6 Chen, T. J. (2019). Marketing channel, corporate reputation, and profitability of life insurers: Evidence of bancassurance in Taiwan. The Geneva Papers on Risk and Insurance-Issues and Practice, 44(4), 679-701. http://doi.org/10.1057/s41288-019-00137-7 Chen, R., & Wong, K. A. (2004). The determinants of financial health of Asian insurance companies. The Journal of Risk and Insurance, 71(3), 469-499. http://doi.org/10.1111/j.0022-4367.2004.00099.x Cheng, J., Qian, W., & Reeb, D. M. (2020). The ownership complaint gap: Mutual versus stock intermediaries. Journal of Financial and Quantitative Analysis, 55(5), 1685-1715. http://doi.org/10.1017/S0022109019000474 Crosby, L. A., & Stephens, N. (1987). Effects of relationship marketing on satisfaction, retention, and prices in the life insurance industry. Journal of Marketing Research, 24(4), 404-411. http://doi.org/10.2307/3151388 Detragiache, E., Tressel, T., & Gupta, P. (2008). Foreign banks in poor countries: Theory and evidence. The Journal of Finance, 63(5), 2123-2160. http://doi.org/10.1111/j.1540-6261.2008.01392.x DeVany, A. S., & Saving, T. R. (1983). The economics of quality. Journal of Political Economy, 91(6), 979-1000. http://doi.org/10.1086/261196 Doerpinghaus, H. I. (1991). An analysis of complaint data in the automobile insurance industry. The Journal of Risk and Insurance, 58(1), 120-127. http://doi.org/10.2307/3520052 Eckardt, M., & Räthke‐Döppner, S. (2010). The quality of insurance intermediary services—empirical evidence for Germany. The Journal of Risk and Insurance, 77(3), 667-701. http://doi.org/10.1111/j.1539-6975.2010.01361.x Eckert, C., Neunsinger, C., & Osterrieder, K. (2022). Managing customer satisfaction: digital applications for insurance companies. The Geneva Papers on Risk and Insurance-Issues and Practice, 47(3), 569-602. http://doi.org/10.1057/s41288-021-00257-z Egan, M., Ge, S., & Tang, J. (2022). Conflicting interests and the effect of fiduciary duty: Evidence from variable annuities. The Review of Financial Studies, 35(12), 5334-5386. http://doi.org/10.1093/rfs/hhac047 Eling, M., & Schmit, J. T. (2012). Is there market discipline in the European insurance industry? An analysis of the German insurance market. The Geneva Risk and Insurance Review, 37(2), 180-207. http://doi.org/10.1057/grir.2011.8 Ellul, A., Jotikasthira, C., & Lundblad, C. T. (2011). Regulatory pressure and fire sales in the corporate bond market. Journal of Financial Economics, 101(3), 596-620. http://doi.org/10.1016/j.jfineco.2011.03.020 Fajrina, R. N., & Waspiah, W. (2021). Supervision by the financial services authority on investment-based life insurance (Unit Link). Unnes Law Journal: Jurnal Hukum Universitas Negeri Semarang, 7(1), 1-22. Fan-Chiang. K., & Cheng, S. W. (2009). An efficiency comparison of direct and indirect channels in Taiwan insurance marketing. Direct Marketing: An International Journal, 3(4), 343-359. http://doi.org/10.1108/17505930911000900 Fecher, F., Kessler, D., Perelman, S., & Pestieau, P. (1993). Productive performance of the French insurance industry. Journal of Productivity Analysis, 4(1), 77-93. http://doi.org/10.1007/BF01073467 Gelman, M., Khan, Z., Shoham, A., & Tarba, S. Y. (2021). Does local competition and firm market power affect investment adviser misconduct? Journal of Corporate Finance, 66, 101810. http://doi.org/10.1016/j.jcorpfin.2020.101810 Halstead, D., & Page Jr., T. J. (1992). The effects of satisfaction and complaining behavior on consumer repurchase intentions. Journal of Consumer Satisfaction, Dissatisfaction and Complaining Behavior, 5, 1-11. Homburg, C., & Fürst, A. (2005). How organizational complaint handling drives customer loyalty: an analysis of the mechanistic and the organic approach. Journal of Marketing, 69(3), 95-114. http://doi.org/10.1509/jmkg.69.3.95.66367 Jahnert, J. R., & Schmeiser, H. (2022). The relationship between net promoter score and insurers’ profitability: An empirical analysis at the customer level. The Geneva Papers on Risk and Insurance-Issues and Practice, 47(4), 944-972. http://doi.org/10.1057/s41288-021-00237-3 Karami, A., & Pendergraft, N. M. (2018). Computational analysis of insurance complaints: GEICO Case Study. arXiv preprint arXiv:1806.09736. https://doi.org/10.48550/arXiv.1806.09736 Kim, W. J., Mayers, D., & Smith Jr, C. W. (1996). On the choice of insurance distribution systems. The Journal of Risk and Insurance, 63(2), 207-227. http://doi.org/10.2307/253743 Kowalczyk-Rólczyńska, P., & Pisarewicz, P. (2015). Unit-linked life insurance in view of the new Act on