The topic of "a woman broke her toe after buying 18 kinds of insurance and was sentenced for cheating 430000 yuan" rushed to the microblog hot search, once again pushing insurance fraud to the forefront of the storm. The shocking "self destruction of muscles and bones", "setting up a scheme to kill his wife to defraud insurance" and forging false cases and tampering with inspection reports have become persistent diseases of insurance fraud and tested the construction of anti fraud "Skynet" in the insurance industry.
Industry insiders said that although the above-mentioned women use relatively low-level insurance fraud means, at present, the crime risk is gradually emerging, the perpetrators are professional, gang oriented, intelligent means, huge funds and other characteristics are obvious, and the anti insurance fraud situation is severe. We should further solve the problem from the legal level, scientific and technological means and so on.
"he's a cruel man!" Self mutilation and insurance fraud attract attention
The miserable "self breaking muscles and bones" and "wife killing and insurance fraud" have attracted high social attention and once boarded the hot search list.
According to media reports, from April 6 to 10, 2021, a woman long spent 13000 yuan to buy 18 kinds of insurance. On April 13 of the same year, long broke two toes with an axe. Netizens commented on this: "he is a cruel man!". 10 days later, Mr. long applied to the insurance company for claim settlement, and the claim amount reached 430000 yuan.
On July 6, 2021, according to the identification of Hubei Tongji forensic forensic judicial identification center, the injury of Long's left foot was caused by the action of sharp tools, but it was inconsistent with the injury mode caused by the accidental fall off of the axe held by the left hand complained by the appraiser. The people's Court of Fenghuang County, Hunan Province held that his behavior had constituted the crime of insurance fraud.
Insurance lawyer Li Bin told the Beijing Business Daily that insurance fraud cases are divided into two types from the perspective of accidents. One is that the accident itself is real. In order to defraud more insurance money and do not belong to the scope of insurance liability, the insured becomes a fraud that conforms to the scope of insurance liability in the form of forged evidence. The other is to deliberately create insurance fraud. Long's case is an intentional accident to defraud insurance.
At the end of 2021, various localities successively issued "countless" insurance fraud cases. According to the ten typical anti insurance fraud cases of Guangdong insurance industry in 2019-2021 released by Guangdong insurance association on December 21, 2021, forging national official seals to cheat claims, internal and external collusion and careful cross-border scams.
According to Guo Yutao, partner of Beijing Gefeng law firm, insurance fraud is high, mainly because insurance claims and loss verification are carried out online, which is becoming more and more convenient. At the same time, some people use this condition to make up some accidents and pictures, and use the "crooked brain" to cheat insurance funds.
Because insurance and claim settlement can be carried out largely relying on the network, Internet insurance fraud is also constantly coming into people's vision. Beijing Business Daily reporter learned that in addition to forging false cases, tampering with inspection reports and other fancy insurance fraud, what is more painful is "murder insurance fraud". Previously, Taizhou Dai had a loss of more than 2.6 million yuan due to stock speculation and speculation in virtual currency. In order to alleviate the economic pressure, Dai's poisonous wife cheated insurance.
According to Li Bin, a professional insurance lawyer, this is related to human greed and the willingness to illegally obtain improper interests. At the same time, he said, "insurance fraud is common all over the world." The reporter of Beijing Business Daily found that more insurance fraud focused on medical insurance, auto insurance and accident insurance. The reason is that the risk liability of these insurances is closely combined with individuals.
From a personal point of view, why are medical insurance and auto insurance easy to "breed" insurance fraud? Li Bin said: "it has something to do with the design defects of these insurances and the problems existing in the insurance industry. For example, the Subsidy Insurance in medical insurance has caused a large number of insured to deliberately go to the hospital for hospitalization in order to settle claims for Subsidy Insurance."
Because the information of industry vehicle price is not accurate and scientific, the insurance amount determined during underwriting is much higher than the actual value of the vehicle. In this regard, Li Bin seems that this has led to intentional accidents. The cases of vehicle damage caused by flooding or fire are more obvious in high-end vehicles.
force out the "three heads and six arms" of supervision
Huge insurance money makes a few criminals take risks, and social moral hazard occurs frequently. While the law enforcement departments continue to crack down severely, the regulatory authorities use "three heads and six arms" to work hard from the aspects of science and technology and information sharing. Local banking and insurance regulatory bureaus are also constantly strengthening the publicity of insurance anti fraud.
With the progress of science and technology, regulators use Internet technology, big data and artificial intelligence to find out insurance fraud more effectively. In May 2021, the China Banking and Insurance Regulatory Commission issued the notice on using big data to carry out anti insurance fraud work, which organized the screening, parallel connection and transfer of fraud clues in key areas such as auto insurance, Italian health insurance, agricultural insurance and guarantee insurance, further improved the system mechanism and information service guarantee, and further promoted the anti insurance fraud work of big data.
Constructing a scientific and effective anti fraud system and mechanism is an important means to promote the sustainable and healthy development of the insurance industry. In February 2018, the former CIRC issued and implemented the guidelines on anti insurance fraud to guide the industry associations and insurance branches under their jurisdiction to improve anti fraud organizations, such as establishing or jointly establishing an anti fraud center and an anti Insurance Fraud Office with public security organs. In January 2022, the China Insurance Industry Association issued the guidelines for anti insurance fraud organizations in the insurance industry (for Trial Implementation) (hereinafter referred to as the guidelines) to standardize the anti insurance fraud organization system in the insurance industry.
