本論文在探討我國壽險理賠調查的價值。理賠調查是調查人員以專業調查技術對受理的案件進行核查，來確定保險事故的原因、性質，使理賠案件能公平、正確地予以處裡，因此調查人員是理賠調查的核心。第二章介紹各式理賠調查方法，說明調查人員面對各種不同型態的保險事故應如何來執行調查工作、發揮調查職能，將保險公司與保戶間資訊不對稱性降至最低，第三章探討保險公司應如何培養稱職的調查人員，其應具備的內在態度及外在技能，並以問卷方式探討我國10家壽險公司的理賠調查作業方式。如此一來，內、外兼備的調查人員構築完整的調查防治網，方能堅固起保險公司阻絕不當理賠的防火牆 第四章探討保險詐欺及實際案例，藉由案例之研討從中學習保險詐欺的防治觀念。最後就我國理賠調查環境所面臨的困難，由10家保險公司票選出亟需改善的問題並加以分析，期以貼近實務的方式提出改善建議。 This study is trying to reassert the merits of claims inspection in the field of life insurance in Taiwan and indicate some limits and difficulties of claims inspection practicing. Claims inspection is that claims inspector investigates insurance claims made by policyholders on behalf of insurance companies to identify whether the occurrence is covered by the insurance policies and to verify the causes of loss or damage. The claims inspector also has to check out claims, assess liability and make detailed assessments to process legitimate claims and to hinder fraudulent claims. Due to the variety of life insurance claims, the claims inspector should be specialized and well trained with professional knowledge to deal with claim adjustment fairly, properly and correctly. It could be said that claims inspection is the core of claim adjustment. This study contains five parts. Chapter One is the introduction of this essay which is about the motive and purposes of the research and the methodology used herein. Chapter Two describes the various methods of investigation while processing claims resulted from different occurrences, such as accident, or incident. It also analyses what method is more appropriate to be used to investigate specific insurance claim and makes claims inspection most effective for the purpose of reducing the disparity of information between insurer and policyholders. Chapter Three states that how a well trained inspector can help the insurance company to prevent from fraudulent or immoral claims and of what aspects the insurance company may train up the inspectors, including strong mentality, knowledge of insurance law, experiences of investigation practicing, and skills investigation, etc. Chapter Four takes dispute cases which are related to fraud and cheat claims as examples to explain how full and accurate claims inspection could prevent from improper claim payment. At last, Chapter Five describes the limits and difficulties of claims inspection in Taiwan provided by the survey of ten insurance companies and offers feasible improvement for the awkward situations as the resolutions and conclusion of this study.
