人身型保險詐欺犯罪特性及防制之研究

The study of characteristic of Anti-Fraud in Life insurance

鄧子震(Tzu-Chen Teng)

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(2015年)

摘要

人身型保險詐欺犯罪特性、歷程及防制之研究 摘 要 保險制度現已成為日常生活中不可或缺的經濟活動，伴隨著保險這一類之經濟活動之蓬勃發展，相對的保險詐欺犯罪活動及手法亦猶如雨後春筍般不停出現，不同於一般暴力犯罪，保險詐欺多屬於智慧型犯罪，其案件的偵辦難度較暴力犯罪更為困難，而在犯罪種類中，保險犯罪一直是政府相關單位所重視以及報章雜誌時常報導討論的議題，保險詐欺犯罪類型包羅萬象，其中不乏肢體自殘、買屍詐死、謀殺詐領保險金、找人頭投保出險詐領保險金、縱火、假車禍、謊報汽車失竊、利用汽車投保載運貴重貨物毀損、偽造證明文件、偽殘、業者監守自盜等類型，犯罪態樣極具挑戰性，財產損失事件往往有跡可循，唯獨人身傷害案件，在調查過程中往往面臨許多偵查的困難，故對於偵辦人身型保險詐欺犯罪之策略研究是刻不容緩的。 本研究利用以司法院法學資料檢索系統針對全國各地方法院搜尋最近5年內（2009-2014年），有關「人身型保險詐欺犯罪」有罪判決之案件作為分析研究，搜尋方法係以「保險公司」名稱作為搜尋標的，共搜尋得到近4000件有關「保險公司」字樣之案件，再依據判決書內容過濾，符合「人身型保險詐欺」犯罪類型案件共57件，再從該57件判決案件中，組合判決書資料中同案起訴或同案犯嫌之判決案例，共整併篩選出40件與本研究「人身型保險犯罪模式之研究」內容相關之判決案例。 本研究經由判決書分析及質性分析，發現保險詐欺犯罪發生在臺灣中南部居多，台中、高雄、台南地區的件數是較多的，而中、南臺灣地區發生保險詐欺犯罪比例較其他地區為高，更發現保險詐欺犯罪在投保一年期間內是犯案的高峰期，而投保者本人與親戚朋友及親屬間的犯案，較其他共犯結構關係高。而保險詐欺犯罪的偵破，從保險公司核保過程到司法機關公權力介入的調查，均需要保險公司與司法機關的相互配合，由縱向及橫向面的聯繫才能達到最佳的防制與偵破之道。所以研究者認為保險詐欺犯罪，從保險公司本身層層把關是預防保險詐欺犯罪最佳途徑，另外，司法機關設立保險詐欺專責單位，訂定獎勵與評核標準是提升保險詐欺破案率最好的方法。

關鍵字

保險詐欺

並列摘要

Abstract
The insurance system has now become one of the indispensable economic activities. With the vigorous development of economic activities such as insurance system, the insurance fraud has also diversified itself with more innovative and smarter approaches. Unlike usual violent crimes, insurance fraud is categorized as “smart crime”, which makes it more difficult to detect, investigate and solve. Among all those crimes, insurance fraud has drawn the most attention by the government, the public and the news. There are various ways to commit an insurance fraud, for instance, self-mutilation, faking death by purchasing corpses, murdering to obtain insurance benefits, purchasing insurance for a person then fake the accident, arson, fake car accident, false report theft of own car, transporting valuable goods on purpose to obtain car insurance by damaging the car, forgery, false self-embezzlement, etc. Despite of the challenges to identify crime activities among these enormous superficialities, it is much less laborious to trace property lost than to pinpoint personal type insurance frauds. As a result, searching for the approaches of personal type insurance frauds is urgently required.
This paper collects data from The Judicial Yuan of the Republic of China Law and Regulations Retrieving System, targeting on personal type insurance frauds with keyword “insurance company” from 2009 to 2014. Initially, there are in total of 4000 cases with keyword “insurance company” has been sifted. And then by screening to the specific type of personal insurance fraud, the data has been funneled down to 57 cases. Finally, 40 out of the 57 cases are found out to be directly related to the subject of this paper.
According to the analysis of the verdict and the categorization, this paper identifies a prevalence of insurance fraud in middle and southern regions of Taiwan, with more cases in Taichung, Kaohsiung and Tainan. Also, it shows that insurance fraud has a tendency to reach its peak within one year of purchasing the insurance by suspects. Also, those accomplices are tend to be the suspect’s relatives and friends. In order to detect an insurance fraud from the verification of insurance company to intervention of the jurisdiction investigation, the thorough examination and close cooperation between the insurance company and the jurisdiction are of the essence. To conclude, it is crucially important for the insurance company to scrutiny their clients step by step to prevent the insurance fraud. Furthermore, to increase the insurance fraud detection rate, the jurisdiction should consider establishing a special division responsible for insurance fraud, regulating commission and evaluating standard guidelines.

並列關鍵字

insurance fraud

參考文獻

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參考文獻