本研究以探討實務中人身保險投保方對於保險方的犯罪案例為主，採敘述性的方式就保險犯罪的類型、手法加以分析，並且根據保險公司的整個理賠流程，來說明決定核付前對於懷疑為保險詐欺案件的申請是如何判讀、調查、需掌握的方向與癥結點、及所遇阻礙，作一說明。以原有的基本概念加以分析並以經法院判決之案例作為相關論點的佐證，最後羅列四案例，分別就個人、集團、傷害及醫療之保險犯罪，藉由細述相關犯罪過程、犯罪手法，以及保險公司如何判讀、調查作一完整的分析、比較、檢討。並針對相關結論，提出建議。 The thesis, in a narrative type, lays stress on the real ；criminal case study arisen between the insureds and the life insurers as well as the analysis of the types and the measurements of the life insurance crime. The thesis, based on the whole claim process, also explains how the life insurers judge, investigate and manage the suspected cheating cases before settling the claim and depicts the difficulties the life insurers encounter now. Furthermore, the thesis illustrates four real cases in the position of the personal, group, general personal accident and medical insurance crime, which fully demonstrate the comprehensive process and status in relation to the crimes and how the insurance companies deal with them founded on the insurance theory and the court trials. In the final section, the thesis conducts some conclusions and constructive suggestions.
