由於保險詐欺案件已有日益蔓延擴大之趨勢，嚴重影響社會公平正義及保險業健全經營，因此為有效防堵保險詐欺案件之發生及降低其對產險公司之影響，本論文以發生於產險公司之實際保險詐欺案例 作分析，將其於承保前後所可能發生之徵兆及理賠時應注意事項予以彙整後，並參酌國外防堵保險詐欺之經驗，最後分為經營面與法治面作出以下結論與建議： 一、經營面：(1)、加強營業、核保、理賠人員之教育訓練。(2)、加強保險公司內稽內控制度。(3)、維繫與相關單位之良好關係。(4)、保險業界建立良好之通報系統。(5)、研發保險新商品應嚴謹。(6)、保險公司間應加強自律。 二、法治面：(1)、強化保險犯罪防治中心之功能。(2)、加強保險犯罪防治宣導。(3)、制定防治保險詐欺相關法律。(4)、提高犯罪所需成本。(5)、設立保險詐欺資料庫。(6)、強化主管機關對保險業者之監理。 The Insurance Fraud has the tendency in growth gradually of which has seriously affected the social justice and normal developments of the insurance industry. Hence, in order to prevent the Insurance Fraud occur continuously and minimize its affects to the insurance industrial, this research is conducted to analyze the actual insurance fraud cases being happened by the insurance companies and consolidate all of the symbolisms prior or after the underwriting for such business and pay more attention while handling the claims in combination with the foreign experiences how to prevent the insurance fraud on which this research will present the conclusion and suggestions in respect of the managements and laws as follows :
1. Managements: (1) strengthen on educations for all staffs engaged in operations, underwriting and claims (2) strengthen the internal audits (3) maintain the close relationship and communications in between the departments (4) build up the efficient notifying system among the insurance companies (5) the developing of new products should be restricted (6) enhance the self-control of the insurance company
2. Laws: (1) strengthen the efficiency of Anti-fraud Insurance Preventing Center (2) strengthen to guide the people by creating a better understanding of the insurance fraud prevention (3) to draw up the related insurance fraud laws (4) increase the cost for those intended to commit insurance fraud (5) set up the insurance fraud data (6) strengthen the supervisions for the insurers executed by the authorities.
