保险欺诈风险的关键因素及法律规制
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摘要
保险欺诈侵蚀保险机构的偿付能力,增加行业的潜在风险,触及保险制度的根基。保险监管的目的是维护市场秩序,保护保险消费者的利益,对欺诈等违法行为采取有效管控。保险反欺诈法规的制定、执行和司法适用都影响潜在违法者的决策。法律诉讼作为解决保险欺诈的一种方式,虽然不是最优选择,但却是化解纠纷的最终途径,其目标与保险监管相同。通过提取典型保险诉讼案例的欺诈关联因子,建立回归模型,探寻保险欺诈的作用机理,明确保险欺诈的制度诱因。在实证研究的基础上评估不同领域的保险欺诈风险,最后提出:阐明如实告知义务制度中保险人解除权的基础,完善如实告知义务制度、重构告知内容标准,提高保险欺诈的法律成本和法律执行率并引入惩罚性赔偿机制,作为完善我国保险欺诈监管法规的具体对策。
Insurance fraud erodes the solvency of insurance institutions, increases the potential risks of the insurance industry, and influences the foundation of the insurance system. The purpose of insurance supervision is to maintain the market order, protect the interests of the credit insurance consumers and take effective control on the illegal acts such as fraud. The formulation,execution and judicial application of the anti-insurance fraud regulations all affect the decision of the potential violators. As a way to solve insurance fraud, litigation is not the best choice, but it is the final way to resolve disputes, and its tasks are the same as insurance supervision. This document extracts the factors associated with fraud in typical insurance litigation cases, establishes regression models, attempts to explore the function mechanism of insurance fraud, defines the institutional incentives of insurance fraud.On the basis of empirical research, the risk of insurance fraud in different areas is assessed. Finally, it proposed to clarify the basis for the insurer 's right to cancel in the truthful disclosure obligation system, improve the truthful disclosure obligation system, reconstruct the disclosure content standards, increase the legal costs and law enforcement rate against insurance fraud, introduce a punitive compensation mechanism,which are concrete measures to improve China's insurance fraud regulations.
Insurance fraud erodes the solvency of insurance institutions, increases the potential risks of the insurance industry, and influences the foundation of the insurance system. The purpose of insurance supervision is to maintain the market order, protect the interests of the credit insurance consumers and take effective control on the illegal acts such as fraud. The formulation,execution and judicial application of the anti-insurance fraud regulations all affect the decision of the potential violators. As a way to solve insurance fraud, litigation is not the best choice, but it is the final way to resolve disputes, and its tasks are the same as insurance supervision. This document extracts the factors associated with fraud in typical insurance litigation cases, establishes regression models, attempts to explore the function mechanism of insurance fraud, defines the institutional incentives of insurance fraud.On the basis of empirical research, the risk of insurance fraud in different areas is assessed. Finally, it proposed to clarify the basis for the insurer 's right to cancel in the truthful disclosure obligation system, improve the truthful disclosure obligation system, reconstruct the disclosure content standards, increase the legal costs and law enforcement rate against insurance fraud, introduce a punitive compensation mechanism,which are concrete measures to improve China's insurance fraud regulations.
引文
[1]COOTER R B,ULEN T.Law and Economic[M].New Jersey:Addison Wesley Longman Inc.,2002.
[2]边文霞.保险欺诈问题博弈研究[D].北京:首都经贸大学,2005.
[3]朱孟骅.保险欺诈防范研究与思考[J].保险研究,2009(5).
[4]王碧波.反保险欺诈之对策与机制研究[D].天津:南开大学,2012.
[5]樊启荣.保险法诸问题与展望[M].北京:北京大学出版社,2015.
[6]李虹,孙蓉.美国新墨西哥州保险反欺诈机构及启示[J].中国保险,2006(12).
[7]任以顺.论投保欺诈背景下的保险人合同撤销权[J].保险研究,2015(3).
[8]王利明.美国惩罚性赔偿制度研究[J].比较法研究,2003(5).
