我國保險詐欺防制之研究

A Study on Insurance Anti-Fraud in Taiwan

陳彥欽(Yan-Chin Chen)

指導教授 ： 施懿純

朝陽科技大學/管理學院/保險金融管理系/碩士(2014年)

摘要

隨著人們風險意識提高，購買保險的人逐漸增加，雖然社會大眾提升保險接受度對於保險業有正面幫助，但也產生其他負面問題。犯罪人為了謀取利益，造成道德風險與違背最大誠信原則，直接造成保險公司經營風險的增加，間接也破壞了全體投保人分攤風險及被公平保障的權益。本文研究目的：一、了解我國保險詐欺之定義、種類、動機、特徵。二、分析我國各種保險詐欺案件之特性。三、針對我國保險詐欺防制之缺失提出改善方法。

本文採用文獻探討法及內容分析法，經由過去文獻探討我國保險詐欺之性質及保險詐欺防制上的缺失該如何改善，然後利用保險犯罪防制中心統計的詐欺案件進行內容分析，歸納出我國保險詐欺型態、特徵、發展趨勢。研究發現保險詐欺犯案地點從國內擴及國外，且趨向集團化的趨勢，加上醫護人員與不良員警配合之下也就更難以防範。由於我國沒有保險詐欺防制的法條，需盡快修法進而增加對於犯罪人的懲處，也應該增加保險詐欺防制的管道，遏止人們為了金錢而一再做出詐欺、傷人等行為。

關鍵字

保險詐欺防制 ； 保險詐欺 ； 保險

並列摘要

As people’s risk awareness is heightened, the number of insurance purchasers is also increasing gradually. Although public acceptance of insurance is elevated and it is bringing a positive assistance to the local insurance industry, it is also causing problems with negative influence. In order to reap benefits, perpetrators create moral hazards and violate the principle of utmost good faith, which leads to a direct increase of operational risks for the insurers, and an indirect damage to the interests of all policyholders for risk sharing and equitable coverage of protection.

The purpose of this study is to---- first, understand the nature of insurance fraud in Taiwan; and secondly, to analyze the characteristics of various forms of insurance fraud in Taiwan; and thirdly, to propose improvement measures for the deficiencies of insurance fraud prevention in Taiwan.

Literature review and content analysis are adopted in this study. Through past literature we investigate how to improve the deficiencies of insurance fraud prevention in Taiwan. Then we conduct a content analysis of fraud cases compiled by Insurance Anti-Fraud Institute before we sum up the patterns, characteristics, and trends of insurance fraud in Taiwan. The study finds that the crime locations of insurance fraud are expanding from Taiwan to overseas, and there tend to be more and more organizational conspiracies. With cooperation from health care workers and policemen, it is even harder to prevent the crime. Since there are no regulations relating to insurance fraud prevention, the laws need to be amended as soon as possible, so that the penalties for the perpetrators can be strengthened. Furthermore, there should also be more insurance fraud prevention channels to deter people from trying to gain illicit insurance claims from fraudulent and wounding behaviors.

並列關鍵字

Prevention of Insurance Fraud ； Insurance Fraud ； Insurance

參考文獻

5.宋學軍(2006)。一次讀完28本管理學經典。台北：海鴿文化出版社圖書有限公司。

9.許春金(2006)。犯罪學。台北：三民書局。

1.陳添壽(2008)。強制汽車責任保險保險詐欺防制之研究。國立政治大學商學院經營管理碩士學程風險管理與保險學組。碩士論文。

2.張綺芫(2008)。保險詐欺相關問題之研究。朝陽科技大學保險金融管理學術暨產學合作研討會，台中。

3.楊超倫(2006)。保險詐欺決意歷程之理性因素研究：以殺人詐領保險金案件為例。國立台北大學犯罪學研究所。碩士論文。