insurance and reinsurance activities. Wiadomości Ubezpieczeniowe, 4, 39-51. Kunreuther, H., Ginsberg, R., Miller, L., Sagi, P., Slovic, P., Borkan, B., & Katz, N. (1978). Disaster insurance protection: Public policy lessons (1st ed.). Wiley. Levine, R. (1996). Foreign banks, financial development, and economic growth. Journal of Economic Literature, 35, 224–255. Liu, T. C., & Wu, L. W. (2007). Customer retention and cross-buying in the banking industry: An integration of service attributes, satisfaction and trust. Journal of Financial Services Marketing, 12(2), 132-145. http://doi.org/10.1057/palgrave.fsm.4760067 Lo, S. F., & Lu, W. M. (2009). An integrated performance evaluation of financial holding companies in Taiwan. European Journal of Operational Research, 198(1), 341-350. http://doi.org/10.1016/j.ejor.2008.09.006 Loewenstein, G., Friedman, J. Y., McGill, B., Ahmad, S., Linck, S., Sinkula, S., Beshears, J., Choi, J. J., Kolstad, J., Laibson, D., Madrian, B. C., List, J. A., & Volpp, K. G. (2013). Consumers’ misunderstanding of health insurance. Journal of Health Economics, 32(5), 850-862. http://doi.org/10.1016/j.jhealeco.2013.04.004 Luo, X., & Homburg, C. (2008). Satisfaction, complaint, and the stock value gap. Journal of Marketing, 72(4), 29-43. http://doi.org/10.1509/jmkg.72.4.29 Mateev, M., Sahyouni, A., & Tariq, M. U. (2023). Bank regulation, ownership and risk taking behavior in the MENA region: policy implications for banks in emerging economies. Review of Managerial Science, 17(1), 287-338. http://doi.org/10.1007/s11846-022-00529-5 Morris, R., Wood, G., & Pierce, B. G. (2011). Improvements in insurance consumer complaint ratios. Insurance Markets and Companies, 2(1), 34-37. Moussawi, C. El., & Mansour, R. (2022). Competition, cost efficiency and stability of banks in the MENA region. The Quarterly Review of Economics and Finance, 84, 143-170. http://doi.org/10.1016/j.qref.2021.12.005 Nissan, E. (2003). Relative market power versus concentration as measure of market dominance: Property and liability insurance. Journal of Insurance Issues, 26(2), 129-141. Ostrowska-Dankiewicz, A. (2017). The Polish life insurance market in view of consumer protection issues. Journal of Insurance, Financial Markets and Consumer Protection, 25(3/2017), 87-99. Pooser, D. M., & Browne, M. J. (2018). The effects of customer satisfaction on company profitability: Evidence from the property and casualty insurance industry. Risk Management and Insurance Review, 21(2), 289-308. http://doi.org/10.1111/rmir.12105 Query, J. T., Hoyt, R. E., & He, M. (E.) (2007). Service quality in private passenger automobile insurance. Journal of Insurance Issues, 30(2),152-172. Rauch, J., & Wende, S. (2015). Solvency prediction for property-liability insurance companies: Evidence from the financial crisis. The Geneva Papers on Risk and Insurance—Issues and Practice, 40(1):47–65. http://doi.org/10.1057/gpp.2014.16 Regan, L. (2007). The optional federal charter: implications for life insurance producers. American Council of Life Insurers. https://citeseerx.ist.psu.edu/document?repid=rep1&type=pdf&doi=f6c43dfdee62b3bee7f0e0e9b75f6fcc0a868799 Shim, J. (2017). An investigation of market concentration and financial stability in property–liability insurance industry. The Journal of Risk and Insurance, 84(2), 567-597. Shiu, Y. M. (2005). The determinants of solvency in the United Kingdom life insurance market. Applied Economics Letters, 12(6), 339-344. http://doi.org/10.1080/13504850500092640 Shiu, Y. M. (2011). Reinsurance and capital structure: Evidence from the United Kingdom non‐life insurance industry. The Journal of Risk and Insurance, 78(2), 475-494. http://doi.org/10.1111/j.1539-6975.2010.01387.x Stone, G. K. (1967). A trend in complaints processed by state insurance departments. The Journal of Risk and Insurance, 34(2), 231-236. http://doi.org/10.2307/251321 Terry, N., De’Armond, D. A., & White, M. (2020). Auto insurance ratings impact on price and complaint index. International Advances in Economic Research, 26(2), 185-187. http://doi.org/10.1007/s11294-020-09780-6 Tseng, L. M., Peng, C. L., & Chen, C. Y. (2011). Insurance salespeople and information asymmetry. Journal of Insurance Regulation, 30, 77-99. Venezian, E. (2002). Complaints ratios: What (or where) is the beef ? Journal of Insurance Regulation, 20(4), 19. Wood, G. L., & Morris, R. L. (2010). Consumer complaints against insurance companies. Journal of Personal Finance, 9, 1-20. Wooldridge, J. (2013). Introductory Econometrics: A Modern Approach (6th ed.). Cengage Learning.