我國當今人壽保險詐欺型態與防制研究

隨著台灣社會對於保險制度之依存度日漸增高，保險市場之穩定對於個人、家庭及社會法益均有莫大意義；然近年來，保險詐欺除了侵蝕保險制度之穩固外，更常伴隨著嚴重性或高或低之刑事犯罪，甚至是社會矚目之重大保險犯罪刑案。保險詐欺形態多變且複雜，近年來又趨於集團化及專業化，不僅不利於防制工作，對於國內保險市場及良善的保險制度功能，均會造成嚴重不良影響和衝擊。耑此，本文由保險犯罪防制中心角度出發，先檢視目前我國防制保險詐欺之現況，列舉出我國近20年來之保險詐欺型態及特性等，並從法律規範層次、防制對策層次及專責單位層次切入，探討目前我國防制保險詐欺之盲點及缺失；次參閱目前各國預防保險詐欺的制度與機制，介紹英國、日本與美國對於保險詐欺之法制與防制作法；最後以我國該如何建制預防保險詐欺之制度與機制，提出結論及修法建議。

關鍵字

保險詐欺；犯罪防制；人壽保險；保險犯罪防制中心；醫療給付詐欺；資訊交換標準作業流程

並列摘要

With the increasing dependence of the Taiwan society on the insurance system, the stability of the insurance system is very important for all. Insurance frauds also have negative influences on the public and the society. The alarming aspect of insurance fraud is the involvement of organized criminal groups and specialization, and harmful to preventing and detecting fraud. Also, if problems of fraud claims of the like cannot be controlled, the society and economics will be facing with more strikes. This paper focus on the current situation of anti-insurance fraud in Taiwan from these three issues: legislative level, administrative level and the insurance industry. Then, this paper will introduce the British, Japanese and USA insurance law relates to anti-insurance fraud. Finally, this paper will draw some conclusions and give some advice of relevant law and strengthen anti-fraud system.

並列關鍵字

Insurance Fraud ； Crime Prevention ； Life Insurance ； Insurance Anti-fraud Institute ； Medical Billing Fraud ； Exchange of Information Standard Operating Procedure