|Abstract: || 隨著近年來經濟的快速發展，各國也由開發中國家邁入已開發國家，國民教育程度的普遍提升，對保險也具有更高的接受度，以至於保險普及率呈現大幅度的上升，但隨著保險密度、保險滲透度越高，發生保險詐欺案件的比例也越來越多，根據財團法人保險事業發展中心的估計，台灣每年因保險詐欺所額外支出的金額約為理賠金額的十分之一，由2012年人身保險業保險給付總額為1229474 (百萬元) 進行推算，當年度因保險詐欺所支出金額為122947.4 (百萬元) ，佔保險業總保費收入的4.7 % ，而中國大陸自1980年文化大革命結束後，開放設立本土保險公司，保險業的發展亦如火如荼，以大陸資本總額最高的保險公司中國人壽為例，每年亦因保險犯罪多支出很多的保險金。|
With the rapid development of the economy in recent years, many countries have prospered from developing into developed countries. The level of national education has increased so as to the acceptance of insurance, which leads to the popularity of insurance. But with the insurance density and insurance penetration gets higher, the insurance fraud case emerges. According to the estimate of Taiwan Insurance Institute (TII), Taiwan had paid extra compensation about one-tenth amount of the original claims due to the insurance fraud each year. By estimated 2012 life insurance industry, the total insurance amount paid were 1229474 (million), and the insurance fraud paid is 122947.4 (million), it takes 4.7% of total insurance income that year. After the end of culture revolution in 1980 in China, the government allowed the establishment of local insurance companies. The insurance industry has prospered. The China life insurance company, which has the highest capitalization in china, having paid extra benefits due to the insurance crime every year.
The research discusses about criminal investigation and prevention of life insurance fraud for Taiwan and China. Author collects and analyzes major life insurance criminal events recent years in Taiwan, and had classified into four categories, including life insurance, health insurance, accident insurance and others. In order to help police and insurance company when they are investigating the insurance fraud, it had listed each type of crime process and supplement with actual case. The research majorly uses literature search and expert interview method, like collecting paper of Taiwan, China and overseas. Analyzing nowadays practical way of preventing insurance crime from each countries, and take legally point of view especially from Europe and America, which has more mature insurance development, to be references when proceeding insurance fraud prevention of Taiwan and China in the future.
When author being an exchange student in China, he had interviewed several China insurance experts. And manager of claim department of Taiwan insurance company, executives of Life insurance association of the Republic of China, Consultant Survey Company and Insurance experts and scholars …etc. He had interviewed with a total of twelve professionals in all areas, which has related insurance backgrounds, seven in China and five in Taiwan. We expect that through different background and interaction of Taiwan and China, it can benefit the healthy development of insurance in the future.
Finally, for the lack part of current prevention of insurance fraud in Taiwan’s insurance industry. Here come up with several recommendations by targeting insurance company, supervision department and future cross-strait cooperation, expecting to effectively prevent insurance crimes.