ارزیابی عملکرد شرکت‌های بیمه‌گر یکی از چالش‌های اصلی بیمه مرکزی ج.ا.ا می‌باشد. مکانیزم فعلی ارزیابی عملکرد شرکت‌های بیمه‌گر مبتنی بر شاخص‌های سنتی حسابداری می‌باشد که در بهترین حالت قادر به ارزیابی50% از شرکت‌ها می‌باشد و عملکرد بازاریابی که شاخص های آن مبتنی بر بازار و بیمه گذار محوری هستند، در مکانیزم فعلی لحاظ نشده است. لذا سئوال اصلی این است که چگونه می‌توان مدلی به منظور ارزیابی عملکرد شرکت‌های بیمه‌گر طراحی نمود تا بتواند واقع بینانه‌ای از عملکرد آن‌ها ارائه نماید؟ به منظور پاسخ دادن به سئوال فوق، ابتدا شاخص‌های فعلی مورد ارزیابی در شرکت‌ها و صنعت بیمه در جهان مورد بررسی و غربالگری قرار گرفت. سپس با انجام مصاحبه از خبرگان داخلی، شاخص‌های نهایی حاصل از پیشینه و مصاحبه تلخیص گردید. بررسی‌ها نشان داد که خلأ قابل توجهی در رابطه با شاخص‌های مبتنی بر بازار به هنگام ارزیابی عملکرد شرکت‌های بیمه‌گر وجود دارد. لذا مدل ریاضی تحلیل پوششی داده‌های شبکه‌ای مبتنی بر شاخص‌های بازار طراحی گردید. جامعه آماری شامل 28 شرکت فعال در صنعت بیمه ایران می‌باشند. داده‌های واقعی از اسناد و مدارک مربوط به سال 1398 بیمه مرکزی ج.ا.ا جمع‌آوری گردید. نتایج حل مدل ریاضی ارزیابی عملکرد شرکت‌های بیمه‌گر نشان داد که تنها 1شرکت در هر سه مرحله و همچنین بطور کلی کارا بوده است. تعداد 12 شرکت در یک مرحله، تعداد 9 شرکت در دو مرحله کارا بودند، در حالیکه کارایی کلی آن‌ها کمتر از 1 بود. همچنین تعداد 6 شرکت دارای کارایی 100% در فرآیند بازاریابی و عملکرد بازار بودند.

The parties to the contract must have good faith in their all statements and also avoid the silence which leads to the misrepresentation of the other party. What the insured asserts must be effective on the premium and the insurance subject. Informing the insurer must be done with complete and accurate answers to the questions mentioned in the insurance proposal.The Insured can not insure all potential risks that threaten the subject of contract. In this case, there are some exceptions like deliberate loss. Insurer must have good faith in arranging the proposal and contract and avoid deceiving the insured by limited and ambiguous proposal. In the situations that insurer knows the bad faith and non accuracy of the assertions and expressions of the insured party, can not invoke to this bad faith in the court. In the time of concluding the contract, that is possible that the insured party intends to insure his or her properties with a higher value than real (deliberately or unintentionally), if this misrepresentation is done in a deliberate situation, then the contract is void and if these false statements are expressed unintentional, the contract is not void, so it is valid. The insured obliges to inform the insurer in the case of risk intensification or changing the insurance subject’s situation. But unfortunately in Iranian law, there is no remark about informing the insured in the case of risk mitigation, which has benefit for the Insured.

Objective(s): Health insurance literacy (HIL) is the knowledge, ability, and confidence of people to find and evaluate information about insurance plans, choose the best plan and how to use it. This study was conducted to examine the level of HIL among the insured person of the Iran Health Insurance Organization in Tehran. Methods: This cross-sectional study was conducted in 2023 with the participation of 309 insured person. The data were collected using a 27-item questionnaire that included three dimensions of access, insurance terms, and performance skills. The validity and reliability of the questionnaire were confirmed. Data analysis was performed in SPSS.24 using T-test and One-way ANOVA. Results: The mean score for access was 8.5±1.91, insurance terms 10.21±2.46 and performance skill was 22.94±3.23. The overall mean HIL score was 41.64±6.22. The HIL status of 60% of the insured person was intermediate and 40% was low. The mean score of HIL was higher among people living in the northern region, those covered by the special diseases fund, those with a monthly less income, and those without supplementary insurance. The HIL level was also higher among people whose source of insurance information was friends and acquaintances (P<0.05). Conclusion: The majority of people had relatively low levels of HIL. Knowing the level of HIL and the factors that influence it can guide policy makers in developing educational interventions to remove barriers and improve HIL. Educational interventions through public media such as television, short videos on the websites and applications of insurance organizations and social media, and the provision of insurance information on waiting room monitors in medical centers are suggested to improve HIL.

Double insurance is provided when several insurers cover the same property against identical risk with respect to the same period. Unlike other legal systems, Iran act insurance does not have any explicit provision about status of double insurance and in this respect different opinions have been raised by legal writers. However, assuming the validity of multiple insurance, this issue is brings up that how the insured is entitled to claim against insurers. Some believe that each insurer will be liable for a rateable proportion only, and some other have an opinion that the insured may recover the full amount of his loss from whichever insurer or insurers he chooses. It seems, that just solution is final devided of liability between insurers and in the other word is the right of contribution that is defined as the right of insurers who have paid a loss to recover a proportionate amount from other insurers who are also liable for the same loss.