保險詐欺之研究與防治-以防疫險為例

Abstract

本文主要研究近期國內保險詐欺之態樣與防治，先行論述保險詐欺相關概要，包含保險詐欺之意義與成因，以及保險詐欺之經濟意義與其分析。而後以法學研究方式探討保險詐欺之法律評價，先就抽象之保險詐欺法律責任為闡釋後，進一步就部分近期所發生之實例案件分析其中的法律意義，並以近年熱門的防疫險議題為主要實例探討。最後章節主要以商業保險公司之角度，探討金融業下保險公司實務風險管理方式，以及保險詐欺在保險公司下風險管理架構之定位，最後就保險公司下風險管理三道防線，業管單位、風險管理部門及法遵部門、內部稽核部門針對於保險詐欺的職能與作業風險防治準則加以介紹。希望能透過本研究探討新穎的保險詐欺議題與案例法學研究，提出自身的看法外，更希望以保險公司之風險管理實務運作角度發掘有效控管保險詐欺之風險管理方式。

This paper primarily explores the recent trends and prevention measures for insurance fraud in the domestic context. The article begins by discussing an overview of insurance fraud, including its significance, causes, and economic implications. It then employs a legal research approach to examine the legal evaluation of insurance fraud, starting with the abstract legal responsibility for insurance fraud and further analyzing the legal significance of recent case studies, with a focus on the popular topic of COVID insurance. The final chapter takes a commercial insurance company's perspective to explore risk management practices in the financial industry, the positioning of insurance fraud within risk management frameworks, and the risk prevention guidelines for operational functions and departments, including the regulatory unit, risk management department, compliance department, and internal audit department. By exploring novel issues and case law related to insurance fraud and providing insights into risk management practices from the perspective of insurance companies, this study aims to offer valuable contributions to the current understanding of insurance fraud and its prevention.