勞工保險詐欺型態及特徵之研究－以地方法院有罪判決為分析

A Study on Patterns and Features of Workers’Insurance Fraud－Analysis of the District Court Conviction Reports

鄭湘怡(HSIANG-YI CHENG)

指導教授 ： 許春金

國立臺北大學/社會科學學院/犯罪學研究所/碩士(2010年)

摘要

本文研究方法主要採內容分析法，透過司法院法學資料檢索系統，搜集全國 21個地方法院近10年關於勞工保險詐欺之第一審有罪判決書計129案，運用Excel建立資料庫，以「規避保險金」與「詐取勞保利益」2種態樣，依勞保給付類型、犯罪主體、犯罪行為、犯罪利益及判決結果等變項分析，探討勞工保險詐欺之趨勢、類型及分布狀況，歸納勞工保險詐欺之型態及特徵，提出具體的預防措施，避免保險制度濫用及政府財政資源的浪費。
研究發現，我國勞工保險詐欺型態主要為「詐取勞保利益」態樣，歸納主要特徵為：1、給付類型：以「詐害勞工保險」最多。2、犯罪主體：9成犯罪者違犯「詐取勞保利益」態樣，1人單獨犯罪比率最高，但「3人以上共犯」集團犯罪已形成趨勢、身分以「勞工」最多，「保險服務的法律提供者」居次但最具有關鍵地位。3、犯罪行為：平均犯罪期間長達2年，各類型犯罪手法不同，以勾串保險服務者類型最多樣化。4、犯罪利益：高獲利且集中於集團犯罪案件。5、判決結果：違犯罪名以「行使偽造文書罪」最多，判決刑度低且緩刑比例高。
勞工保險詐欺犯罪者係依循「理性選擇理論」，權衡犯罪的利益高於成本，經理性思考而選擇犯罪，故試圖運用「情境犯罪預防理論」，提出預防措施如下：1、增加犯罪阻力：建立勞工保險詐欺防制專責機構、強化勞工保險局的監控能力。2、增加犯罪風險：建置勞工保險詐欺指標及資料庫、與警方建立聯繫通報系統。3、減少犯罪誘因：設立檢舉專線及檢舉獎金、公布勞工保險詐欺定罪資訊。4、減少犯罪刺激：建立專人專線理賠查詢機制、簡易查詢投保薪資方式。5、移除犯罪藉口：教育正確勞工保險觀念、宣導勞工保險詐欺資訊等。

關鍵字

勞工保險 ； 保險詐欺

並列摘要

The research technique is content analysis by search the judicial yuan legal science data retrieval system, collects 21 district courts in the recent 10 years (from 89 years to 98 years) and found 129 documents guilty in the first distance. Two major kinds of crime was discussed : (1)premium avoidance and (2)benefit fraud. We also analyzed the types of fraud, the subject of crime, the criminality, the crime benefit and the result of judgement to discusses the tendency, the type and the distribution the workers’ insurance fraud. We hope we can give some suggestions to the reform of workers’ insurance system.
This research found that the major type of workers’ labor insurance fraud is benefit fraud. We found some results : (1) the major benefit fraud is faked injury. (2) 90% criminals violate benefit fraud , most crimes were committed by just one person but the group crime (committed by 3 persons at least ) increased incessantly ,most crimes are committed by labor but the service provider,like doctors and lawyers, play important role. (3)the duration time of crime is 2 years. (4)the fraud benefit is very high especially in the group criminal case .(5) most crimes were judged as document forgery crime , the punishment is low and the proportion of probation is high.
We proposed some preventive methods as follows:estabilish workers’ insurance fraud detecting system, strengthen the ability of workers’ insurance bureau, establish the data bank about workers’ insurance fraud , set up hot line for reporting the crime, establishe the special line for affording the information of compensation process and afford the correct information about worker’s insurance.

並列關鍵字

Workers’Insurance ； Insurance Fraud

參考文獻

林山田，1989，《刑法特論（上）》。臺北：三民。

周愫嫻、張耀中，2006，＜各國保險詐欺犯罪管制政策之比較研究＞，《刑事政策與犯罪研究論文集(9)》，頁61-80。臺北：法務部。

林虹榕，2008，《健保詐欺型態之研究》，國立台北大學犯罪學研究所碩士論文。

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