《保险研究》20210601-《车险欺诈与反欺诈问题研究及监管建议》（车险反欺诈联合课题组）

［摘   要］车险领域历来是保险欺诈的“重灾区”,车险欺诈案件数量占保险涉刑案件的70%~80%,严重侵害保险消费者合法权益,破坏正常的车险市场秩序,影响道路交通安全和公民人身、财产安全,是行业监管部门、公安司法机关防范打击的重点犯罪类型。近年来车险欺诈案件频发、手段多样,且日趋职业化、团伙化、专业化,对行业车险反欺诈以及监管工作提出了新的挑战。本文基于近年来反欺诈监管工作实践,以北京地区5家大中型保险公司的理赔及反欺诈工作数据为基础,分析了当前车险欺诈案件的新趋势和新特点,进而从保险公司经营管理、行业信息共享、外部环境、法律法规等多个方面剖析问题成因,并针对性地提出了以大数据为核心构建多方协作联动防控体系的监管工作建议。

［关键词］车辆保险；保险欺诈；现状分析；保险监管

［作者简介］课题组成员:宋旭红、程静,现供职于中国银保监会风险处置局;刘智勇、胡杨、刘述、曹媛、谭锐,现供职于北京银保监局。

A Research on Vehicle Insurance Frauds and Anti-fraud Issues and Regulatory Suggestions

The Joint Research Team on Anti-Vehicle Frauds

Abstract：Vehicle insurance has always been plagued by insurance frauds,which accounts for 70-80% of insurance-related criminal cases.These frauds gravely infringe lawful rights of insurance consumers,disrupt the normal order of the vehicle insurance market,and affect traffic security and personal and property security of the public.Therefore,they are an important type of crimes targeted by the insurance regulator and the public security and judicial organs.Vehicle insurance frauds have occurred more frequently,become more diversified in forms,and has the tendency of becoming professionalized,specialized and committed by gangs in recent years.This makes anti-fraud actions and regulatory work more challenging.This paper was based on the anti-fraud regulatory practices and claims and anti-fraud statistics of five Beijing-based large and medium-sized insurers in recent years.It analyzed the new trends and characteristics of vehicle insurance frauds,and explored on the causes of the problem from the perspectives of operation and management of insurers,data sharing of the industry,external environment,laws and regulations,etc.Finally,the paper put forwards regulatory suggestions to construct a multi-party cooperative prevention and control system with big data as the core.

Key words：vehicle insurance;insurance fraud;analysis of the current situations;insurance regulation