因保險公司經營本業即係保障危險發生，因保障不太容易實質化，故現行大多量化為金額補助，但關於金錢的利益，就很容易造成的保險詐欺或保險犯罪的案件發生，在社會新聞耳熟能詳的李雙全殺人詐領保險金命案、時有耳聞金手指、金手掌案件、澄清湖命案…等，一再顯示投機份子、保險犯罪者將保險公司作為提款機。本研究犯罪防制中心的破案資料、國內相關的論文、書籍、研究報告等資料，進行內容歸納保險詐欺犯罪特性及整理各種調查方式，並提出有關保險詐欺犯罪防制建議如下： 一、政府層面 (一)學習美國整合保險詐欺協會與檢警打擊醫療詐欺犯罪 (二)建置完整產壽險業者同業索引及通報機制 (三)成立客觀的醫療仲裁機構 (四)成立保險專業法庭及專責保險詐欺防制機構 (五)保險詐欺入罪化 二、公司層面 (一)建立完整稽核制度 (二)加強理賠人員訓練 三、理賠人員層面 (一)自發性的學習，增加本身抵抗力 (二)抒解壓力管道 Since the insurance company provides security for potential dangers, which is usually not with substance, now most securities are quantified as money subsidies. However when it’s involving with money and interests, it will easily cause cases insurance frauds or crimes, like the familiar case, Li Shuang-chuan murdering for insurance fraud, and hearing cases such as golden fingers, golden palm and Chengcing Lake murder. These cases show that speculators and insurance offenders take insurance companies as cash machines. The study, through arranging case files from crime prevention center, domestic related papers, books and research reports, made a conclusion of characteristics of insurance fraud crime and survey methods, and made some recommendations for prevent insurance fraud crimes as follows: 1. Government 1.1 Learning experiences from America, make an integration of Association of insurance fraud with prosecutors and police to combat medical fraud crime together 1.2 Establish a complete mechanism of report and index for property and life insurance industry 1.3 Establish an objective medical arbitration institution 1.4 Set up specialized Insurance Court and the special insurance fraud prevention and control institution 1.5Criminalize insurance fraud 2. Company 2.1 Set up a complete auditing system 2.2 Strengthen the training for claims personnel 3. Claims personnel 3.1 Spontaneous learning, improve self-resistance 3.2 Relieve pressures
