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    Please use this identifier to cite or link to this item: https://tkuir.lib.tku.edu.tw/dspace/handle/987654321/74104

    Title: 論人身保險智慧型詐欺之型態及防制之道
    Other Titles: Type and prevention method for the intelligent life insurance fraud
    Authors: 李思穎;Li, Szu-Yin
    Contributors: 淡江大學保險學系保險經營碩士在職專班
    Keywords: 理賠;保險詐欺;道德危險;claim;Insurance Fraud;Morality Risk
    Date: 2011
    Issue Date: 2011-12-28 18:04:34 (UTC+8)
    Abstract: 鑒於人身保險詐欺的手法不斷翻新,僅依靠保險業間彼此互相聯繫是不足以來防制保險詐欺犯罪。保險公司、公會、保險犯罪防制中心與政府機關應建立聯繫機制及合作,透過公務部門的力量如與警方、健保局間合作偵辦。此種相互合作的模式,在國外如英國、美國等先進國家已能有效降低保險詐欺之案件與損失。
    Given the way life insurance fraud is ever-changing, only relying on the contact between each insurance industry is not enough to prevent the insurance fraud crime. Insurance companies, insurance associations, Insurance Anti-Fraud Institute (IAFI) and Government should cooperate and establish a communication with each other to fight against crime through government apartments, such as Police Force and Bureau of National Health Insurance. This cooperation way has been applied in other countries such as Britain, United States and other developed countries. Also, it has been approved that the insurance fraud crime is reduced effectively.
    In this study, the characteristics of intelligent life insurance fraud is summarized and investigate the raising problem of solicitation, underwriting and claims through different cases In addition, we learn the effective prevention method of insurance fraud from other countries and hope it can be applied to our country to prevent the life insurance fraud.
    From the view of insurance company and supervision institution, we provide some recommendations about the prevention way of insurance fraud as below to hope the loss due to insurance fraud can be reduced.
    1. The view of the insurance company.
    (A) Set up an insurance claim of crime control department.
    (B) Set up the minimum training hours of insurance education.
    (C) Implementing the insurance company internal audit and control system.
    (D) Rigorously design for new insurance products.
    (E) Reviewing the current notification system and network building claims reporting system.
    (F) Maintain close cooperation with relevant units, and establish overseas contacts channel.
    2. The view of supervisory agencies.
    (A) Promote the concept of Insurance Fraud Prevention.
    (B) Develop the personnel protection laws for the investigator of Insurance Crime Prevention.
    (C) Convicted of insurance fraud.
    (D) Clearly express to terminate the right for the immoral behavior on Insurance Law.
    Appears in Collections:[Graduate Institute & Department of Insurance Insurance] Thesis

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