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Claims survey for CALI

1. Purposes

Every operator of a motor vehicle is required to carry a compulsory automobile liability insurance (CALI) policy. Under the CALI system, victims of automobile accidents causing injury or death are indemnified and the limits of insurance claim payments are stipulated. CALI insurance rates are calculated in accordance with the principle of no loss and no profit in order to make CALI affordable.

Since the establishment of the CALI system, insurers have been legally required to provide CALI policies to operators, and the GIROJ, a neutral and independent organization, has been conducting claims survey for CALI. The GIROJ has set up 46 CALI Claims Survey Offices and 7 Regional Headquarters to enable “fair, prompt and kind” claims survey.

In this way, the GIROJ helps to protect the victims of automobile accidents and uses the data obtained from claims survey to calculate fair premium rates for CALI.

CALI has the following characteristics that are different from ordinary compensation principles:

  • Compensation is made in accordance with criteria prescribed by the Minister of Land, Infrastructure, Transport and Tourism and the Commissioner of the FSA.
  • In assessing damages, unlike the general concept of comparative negligence, claims are reduced due to gross negligence only if the negligence of the victim accounts for 70% or more of the accident.
  • The Government’s Automobile Liability Compensation Business indemnifies victims suffering bodily injury from hit-and-run accidents, which are not covered by CALI, or from accidents caused by vehicles that are operated without CALI. The GIROJ also conducts claims survey for the Government’s Automobile Liability Compensation Plan.

Also contributing to data for calculating rates

Through claims survey, the GIROJ, as an insurance ratemaking organization, can collect the detailed results of surveys for CALI efficiently. When calculating Standard Full Rates for CALI, the GIROJ uses the results as important underlying data.

2. Workflow of Claims Survey

3. GIROJ’s Claims Survey System

As described above, CALI claim documents are sent to a GIROJ CALI Claims Survey Office. Below is a flowchart of GIROJ claims survey.

* The CALI Claim Assessment Board, comprising outside experts, including lawyers and medical specialists, shall review claims that are difficult to assess and therefore require highly professional expertise to ensure objectivity and neutrality.
  • Claim documents are received by members and are sent to CALI Claims Survey Offices. CALI Claims Survey Offices conduct claims survey. Specifically, each CALI Claims Survey Office surveys accidents, examines whether payments should be made (whether an accident should be covered by CALI and whether there is a causal relationship between accident and injury), and the amount of damages in a fair and neutral manner. If the information provided on the claim documents is insufficient to verify the circumstances of the accident, the office conducts additional survey, such as inquiries with people and hospitals involved, and onsite investigation of the accident, and so on.
  • Claims that are difficult for the CALI Claims Survey Office to decide on, including claims that may not be paid by CALI, claims that may be reduced and claims where assessing the grade of permanent-disability is difficult, are examined at Regional Headquarters or the National Headquarter, which are senior organizations.
  • Claims that require highly technical expertise and are difficult to assess, and claims that are made again as a result of objections to the findings of survey or the amount of payment, are examined by the CALI Claim Assessment Board.