我國人身保險詐欺集團犯罪及壽險公司防制對策之研究

The research on organized crime of life insurance fraud and the preventive strategies of the life insurance company in Taiwan

韋俊青(Chun-Ching, Wei)

指導教授 ： 曾妙慧

淡江大學/商學院/保險學系保險經營碩士在職專班/碩士(2006年)

https://doi.org/10.6846/TKU.2006.00823

摘要

隨著社會環境演變及保險事業的蓬勃發展，保險詐欺現象也日漸普遍，近年來各種假藉保險名義詐領保險金之理賠案件層出不窮，在此類理賠詐欺案件日益增加及已有演變為集團化犯罪之趨勢下，本研究針對近期經刑事局破獲之保險詐欺集團犯罪理賠個案作實例分析，並藉由相關理論探討、文獻回顧及蒐集保險犯罪防制中心與業界之統計資料深入探討保險詐欺集團犯罪之成因、現況、犯罪特性、犯罪類型及手法、所觸犯法條及其犯罪成員組織結構，同時彙整目前保險詐欺集團犯罪防制工作上遭遇之困難，並提出壽險公司可採行之有關保險詐欺犯罪集團未來防制對策建議如下：
一、擴大通報制度範圍及建立理賠通報制度；
二、由核保端篩檢犯罪集團成員；
三、設計新商品及修正保單條款內容；
四、定期進行理賠異常統計分析；
五、與檢警單位保持密切合作；
六、建立海外聯繫及調閱相關文件管道。

關鍵字

理賠 ； 保險詐欺 ； 道德危險

並列摘要

During the vigorous development of varied social environments and insurance industry,ths phenomena of insurance fraud is more particular,life insurance fraud cases have kept happening continuously in recent years, which reveal that the amount of insurance fraud is keeping increasing and becomes the organized crime.
In this research, we introduce the organized criminal cases of insurance fraud arrested by Criminal Investigation Bureau(CIB) recently,and administer the analysis of practical examples by discussion of the relative theory and overview of the research. In the same time,in order to examine the organized crime of insurance fraud’s formation,current status,characteristics,patterns,legal aspects and organizational structure, we collect the data of statistics about insurance fraud from the Insurance Anti-Fraud Institute and in business.
We also compiles the present difficulty on prevention of organized crime of life insurance fraud and propose the preventive strategies of the life insurance company in Taiwan as follows：
1.Enlarging the rangeof the life insurance notification system,
2.Using the skill of underwriting to detect the members of the criminal organization,
3.Designing new product and to modify the provision of the policy,
4.Aberrant analysis of claim,
5.Keeping the closed relationship with prosecutor and police,
6.Establishing the obtained channel of foreign information.

並列關鍵字

Claim ； Insurance Fraud ； Moral Hazard

參考文獻

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