從人身保險案例談保險詐欺的影響

A Study on the Influence of Insurance Fraud Based on the Life Insurance Cases

萬添金(Tien-Chin Wan)

指導教授 ： 施懿純博士

朝陽科技大學/管理學院/保險金融管理系/碩士(2013年)

摘要

人身保險是一種分散危險、分擔損失原理的運用。它是透過多數人的集合，將集中在少數人身上的危險，分散給每個人。因此，當被保險人在面臨不可預料的各種死亡、傷殘、疾病、老年等人身危險發生時，將經濟上的風險轉嫁予保險人，並適時地獲得生活上的保障。
　　財團法人保險事業發展中心推估，台灣保險業者每年因為保險詐欺所支出的保險理賠金約占百分之十，保險公司額外付出的理賠金額一年約三百億元。這對保險公司而言是個大黑洞，若沒有擬定適當的防堵機制，則將對其他善意的被保險人權益造成嚴重的損害。
　　本研究採用文獻探討法和個案研究法。蒐集法院判決的案例進行個案研究，以實際案例驗證保險詐欺，提出目前保險詐欺防制之缺失，提供未來改進之建議，以防範保險詐欺案件之一再發生。在中小學實施保險教育課程，向下紮根建立正確的法治觀念。提供檢調單位偵辦保險詐欺犯罪者的行為模式，以達到積極防阻、防範未然與減少損失的目的。

關鍵字

人身保險案例 ； 保險詐欺 ； 人身保險

並列摘要

Life Insurance is a kind of usage of principle in separated risks and sharing damages. It is done by numbers of people through sharing with the risks which are put on some people. When the insured people face the uncertain life risks which happen in deaths, injuries, illness, and aging, they can give the economic risks to the insurance companies. They also can get safety in their daily lives at the right time.
Taiwan Insurance Institute estimates that insurance companies in Taiwan have to pay about 10 percent of insurance claim for the frauds, the total amount each year about 30 billion NT dollars. This is a big black hole for the insurance companies. Without making a proper prevention project, it will be the serious damage for the other nice insured people’s rights and benefits.
The methods of this research were based on the literature review and case study. Collecting the cases which were sentenced by the court was studied and analyzed. The practical cases were used to prove the life insurance frauds.
However, firstly to prevent the fraud cases happened again and again, the researcher tried to find out the defects of the insurance companies facing at the present and gave them some suggestions to take measures for the future.
Secondly, life insurance lessons for both the elementary school and junior high school students will be taught. It is very important to have correct lawful knowledge and concepts for the younger generations. Last, supplying the insurance fraud models to the investigators and police officers kept fraud offenders from the crimes and positively decreased the social and people’s damages. Its goal was to achieve the insurance companies to lower their running business risks.

並列關鍵字

insurance fraud ； life insurance ； life insurance cases

參考文獻

5. 陳豐年(2012，6)。保險詐欺防制對策：從保險人角度出發。萬國法律。183，11-22。

1. 李思穎(2011)。論人身保險智慧型詐欺之型態及防制之道。淡江大學保險學系保險經營碩士在職專班論文。未出版論文。

6. 傅建承(2007)。壽險業保險犯罪實務之研究。淡江大學保險學系保險經營碩士在職專班論文。未出版論文。

3. 周愫嫻、張耀中(2006，11月)。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)。台北：法務部編印。

一、書籍：