The insurance industry association said that the insurance fraud organization has made the anti fraud work effective. Li Wenzhong, deputy director of the insurance Department of Capital University of economics and trade, said that first, anti insurance fraud organizations can mobilize forces to carry out anti insurance fraud research and anti insurance fraud planning and technology development; Secondly, the anti insurance fraud organization can share data and information among its members, spin the anti insurance fraud network and improve the anti insurance fraud ability; Thirdly, we can carry out anti insurance fraud publicity and education, on the one hand, improve the ability of ordinary consumers to identify insurance fraud, on the other hand, we can also mobilize the public and ordinary consumers to actively report insurance fraud cases.
According to the Circular of the CIRC, as of December 2020, the national insurance industry transferred 28005 frauds to public security organs, and the public security organs filed more than a thousand cases, involving nearly 600 million yuan and nearly 2000 suspect.
For the regulatory attitude of zero tolerance towards insurance fraud, Guo Yutao said that the high incidence of insurance fraud is damaging the interests of insurance companies and the country's financial order. In addition, it will also damage the interests of other insured in the end. Because the crime of insurance fraud is increasing, insurance companies will certainly be more strict in claims settlement, and will review similar insurance accidents of other insured more strictly, and the claim settlement efficiency will be slower; In terms of payment, payment will be more cautious.
the defense line of fraud and insurance needs to be built firmly from the source
With the rapid development of China's insurance industry, the risk of insurance fraud gradually appears, and the anti insurance fraud situation is grim.
In this regard, Li Wenzhong pointed out that with the development of China's insurance industry, more and more people buy insurance, insurance fraud cases are also growing, and the pressure of anti insurance fraud is increasing. Secondly, as more and more people have certain insurance professional knowledge, insurance fraud cases are more and more hidden, more and more difficult to find and identify.
Although regulatory authorities and anti insurance fraud organizations can use scientific and technological means to build an anti insurance fraud work network, they can improve the ability to identify insurance fraud cases. However, Li Wenzhong believes that there are still difficulties in the current anti insurance fraud work. First, how to improve the tightness of the anti insurance fraud network. At present, when anti insurance fraud organizations use big data to fight insurance fraud, these data are mainly in the insurance industry, and there are few data outside the industry, so there are still blind spots in big data analysis. Second, how to coordinate the relationship between anti insurance fraud and the protection of public privacy. If the boundary of anti insurance fraud to obtain social data outside the insurance industry is mastered carelessly, it may infringe on public privacy.
In addition, the reporter of Beijing Business Daily found through the investigation that some insurance companies maintain the attitude of "it's none of their own and hang up" to cheating. People in the legal industry told the Beijing Business Daily that some insurance companies are not worried about insurance fraud. As far as long is concerned, he cheated by breaking two toes with an axe, which not only compensated his own health, but also faced prison. The insurance company does not bear the liability for compensation and has no economic losses.
Article 33 of the insurance law clearly stipulates that an applicant cannot insure an insurance including death liability for a person without civil capacity, and an insurance company shall not underwrite it. In Li Bin's view, in insurance practice, especially in the signing process of Internet insurance, insurance companies rarely review the insured's civil capacity on the one hand. On the other hand, in order to collect more premiums, the contracting procedures are artificially simplified, the legal obligations stipulated in articles 33 and 34 of the insurance law are not fulfilled, and the restrictions of multiple insurance and high insurance are not carried out.
For example, Li Bin said: "There is a certain moral hazard in the design and sales of accident insurance for drivers and passengers. The insurance covers five seats of the vehicle, no matter who sits in this seat. The relevant death liability insurance is imposed on this person, who may not know it. Theoretically, the total insurance amount of driving accident insurance of insurance companies in the whole industry may reach more than 30 million yuan."
Li Bin told the Beijing Business Daily that as a professional insurance lawyer, he has done research and Practice on insurance compliance operation and anti insurance fraud in recent years. At his own expense, he signed driving accident insurance with more than 20 insurance companies and purchased up to 31 of the above insurance, including various head property insurance companies. In the process of its insurance, there is no review and obstacle, and the signing and payment of this insurance contract including death liability are unimpeded. In the process of contact with insurance companies, insurance companies generally have a vague understanding of the moral hazard in death liability insurance, especially property insurance companies. Li Bin? He said that in addition to correcting the illegal acts of insurance companies through judicial and administrative procedures, an investigation report will be formed and submitted to the China Banking and Insurance Regulatory Commission.
Under the severe situation, the insurance industry itself still needs to be improved in the system of insurance fraud prevention. Li Bin said that such as accident insurance, this kind of insurance premium investment is low. The compensation of accident insurance companies is higher. As for the protection insurance products with high amplification effect, the industry information sharing, amount restriction and prevention system has not been fully established for multiple insured and high insured.
For the difficulties existing in the regulatory authorities' use of big data and increasing investment in science and technology, Li Wenzhong suggested that relevant research should be strengthened, the boundary of anti fraud access to data outside the industry in the insurance industry should be clarified, and confirmed in the form of legislation; Anti insurance fraud organizations collect internal and external data of the industry and use scientific and technological means to strengthen insurance anti fraud.
To curb and reduce the occurrence of insurance fraud from the source, Li Bin believes that it is necessary to increase the possibility of preventing moral hazard in industry design, insurance contracts and insurance products, as well as in the process of operation, such as implementing the provisions of articles 33 and 34 of the insurance law. Restricted indemnificatory insurance with strong amplification effect, multiple insurance and high insurance.
"When an insurance company fails to comply with the insurance law When there is a problem with the legal obligations stipulated in articles 33 and 34. The insurance company shall bear the liability for tort compensation. That is, if the insurance company does not obtain the consent and approval of the insured when concluding the death liability insurance, it will underwrite it, and the insured is killed due to the reason of the insurance. The insurance company shall bear the liability for tort compensation. " Li Bin said.
(source: Beijing business daily)
