| 研究生: | 孫騰敏 |
| 研究生(外文): | |
| 論文名稱: | 汽車保險詐欺型態之研究 |
| 論文名稱(外文): | The Research of Automobile Insurance Fraud |
| 指導教授: | 廖述源 |
| 指導教授(外文): | |
| 學位類別: | 碩士 |
| 校院名稱: | 淡江大學 |
| 系所名稱: | 保險學系保險經營碩士在職專班 |
| 論文出版年: | 2008 |
| 畢業學年度: | 96 |
| 語文別: | |
| 論文頁數: | |
| 中文關鍵詞: | 汽車保險 保險詐欺 內控內稽 核保理賠 |
| 外文關鍵詞: | Automobile insurance Insurance fraud Internal control and audit Underwriting and claim |
| 摘要: | 以我國保險市場而言，汽車保險詐欺之問題向來未受到重視，亦無完整統計資料可供參考。事實上，保險詐欺在我國亦屬常見，在壽險市場上，違反據實說明告知義務及複保險糾紛經常涉及道德危險。另外，在產險市場上，海上貨物險、火災保險及汽車保險之異常理賠亦所在多有，造成損失率偏高現象不容忽視。保險詐欺獲利頗高，尤其在經濟不景氣時，成長甚速，危及保險公司之經營。因此本「汽車保險詐欺型態之研究」經過仔細探討研究後發現：汽車保險詐欺案例型態區分為「承保端」及「理賠端」兩部份，共有20種犯案類型，其中承保端之「事後投保」、理賠端之「謊(偽)報保險事故」及「製造假事故」，尤為詐欺案發生之主因。 為使保險從業人員、消費者、主管機關及相關作業配合人員，瞭解、避免及防制汽車保險詐欺之發生，本研究重要結論為：一、熟悉各類型詐欺案例型態，二、落實保險從業人員教育訓練，三、強化內控內稽制度之執行，四、加強對配合廠商及相關單位法令宣導。 經本研究討論後，可以由兩個面向對於產險業汽車保險之經營給予些許之建議，第一面向為對於防制保險犯罪政策之擬定及推動：一、加強保險犯罪防制中心功能，二、建立保險詐欺動態追蹤機制，三、設置保險犯罪防制檢舉專線暨提供檢舉獎金，四、修訂相關法律，五、成立專責檢警單位，六、建構產醫警聯護網，七、保險教育化。第二面向為對於產業之合作與提昇：一、培訓保險詐欺防制專業人才，二、有效建立保險詐欺通報平台，三、強化保險商品設計，四、與國際接軌交流，五、履行社會責任。 |
| 外文摘要: | Automobile insurance fraud is an issue that has fallen on deaf ears in Taiwan’s insurance market and there is no sufficient statistics for reference. In fact, the insurance fraud is common in our insurance industry. In life insurance market, the breach of disclosure and the double insurance dispute are often involved in moral hazard. Furthermore, the abnormal losses are also found in the non-life insurance industry, especially in the marine cargo insurance, the fire insurance and the automobile insurance. This situation which leads loss ratio much higher than normal can not be neglected. Insurance fraud makes high profit especially when the economy goes to depression. The rapid growth of Insurance Fraud could be a threat to an insurance company. Thus, this research, 「The Research of Automobile Insurance Fraud」 divides the automobile insurance fraud into two major parts, one is underwriting and the other is claim. There are 20 types of automobile fraud. The top 3 causes are applying for insurance after loss on underwriting side, making up an insurance loss and making fake insurance accidents on claim side. In order to identify, avoid and prevent the insurance fraud for insurance companies, consumers, government and other related parties, there are 4 conclusions in this research. The first is to understand and analyze the types of insurance fraud. The second is to enhance the professional training for insurance employees. The third is to conduct internal auditing. The last is to enforce legal guidance for cooperating shops and related parties. This research concludes two ideas that could be provided to the non-life insurance operation. The first idea is to make anti insurance fraud law into practice. The contents are to enforce the function of the insurance anti-fraud institute of the R.O.C., to establish the dynamic tracking system of the insurance fraud, to set up the special telephone line for informing the crime and rewards, to amend related laws, to set up anti insurance fraud policy unit, to establish the network among the insurance industry, the medical industry, and the police, to educate more on insurance. The second idea is more cooperation to the insurance industry, including professional anti-fraud training, anti insurance fraud reporting system, insurance product design enforcement, international market linking, and social responsibility. |
| 目次: | 第一章 緒 論 1 第一節 研究動機 1 第二節 研究目的 3 第三節 研究限制與流程 3 第四節 研究內容 5 第二章 文獻回顧 6 第一節 國內文獻 6 第二節 國外文獻 10 第三章 汽車保險詐欺之探討 13 第一節 汽車保險之概述 13 第二節 汽車保險詐欺之意涵及型態 18 第三節 汽車保險詐欺案例探討 32 第四章 保險風險控管與犯罪防制 44 第一節 產險業者內控內稽之探討 44 第二節 汽車保險之核保理賠 49 第三節 汽車保險詐欺之防制 67 第五章 研究設計與實證 71 第一節 問卷方法 71 第二節 研究架構 74 第三節 實證分析 76 第六章 結論與建議 87 第一節 結論 87 第二節 建議 90 參考文獻 94 附錄一：研究問卷 100 附錄二：研究問卷內容回覆摘述 104 附錄三：汽車保險內控內稽相關表格 107 附錄四：汽車保險核保理賠相關表格 110 附錄五：有關汽車保險詐欺相關法條 120 |
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