[9]叶明华.基于BP神经网络的保险欺诈识别研究:以中国机动车保险索赔为例[J].保险研究,2011(3).
[10]王珺,高峰,孙楠.车险市场分离道德风险和逆向选择的实证分析[J].保险研究,2013(12).
[11]林源.美国医疗保险反欺诈法律制度及其借鉴[J].法商研究,2013(3).
[12]周建涛,秦炳山,宋晓东.意外、健康保险欺诈概率识别[J].河北经贸大学学报,2014(11).
[13]罗伯特·考特,托马斯·尤伦.法和经济学[M].史晋川,等,译.上海:上海人民出版社,2010.
[14]DIONNE G,GAGNE R.Deductible Contracts Against Fraudulent Claims:Evidence from Automobile Insurance[J].Review of Economics Statistics,2001,83(2).
[15]乔治·迪翁.保险经济学前沿问题研究[M].朱铭来,田玲,魏华林,等,译.北京:中国金融出版社,2007.
[16]刘轶.基于Logistic模型的保险欺诈分析[J].金融经济,2017(7).
[17]卢学希.保险法中的最大诚信原则适用研究[J].求索,2012(6).
[18]约翰·F.道宾.美国保险法[M].梁鹏,译.北京:法律出版社,2008.
[19]刘轶.中美保险如实告知制度重要性判断方法研究[J].北方经贸,2017(11).
(1)本文的保险欺诈仅指投保人、被保险人和受益人的欺诈,不包含保险人欺诈。
(2)根据保监会公布的数据计算。
(1)余勋盛.保险诉讼典型案例年度报告(第一辑至第七辑)[R].北京:法律出版社,2009-2016.
[2]边文霞.保险欺诈问题博弈研究[D].北京:首都经贸大学,2005.
[3]朱孟骅.保险欺诈防范研究与思考[J].保险研究,2009(5).
[4]王碧波.反保险欺诈之对策与机制研究[D].天津:南开大学,2012.
[5]樊启荣.保险法诸问题与展望[M].北京:北京大学出版社,2015.
[6]李虹,孙蓉.美国新墨西哥州保险反欺诈机构及启示[J].中国保险,2006(12).
[7]任以顺.论投保欺诈背景下的保险人合同撤销权[J].保险研究,2015(3).
[8]王利明.美国惩罚性赔偿制度研究[J].比较法研究,2003(5).
[9]叶明华.基于BP神经网络的保险欺诈识别研究:以中国机动车保险索赔为例[J].保险研究,2011(3).
[10]王珺,高峰,孙楠.车险市场分离道德风险和逆向选择的实证分析[J].保险研究,2013(12).
[11]林源.美国医疗保险反欺诈法律制度及其借鉴[J].法商研究,2013(3).
[12]周建涛,秦炳山,宋晓东.意外、健康保险欺诈概率识别[J].河北经贸大学学报,2014(11).
[13]罗伯特·考特,托马斯·尤伦.法和经济学[M].史晋川,等,译.上海:上海人民出版社,2010.
[14]DIONNE G,GAGNE R.Deductible Contracts Against Fraudulent Claims:Evidence from Automobile Insurance[J].Review of Economics Statistics,2001,83(2).
[15]乔治·迪翁.保险经济学前沿问题研究[M].朱铭来,田玲,魏华林,等,译.北京:中国金融出版社,2007.
[16]刘轶.基于Logistic模型的保险欺诈分析[J].金融经济,2017(7).
[17]卢学希.保险法中的最大诚信原则适用研究[J].求索,2012(6).
[18]约翰·F.道宾.美国保险法[M].梁鹏,译.北京:法律出版社,2008.
[19]刘轶.中美保险如实告知制度重要性判断方法研究[J].北方经贸,2017(11).
(1)本文的保险欺诈仅指投保人、被保险人和受益人的欺诈,不包含保险人欺诈。
(2)根据保监会公布的数据计算。
(1)余勋盛.保险诉讼典型案例年度报告(第一辑至第七辑)[R].北京:法律出版社,2009-2016.