《保险研究》20210408-《大金融背景下保险欺诈的新特征和风险防范路径》（李玉泉、乔石）

［摘   要］随着以互联网、大数据为核心的新科技的出现,在大金融背景下,保险欺诈呈现出新的特征。本文从保险欺诈的欺诈行为、实施者的主观过错、欺诈行为与保险赔偿之间具有因果关系这三个构成要件入手,详细分析了在金融活动相互融合以及互联网、大数据等科技手段广泛运用的当今时代下保险欺诈的三个新特征,并从健全保险欺诈法律法规体系、建立健全跨行业的反保险欺诈协作机制、建立整个保险行业的反欺诈数据一体化管理体系和夯实保险机构的反保险欺诈管理能力四个方面提出具体的保险欺诈防范路径。

［关键词］保险欺诈；互联网；保险理赔；大数据；防范机制

［作者简介］李玉泉,法学博士,研究员、仲裁员,中国保险学会法律专业委员会主任,曾任中国人民保险集团股份有限公司副总裁；乔石,法学博士,中国人民养老保险有限责任公司法律合规部高级经理。

New Features of Insurance Frauds under the Pan-financial background and the Path of Risk Prevention

LI Yu-quan,QIAO Shi

Abstract：With the advent of new technologies based on Internet and big data,and under the pan-financial background,insurance frauds have exhibited new features.The Paper proceeded from the three components with causal relationship to insurance claims payments,namely,fraudulent behaviors,subjective faults of the executor and fraudulent activities,and made an in-depth analysis of the three new features of insurance frauds amid today′s wide application of Internet and big data and integration of financial activities.It put forwards specific paths for guarding against insurance frauds from the perspectives of completing laws and regulations on insurance frauds,establishing anti-fraud cooperative mechanism across the whole insurance industry,setting up an integrated management system for anti-fraud data,and consolidating insurance companies′ anti-fraud capability.

Key words：insurance frauds;Internet;insurance claim payment;big data;preventive mechanism